Research options after fellowship

[deleted1164820]

I am currently in my last few months of my IM residency training. I matched into a Nephrology/critical care care fellowship training. I plan on doing Nephrology research work after graduating from fellowship but I would like to keep my critical care to be my primary bread winner option. In Critical care there is an option of 7day on and 7 day off kind of work. I don't want to waste away the time I have. I would rather want to spend in Nephrology or critical care research during that time when i am off from critical care. I want to know what kind of research options I have after graduating from fellowship. My fellowship does not have anyone who have done T32 or F32 research during their fellowship time. After graduating fellowship, I want to be in a academic place where I can contribute to NIH trials if I can. Please advise. I am completely oblivious.

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[SurfingDoctor]

I am currently in my last few months of my IM residency training. I matched into a Nephrology/critical care care fellowship training. I plan on doing Nephrology research work after graduating from fellowship but I would like to keep my critical care to be my primary bread winner option. In Critical care there is an option of 7day on and 7 day off kind of work. I don't want to waste away the time I have. I would rather want to spend in Nephrology or critical care research during that time when i am off from critical care. I want to know what kind of research options I have after graduating from fellowship. My fellowship does not have anyone who have done T32 or F32 research during their fellowship time. After graduating fellowship, I want to be in an academic place where I can contribute to NIH trials if I can. Please advise. I am completely oblivious.

What is it you are looking for for “research”? What do you mean “contribute to NIH trials”? Like being a site PI? That doesn’t really require anything other than being a friend/good acquaintance of the study PI (actually the most important part). They write the grant, they ask you to help for that reason, usually with metrics that you have X number of patients with the disease being studied (you don’t get to be a site if you don’t have the right patient population), you work with the institutional IRB as well as the study PI, then you consent (or a research nurse consents if there a lot of money behind it) and set up a material transfer agreement to send materials and data to the coordinating center. That’s the gist.

 

[deleted1164820]

What is it you are looking for for “research”? What do you mean “contribute to NIH trials”? Like being a site PI? That doesn’t really require anything other than being a friend/good acquaintance of the study PI (actually the most important part). They write the grant, they ask you to help for that reason, usually with metrics that you have X number of patients with the disease being studied (you don’t get to be a site if you don’t have the right patient population), you work with the institutional IRB as well as the study PI, then you consent (or a research nurse consents if there a lot of money behind it) and set up a material transfer agreement to send materials and data to the coordinating center. That’s the gist.

I want to do research that allows me to answer clinical questions that I have in my preferred area and build new concepts down the line and thought process out of it for others to pick up and do further research when I am done. How do I intend to do it? - Review articles, drug trials/NIH funded-basic science research.

Contribute to NIH trials: I have not come across anyone who is doing NIH trials in my facility. But I am concerned that I don't have the training to work on a trial as I don't have the experience. I worry that since my fellowship program is not in the top 50 program and I don't think I ll get a lot experience there either in regards to trials, I fear academic discrimination once I graduate and trying to fit into a top tier program for job as I don't have experience in NIH/drug trials.

I know my limitations are bound by the choices I have made, but I want to elevate myself higher to a better academic institution when I graduate from fellowship.

What I am looking for in this forum is what I should do in order for me to be prepared to offset my limitations during my fellowship years and be better equipped, if I have to work in the top 10 programs in the country.

Correct me If I am wrong if my thought process is basically not how it works in the real world.

 

[SurfingDoctor]

I want to do research that allows me to answer clinical questions that I have in my preferred area and build new concepts down the line and thought process out of it for others to pick up and do further research when I am done. How do I intend to do it? - Review articles, drug trials/NIH funded-basic science research.

Contribute to NIH trials: I have not come across anyone who is doing NIH trials in my facility. But I am concerned that I don't have the training to work on a trial as I don't have the experience. I worry that since my fellowship program is not in the top 50 program and I don't think I ll get a lot experience there either in regards to trials, I fear academic discrimination once I graduate and trying to fit into a top tier program for job as I don't have experience in NIH/drug trials.

I know my limitations are bound by the choices I have made, but I want to elevate myself higher to a better academic institution when I graduate from fellowship.

What I am looking for in this forum is what I should do in order for me to be prepared to offset my limitations during my fellowship years and be better equipped, if I have to work in the top 10 programs in the country.

Correct me If I am wrong if my thought process is basically not how it works in the real world.

I'm still a little confused. Review articles can be written by anyone. If it wasn't so terrible at identifying references, ChatGPT could probably write a pretty decent review article. That's not something anyone needs training on.

NIH basic-science and drug/clinical trials are so vastly different, they aren't even comparable. And sorry to say, if you aren't going to a fellowship that has a robust basic-science program with T32, that ship has probably sailed. There are people who get PhD after completing training, but they are few and far between and a significant burden to do so that late in the game.

So you want to answer clinical questions. Well frankly, that's what most people in academia do and they do it through retrospective analysis. This is usually through datasets and EMR pulls. Generally speaking, these aren't funded though if one develops the "right" question and has access to the "right" people, there are NIH-mechanisms that exist for that kinda of data research. There is a currently an NHLBI R21 looking at secondary analysis of existing datasets. It becomes a lot more fundamental if you are into AI and predictive modeling (see NIH Bridge2AI program). But you need a wealth of long established expertise. Now I have seen people go back to school while being an attending and get a Masters in Clinical Informatics. There is also a board certification for it. I know a person in my group where the institution was awarded a H-ARPA grant and they were given some buydown to pull telemetry data as part of that grant because they went back and got a informatics degree. Technically, many of that training is online through programs so it's something you could do even if your institution doesn't offer it.

As far as drug trials, I bet there are people on here that could answer better than me, but from an NIH standpoint, many drug trials are losers and in many realms, the NIH has gotten out of that game. They typically want hypothesis-driven, mechanistic-based research. What you would actually need are pharma connections as they are the ones who initiate a majority of the drug trials because they want to hit paydirt and they need physicians to be the contact point to test their drug. Often these trials have equivocal and non-publishable results, but in the chance that the drug works in comparison to the standard treatment, that is often publishable. I can tell you as far as critical care, there really aren't any. Occasionally, the NIH conjures up some consortium (RM1 or multicenter R01 or U grants) to randomize some equivocal test or drug, but it's rare because its a lot of money that generally produces nothing. I don't know about nephrology. Maybe there is a better anti-hypertensive drug regimen out there. But that's generally gonna be funded by pharma and industry. Though maybe others have a different experience.

 

[deleted1164820]

Thank you so much for the answer. I think I have to figure out what I want to do in terms of research. I definitely get that part.
You have not answered my question yet. Not that I am demanding here, but In case if you know please let me know.
Is there anything that would absolutely like a showstopper preventing me getting hired in places like UCSF or stanford as I am not from a top 50 university?

 

[IlDestriero]

The best way to set yourself up to succeed in a back door academic track if you want to do research without a solid background is to get a job for a year or 2 as a research fellow/part time faculty or take a clinical instructor position with significant protected academic time and a commitment to mentorship with a research faculty. You can still get there without that, but it’s harder and you still need real protected academic time and real mentorship from a researcher.
PS The reason to start as a clinical instructor or research fellow for a couple of years is to not start the Up or Out Clock as an Assistant Professor. You need that time to get your feet wet, identify and work with your mentor(s), get involved in projects, find a research interest, etc. so you can hit the ground running as an an Associate.
PPS Up or Out refers to the timeline required for promotion to Associate Professor. The university will dictate that you need to be promoted by year X or you will be gone. And some places (Stanford, Harvard, Penn, etc.) have a very high bar for promotion in a research track.

 

[Mr.Smile12]

Look at the graphic on this page:

Let NIH Help You in Your Research Career Goal toward Becoming a Physician-Scientist | Research Training

researchtraining.nih.gov

 

[deleted1164820]

The best way to set yourself up to succeed in a back door academic track if you want to do research without a solid background is to get a job for a year or 2 as a research fellow/part time faculty or take a clinical instructor position with significant protected academic time and a commitment to mentorship with a research faculty. You can still get there without that, but it’s harder and you still need real protected academic time and real mentorship from a researcher.
PS The reason to start as a clinical instructor or research fellow for a couple of years is to not start the Up or Out Clock as an Assistant Professor. You need that time to get your feet wet, identify and work with your mentor(s), get involved in projects, find a research interest, etc. so you can hit the ground running as an an Associate.
PPS Up or Out refers to the timeline required for promotion to Associate Professor. The university will dictate that you need to be promoted by year X or you will be gone. And some places (Stanford, Harvard, Penn, etc.) have a very high bar for promotion in a research track.

How do I get those jobs? Where should I look?

 

[deleted1164820]

Look at the graphic on this page:

Let NIH Help You in Your Research Career Goal toward Becoming a Physician-Scientist | Research Training

researchtraining.nih.gov

very good outline, I am basically an IMG so I did not know all these different tracks and things that you can do along the line. Appreciate you sharing!

 

[tr]

The best way to set yourself up to succeed in a back door academic track if you want to do research without a solid background is to get a job for a year or 2 as a research fellow/part time faculty or take a clinical instructor position with significant protected academic time and a commitment to mentorship with a research faculty.

How is the OP going to obtain a clinical instructor or even fellowship position with 'significant protected academic time' with zero research background? When I was at that transition point I couldn't get significant protected academic time with a PhD, 10+ papers, and foundation (not NIH) funding. No K = no dice.

very good outline, I am basically an IMG so I did not know all these different tracks and things that you can do along the line. Appreciate you sharing!

OK given IMG status, fellowship at non-research institution, and no existing research background, you are starting from zero very late in the game.

I actually think the best thing to do at this point would be to go back to school, which somewhat 'resets' the academic CV timeline.
The bars for entry into master's programs are low, and tuition won't be an issue for you as an attending.

After you finish your fellowship, I suggest you seek employment as a critical care attending in an academic hospital system with a medical and graduate school, and enroll at the same institution for a master's in epidemiology, statistics, or clinical research. This should be very doable with the 7 on/7 off schedule you describe.

A two year master's will give you some research skills, a topic of interest/expertise, a couple of papers for your CV, and some connections with researchers within the institution. From there you will be in a better position to integrate participation in research into your clinical career.

 

[tr]

Thank you so much for the answer. I think I have to figure out what I want to do in terms of research. I definitely get that part.
You have not answered my question yet. Not that I am demanding here, but In case if you know please let me know.
Is there anything that would absolutely like a showstopper preventing me getting hired in places like UCSF or stanford as I am not from a top 50 university?

No I don't think your CV would be an issue here. I don't know about the job market in critical care specifically, but in general, most academic medical centers are very happy to hire clinicians, whom they will happily exploit for financial gain by paying them significantly below market value, so those jobs are not in high demand.

What they won't do under any circumstances is give you protected research time. This is because it would cost them money. Time protected for research is time that you are not seeing patients, and therefore time that you are not making money for the medical center.

So if you really want to integrate research into your career on some level (and why you would want to do this at this point is a whole other issue, but I'm taking you at your word here), you will have to put a fair amount of your own unpaid time into it up front.

I think the master's route is the most straightforward way to do this.

 

[SurfingDoctor]

No I don't think your CV would be an issue here. I don't know about the job market in critical care specifically, but in general, most academic medical centers are very happy to hire clinicians, whom they will happily exploit for financial gain by paying them significantly below market value, so those jobs are not in high demand.

What they won't do under any circumstances is give you protected research time. This is because it would cost them money. Time protected for research is time that you are not seeing patients, and therefore time that you are not making money for the medical center.

So if you really want to integrate research into your career on some level (and why you would want to do this at this point is a whole other issue, but I'm taking you at your word here), you will have to put a fair amount of your own unpaid time into it up front.

I think the master's route is the most straightforward way to do this.

To jump on this, no department at a top 10 (or even much lower) is going to offer an instructorship position on a tenure track who doesn't have significant previous evidence research pursuits. As mentioned, especially in a field like critical care which has significant revenue generation through procedure and critical care billing codes, any time you are not seeing patients, you are functionally losing the hospital and department/division money. Now they may be willing to often this with an instructorship on a research track (functionally paying less for the same RVU generation) with reduced clinical FTE, but they are basically only doing that if you are a sure bet with a likely ROI on getting indirects from future grants.

And I would second the comment on getting a masters (MSCI, MCI), but that will likely have to be done on one's own time and own money.

 

[deleted1164820]

So to give some perspective, i have done retrospective studies, meta-analysis, bunch of case reports and all of these constitutes about 30 odd papers. I was a research scholar at the university of pittsburgh(Neurology) and NYU for neuroscience(nothing materialized as we didnt finish the study) for almost 3 years combined in both places. I have not done prospective studies or trials.

I completely understand that the department who hires me is going to value what the chairman of the dept likes for sure, but I want to know what I can accomplish during my fellowship years in regards to research so that I may look like a attractive hire and not be just disposed based on my place of graduation of the fellowship.

 

[tr]

So to give some perspective, i have done retrospective studies, meta-analysis, bunch of case reports and all of these constitutes about 30 odd papers. I was a research scholar at the university of pittsburgh(Neurology) and NYU for neuroscience(nothing materialized as we didnt finish the study) for almost 3 years combined in both places. I have not done prospective studies or trials.

I completely understand that the department who hires me is going to value what the chairman of the dept likes for sure, but I want to know what I can accomplish during my fellowship years in regards to research so that I may look like a attractive hire and not be just disposed based on my place of graduation of the fellowship.

OK you have papers, that's good.
Fundamentally, as long as you have an MD+relevant residency/fellowship and a pulse, you should be fine to be hired by an academic medical center for a purely clinical job. The subtle details of your academic record (publications, institutional pedigree, etc) shouldn't matter much one way or another. As long as you do a good job in your fellowship, provide good clinical care and don't antagonize people, I imagine you'll be fine.

(*Caveat I am not in your field so I am open to correction by anyone with experience in nephrology/critical care - but my grapevine understanding is those are not in the handful of exceptionally competitive fields where the above advice would be inapplicable.)

The difficulty may be more in the legwork of finding the jobs. A lot of those jobs are filled by internal recent graduates just out of convenience, so you may not find them advertised on official channels. You might have to do some more detailed searching, including cold-emailing dept chairs with your CV.

(After that, the difficulty will mainly lie in tolerating doing the same or more/harder work for significantly less money than you would get in the private sector. But your motivations are your own business.)

 

[deleted1164820]

OK you have papers, that's good.
Fundamentally, as long as you have an MD+relevant residency/fellowship and a pulse, you should be fine to be hired by an academic medical center for a purely clinical job. The subtle details of your academic record (publications, institutional pedigree, etc) shouldn't matter much one way or another. As long as you do a good job in your fellowship, provide good clinical care and don't antagonize people, I imagine you'll be fine.

(*Caveat I am not in your field so I am open to correction by anyone with experience in nephrology/critical care - but my grapevine understanding is those are not in the handful of exceptionally competitive fields where the above advice would be inapplicable.)

The difficulty may be more in the legwork of finding the jobs. A lot of those jobs are filled by internal recent graduates just out of convenience, so you may not find them advertised on official channels. You might have to do some more detailed searching, including cold-emailing dept chairs with your CV.

(After that, the difficulty will mainly lie in tolerating doing the same or more/harder work for significantly less money than you would get in the private sector. But your motivations are your own business.)

Thank you so much for the much needed right advice. I was and still am oblivious of how things work. I plan to reach out to the department chairs like you said. I appreciate your help. Thanks again!

 

[mszzeta]

Are you interested in leading a clinical trial, or simply participating?

Leading a clinical trial would be extremely difficult as these are expensive and requires NIH funding, which would be extremely competitive and only possible for senor investigators. Most people into this serious research field would either need a PhD degree, would at least extensive research training and prestigious mentor pedigree

If you are just to enroll patients, give treatment and assess, there can be plenty of opportunities depending on the center you are going to be employed. Most of these are drug company sponsored trials. Some private practice with a large patient base can even participate to these studies.

Overall, research in US academic medicine is like "all vs null". Either you are extremely hardcore and spend 80% of your work time doing research funded by NIH, or not doing any research at all (this is very different in my home country, where all physicians in a university hospital is required/mandatory to do some research). There are uncommon exceptions such as physician educators/PD supervising some small projects for residents/fellows

 

[tr]

Overall, research in US academic medicine is like "all vs null". Either you are extremely hardcore and spend 80% of your work time doing research funded by NIH, or not doing any research at all (this is very different in my home country, where all physicians in a university hospital is required/mandatory to do some research). There are uncommon exceptions such as physician educators/PD supervising some small projects for residents/fellows

This is... not true.
Outcomes for graduates of MD/PhD programs (i.e. individuals with stated interest in biomedical research) show that % research effort is a range from 0-100%, with relatively even distribution across the bins.

JCI Insight - The national MD-PhD program outcomes study: Relationships between medical specialty, training duration, research effort, and career paths

insight.jci.org

 

[IlDestriero]

How is the OP going to obtain a clinical instructor or even fellowship position with 'significant protected academic time' with zero research background? When I was at that transition point I couldn't get significant protected academic time with a PhD, 10+ papers, and foundation (not NIH) funding. No K = no dice.

Everything is negotiable. He should try to be involved in any research happening in his fellowship. He should try to write up interesting cases, maybe some posters for meetings, a review article, co author an opinion letter with a faculty member, etc. That shows commitment and a willingness to engage in research. Then flex that, with an explanation about limited research opportunities during residency and fellowship, when they are interviewing for academic jobs.
The other thing that will make you desirable to a big academic center is sub sub specialization with a narrow interest that fills an unmet need. See if you like some facet of your specialty, then try to become an expert in it. Bonus points if it’s uncommon and/or undesirable for most of your peers. You can be the go to guy for some “X” that everyone else hates and then they can market you as “the guy” for that as you engage in research, find X research mentors, collaborate globally with other experts in X, etc. Then you will become “the guy” for X, get research funding of some kind, get promoted, etc.
Though you better really like X. I’m a somewhat known expert in an anesthesia X, have lectured about it nationally and internationally, teach workshops in my specialty meetings and some others too, etc. but this X can be challenging and stressful, and my interest in X is waning as I get older. Fortunately there are a few experts in X to share the love where I work.

 

[tr]

Everything is negotiable. He should try to be involved in any research happening in his fellowship. He should try to write up interesting cases, maybe some posters for meetings, a review article, co author an opinion letter with a faculty member, etc. That shows commitment and a willingness to engage in research. Then flex that, with an explanation about limited research opportunities during residency and fellowship, when they are interviewing for academic jobs.

I mean sure, none of the above is a bad idea. I just think it's misleading to claim that it's going to result in a faculty job with protected research time.

IME, the only thing that gets you protected research time is grant money in hand.

 

[SurfingDoctor]

This is... not true.
Outcomes for graduates of MD/PhD programs (i.e. individuals with stated interest in biomedical research) show that % research effort is a range from 0-100%, with relatively even distribution across the bins.

JCI Insight - The national MD-PhD program outcomes study: Relationships between medical specialty, training duration, research effort, and career paths

insight.jci.org

View attachment 383011

That's me... smack dab in the middle. Personally, I like being average. It's a good mix.

 

[mszzeta]

This is... not true.
Outcomes for graduates of MD/PhD programs (i.e. individuals with stated interest in biomedical research) show that % research effort is a range from 0-100%, with relatively even distribution across the bins.

JCI Insight - The national MD-PhD program outcomes study: Relationships between medical specialty, training duration, research effort, and career paths

insight.jci.org

View attachment 383011

I am saying US physicians in general. MD-PhD represents 3% of all US medical graduate. So this sample by no means is representative.....In any Department/Division of an academic center, most physicians do minimal research, and even less if excluding industry-sponsored trials or small resident/fellow projects

 

[IlDestriero]

I mean sure, none of the above is a bad idea. I just think it's misleading to claim that it's going to result in a faculty job with protected research time.

IME, the only thing that gets you protected research time is grant money in hand.

That’s not my experience in the anesthesia community. Almost none of the research track folks have a PHD and we fund a lot of programs ourselves. Though most of them are ~25% non clinical. If you want to move up to 50% though you need to fund yourself. I’m sure this is variable by specialty and location.

 

[tr]

That’s not my experience in the anesthesia community. Almost none of the research track folks have a PHD and we fund a lot of programs ourselves. Though most of them are ~25% non clinical. If you want to move up to 50% though you need to fund yourself. I’m sure this is variable by specialty and location.

OK well that's amazing and super lucky for anesthesia folks who are interested in research. There must be a lot of extra money sloshing around in those departments.

In psychiatry I don't think I've ever encountered a research track resident without a PhD, and dept chairs are generally not handing out protected research time for free to new faculty; and the experience of several other folks in different fields who have been hanging around on the physician-scientists forum for a while seems to parallel mine.

That said, I believe @SurfingDoctor is peds critical care, so although not the same as adult nephrology/critical care, out of all of us he may have the closest relevant perspective for the OP.

 

[tr]

That's me... smack dab in the middle. Personally, I like being average. It's a good mix.

Same here. I'm in that middle bin in both the first and third graphs. It's great and I like it. But it's all soft money for sure.