Thoughts on working in a thoracic transplant (evlp) lab for a cardiac resident?

[Medstart108]

What are people's thought's on doing 3-4 years of evlp work in a thoracic lab and trying to tie that to cardiac transplant if your career goal is to become a cardiac transplant surgeon? Would that be a bad idea. The alternative would be to try to do similar but heart related work in a lab that may potentially be less desirable to work in from a lab environment/supervisor perspective with a weaker track record. Which would you choose and why?

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[deleted50541]

Would this be taking away time from clinical training? What are your career goals? If you're trained adequately in your CT residency with good exposure to cardiac transplants, I don't think you'll have a hard time finding work as a transplant surgeon. You could also consider a fellowship in transplant once you're done with residency. Doing up to 4 years in an EVLP lab seems excessive, especially if you're not going to do lung transplants.

 

[Medstart108]

Would this be taking away time from clinical training? What are your career goals? If you're trained adequately in your CT residency with good exposure to cardiac transplants, I don't think you'll have a hard time finding work as a transplant surgeon. You could also consider a fellowship in transplant once you're done with residency. Doing up to 4 years in an EVLP lab seems excessive, especially if you're not going to do lung transplants.

This would be time away from clinical training, would probably do a bit of clinical work here and there but this would be <10% of my time. Career goals wise I want to be academic, but haven't been to the community yet so can't rule it out, but definitely can't rule out academic right now.

I would be interested in doing both heart and lung transplants, but would probably otherwise have a cardiac practice if that helps.

 

[ed*26]

Why on earth would you be taking 3-4 years out to do research? That seems like massive overkill unless you're aiming for a PhD or to otherwise establish a basic science career, which doesn't seem like the case for you.

Assuming you're a gen surg resident, spending a reasonable amount of time (1-2 years) in a thoracic lab would have some benefit for getting into fellowship since the field is cardiothoracic surgery after all, but be prepared to explain why you did thoracic research but really want to do cardiac. Don't commit several years of your life to a lab with a questionable track record, but make sure your impressions are correct before turning down an opportunity to do research that aligns with your goals (ie just because a lab is a bit less prestigious doesn't mean it's questionable).

 

[dienekes88]

This would be time away from clinical training, would probably do a bit of clinical work here and there but this would be <10% of my time. Career goals wise I want to be academic, but haven't been to the community yet so can't rule it out, but definitely can't rule out academic right now.

I would be interested in doing both heart and lung transplants, but would probably otherwise have a cardiac practice if that helps.

3-4 years is a long time away from clinical training. You don't need to do that much time in order to get a transplant/VAD fellowship.

You should do whatever you think will make you successful in terms of publishing (lots of papers, some high impact) and getting the appropriate mentorship to develop your academic career. In my opinion, the exact nature of your research matters less.

 

[Medstart108]

Would 2 years in the lab be enough to potentially run your own lab though? People seem to suggest that a 3-4 year PhD is the way to go if you are thinking basic sciences. I'd be doing this out of interest in the area, to do something non-clinical, help me find a good fellowship and job and hopefully have the ability to move the field forward and run a lab in the future.

People around me have been trying to steer me away from the heart lab as it is not doing so well, but I am now also considering a stem cell heart lab that does some animal work as well as this lung ex-vivo lab.

The alternative to all this would be to do an epi masters or the like. I've done epi and i'm not a big fan of it, but i'll do it if it helps me get a job.

 

[dienekes88]

Would 2 years in the lab be enough to potentially run your own lab though? People seem to suggest that a 3-4 year PhD is the way to go if you are thinking basic sciences. I'd be doing this out of interest in the area, to do something non-clinical, help me find a good fellowship and job and hopefully have the ability to move the field forward and run a lab in the future.

People around me have been trying to steer me away from the heart lab as it is not doing so well, but I am now also considering a stem cell heart lab that does some animal work as well as this lung ex-vivo lab.

The alternative to all this would be to do an epi masters or the like. I've done epi and i'm not a big fan of it, but i'll do it if it helps me get a job.

In the older generation, folks only did 2 years during their general surgery time. And most didn't get a PhD. So doing it is possible.

Part of this depends on what you want to do with this basic science thing. Are you looking to be one of only a few R01 funded cardiac surgeons in the country? In that case it may make sense to be a PhD, but you also have to consider that your research will be somewhat dated by the time you are applying for jobs 4 or 5 years later. And your lab may not even be related to your PhD. The issue you face when competing to be NIH funded is that you will be up against PhDs and medicine folks who will have a lot more time to work on research. If this is your goal, then more power to you. It's a tough road.

Re: Epidemiology... A lot of people do surgical outcomes. Most don't do it well. Honestly, I can think of only a few who do a really good job. If it doesn't interest you, don't do it. You'll struggle in an academic environment trying to do something you don't want to do just to write papers.

 

[Medstart108]

In the older generation, folks only did 2 years during their general surgery time. And most didn't get a PhD. So doing it is possible.

Part of this depends on what you want to do with this basic science thing. Are you looking to be one of only a few R01 funded cardiac surgeons in the country? In that case it may make sense to be a PhD, but you also have to consider that your research will be somewhat dated by the time you are applying for jobs 4 or 5 years later. And your lab may not even be related to your PhD. The issue you face when competing to be NIH funded is that you will be up against PhDs and medicine folks who will have a lot more time to work on research. If this is your goal, then more power to you. It's a tough road.

Re: Epidemiology... A lot of people do surgical outcomes. Most don't do it well. Honestly, I can think of only a few who do a really good job. If it doesn't interest you, don't do it. You'll struggle in an academic environment I'd try to do something you don't want to do just to write papers.

Thats a great point, thanks. I guess my question is, yes i'd love to be one of those cardiac surgeons, but I look around me and realize that the chances are slim. I see plenty of senior surgeons who have done lab work that are doing absolutely nothing with it anymore. I see the disincentives. Work twice as hard and make half as much? Doesn't sound as appealing to anyone in their mid 30s with a wife and kids compared to the mid 20s keen resident. I'm hardworking but i'm not the most hardworking person in my program, so while I'd love to be, I also want to know what are the realistic backups, i.e. what else can a basic science PhD bring to my career if I don't get NIH funded? Will I be able to collaborate with a dedicated researcher and run a joint lab? Will the skills and knowledge from a PhD help me with tech/enterprise? Will it bring me contacts and industry connections that I can leverage? I'm ambitious, I won't lie that part of the appeal of basic science for me is to have the tools to develop and change the field, be at the forefront of tech and development and to leave a legacy. I think i'd be absolutely satisfied if i could even accomplish 1/10th of what people like JH Gibbon Jr., Starzl, Cribier were able to accomplish. Whether or not basic science is even likely to achieve those things in my hands is also an open question for me.

That also goes to point which drives me to do more translational/surgical/large animal type research. I don't want to go up against the dedicated basic scientists and doctors of the world, i know I won't be able to put in the time they can and i believe i can only be dumber than they are. I wonder if gaining skills in a surgical lab and leveraging that might give me the unique advantage to run a lab that way.

re: epi. The biggest selling point of epi is that it can be done anywhere on a shoestring budget but I've done some of that work and just don't find it appealing. I don't believe my own research is worth its salt frankly and yes I agree, I think ultimately i'll struggle. It's probably one of the things I avoid doing the most, in fact i'm procrastinating on it right now.

 

[dienekes88]

Thats a great point, thanks. I guess my question is, yes i'd love to be one of those cardiac surgeons, but I look around me and realize that the chances are slim. I see plenty of senior surgeons who have done lab work that are doing absolutely nothing with it anymore. I see the disincentives. Work twice as hard and make half as much? Doesn't sound as appealing to anyone in their mid 30s with a wife and kids compared to the mid 20s keen resident. I'm hardworking but i'm not the most hardworking person in my program, so while I'd love to be, I also want to know what are the realistic backups, i.e. what else can a basic science PhD bring to my career if I don't get NIH funded? Will I be able to collaborate with a dedicated researcher and run a joint lab? Will the skills and knowledge from a PhD help me with tech/enterprise? Will it bring me contacts and industry connections that I can leverage? I'm ambitious, I won't lie that part of the appeal of basic science for me is to have the tools to develop and change the field, be at the forefront of tech and development and to leave a legacy. I think i'd be absolutely satisfied if i could even accomplish 1/10th of what people like JH Gibbon Jr., Starzl, Cribier were able to accomplish. Whether or not basic science is even likely to achieve those things in my hands is also an open question for me.

That also goes to point which drives me to do more translational/surgical/large animal type research. I don't want to go up against the dedicated basic scientists and doctors of the world, i know I won't be able to put in the time they can and i believe i can only be dumber than they are. I wonder if gaining skills in a surgical lab and leveraging that might give me the unique advantage to run a lab that way.

re: epi. The biggest selling point of epi is that it can be done anywhere on a shoestring budget but I've done some of that work and just don't find it appealing. I don't believe my own research is worth its salt frankly and yes I agree, I think ultimately i'll struggle. It's probably one of the things I avoid doing the most, in fact i'm procrastinating on it right now.

I don't know much about joint labs. Why would an independent researcher take you on as a partner and split funding etc. The other person presumably would be able to just function independently: it's you who needs the other person's help.

The contribution of the PhD to a career in tech is hypothetically getting you immersed and up to the cutting edge of the field. But you don't need it is my understanding. If you have an idea for a device, you don't need a phd in immunology or cell biology or whatever to start making your new transcatheter device delivery system. You'd have to ask folks in PhD programs where you are whether they have industry contacts. Highly variable is my suspicion.

Regarding the opportunity costs: these are tough decisions. Lab time is time that you could otherwise use to finish your training and get out into the workforce. Same for fellowship time. Academic vs private is a similar challenge. The difference could be millions of dollars. When you are closing in on the finish line, that is quite a bit harder to swallow.

 

[ed*26]

i.e. what else can a basic science PhD bring to my career if I don't get NIH funded?

You get a basic science Ph.D. in order to start a career being an NIH-funded basic scientist. Yes, spending a lot of time doing research will get you contacts and experience within the research world if you're good at it, but if your goal is primarily to be a transplant surgeon who collaborates on projects then you have to ask if it's really the best use of your time. What makes you think that you would like working full time in a basic science lab, or be successful?

Plenty of surgeons collaborate regularly on projects, including basic science and device work, without doing the grunt work themselves. To achieve that you do a couple years of research and then get into an academic residency.

 

[Medstart108]

You get a basic science Ph.D. in order to start a career being an NIH-funded basic scientist. Yes, spending a lot of time doing research will get you contacts and experience within the research world if you're good at it, but if your goal is primarily to be a transplant surgeon who collaborates on projects then you have to ask if it's really the best use of your time. What makes you think that you would like working full time in a basic science lab, or be successful?

Plenty of surgeons collaborate regularly on projects, including basic science and device work, without doing the grunt work themselves. To achieve that you do a couple years of research and then get into an academic residency.

What about doing lets say 2-3 years in the lab then? I'm in an I-6 program so it'll be time taken out of my residency. I've been told that 2 years isn't enough i.e. not enough time to run a lab and not enough time to collaborate in a meaningful way with researchers, so ultimately just time that could've been better spent elsewhere.

I have the interest for sure, but it isn't an obsession for me and I do think ultimately if someone made me choose between a career in 100% surgery or 100% research i'd choose surgery. At the same time, i do want to keep the academic door open and I definitely want to be involved at the forefront of the field if possible.

One of the questions I would love to know is are the people who do ultimately end up taking their research far, people who were absolutely obsessed about the topic before they started their research? (I have had obsessions over things before, and these were things i would end up doing in my free time, whether it be collecting data on certain topics etc. and i don't think i currently have that level of obsession for the basic science lab topics i'm considering but i do have an interest in it) Or people who knew they would absolutely love research because it just fits their personality so well? I like research, but i have doubts as well, is it wrong to be also thinking a lot of practical minded things about what research brings, i.e. improving job prospects vs decreased income, opportunities lost. I'm partially worried i'm not cut out for it, but at the same time in my dreams i'd be great at it, do it well and take it far if that makes sense...

 

[dienekes88]

What about doing lets say 2-3 years in the lab then? I'm in an I-6 program so it'll be time taken out of my residency. I've been told that 2 years isn't enough i.e. not enough time to run a lab and not enough time to collaborate in a meaningful way with researchers, so ultimately just time that could've been better spent elsewhere.

I have the interest for sure, but it isn't an obsession for me and I do think ultimately if someone made me choose between a career in 100% surgery or 100% research i'd choose surgery. At the same time, i do want to keep the academic door open and I definitely want to be involved at the forefront of the field if possible.

One of the questions I would love to know is are the people who do ultimately end up taking their research far, people who were absolutely obsessed about the topic before they started their research? (I have had obsessions over things before, and these were things i would end up doing in my free time, whether it be collecting data on certain topics etc. and i don't think i currently have that level of obsession for the basic science lab topics i'm considering but i do have an interest in it) Or people who knew they would absolutely love research because it just fits their personality so well? I like research, but i have doubts as well, is it wrong to be also thinking a lot of practical minded things about what research brings, i.e. improving job prospects vs decreased income, opportunities lost. I'm partially worried i'm not cut out for it, but at the same time in my dreams i'd be great at it, do it well and take it far if that makes sense...

As far as I can tell, a person's research interest evolves over time. I thought I would write papers and publish just because it was something to do. I really only enjoyed it because it was another accomplishment/line on my CV. However, I got involved with a great research group, and I really enjoy doing research now to the point that I definitely do want this to be a major part of my career. There are also people who start off loving research and go the MD/PhD route and then subsequently give up on science and do private practice.

More important than the years is what you accomplish. You could do 3 years and waste it all. Or you could absolutely kick ass during 2 years. The important thing is just that... if you're kicking ass, a 3rd year will go a long way since it's almost doubling your active years (assuming the first 6 months is getting your stuff up to speed). However, if you're not being productive in 2 years, a magical 3rd year won't get you there.

Sounds like you need more direct mentorship in your specific situation with respect to the existing opportunities

 

[Medstart108]

Another question about this, would people recommend doing cardiac stem cell translational work (myocardial regeneration in large animal models) or thoracic evlp if one is planning to do cardiac surgery with a potential interest in transplant and heart failure fellowship?

 

[ThoracicGuy]

Another question about this, would people recommend doing cardiac stem cell translational work (myocardial regeneration in large animal models) or thoracic evlp if one is planning to do cardiac surgery with a potential interest in transplant and heart failure fellowship?

If you're going to do research, do whichever can lend itself to a paper the soonest.

 

[deleted50541]

If you're going to do research, do whichever can lend itself to a paper the soonest.

Agreed. Although cardiac stem cell translational research is probably not as hot a topic as it once was, particularly with a lack of positive or consistent results in clinical trials for acute MI and HF. Unless the PI is looking at refining the large animal model or is investigating other pathways of myocardial regeneration that could yield a faster paper, consider the EVLP research.

 

[SpliceOfLife]

My understanding is that cardiac transplant fellowships are *relatively* plentiful (bc the work is hard and bodies are needed) and you should be able to find one fairly easily. I know a couple of I6 grads who did NO research and are now going to well-known transplant programs.

My $0.02 if you really are interested in research: If you take time off I do not think you should think about it in terms of how many years to take, but rather in what you need to get to the next step (i.e., F grant, T32, K award, and/or eventual R01). Then figure out the relative likelihood of you achieving that in residency and what is the likely amount of time you need to get there.