October 2002

By: Rita Ryan and Angela Wang

An MD fellow seeking to establish an academic research career is faced with multiple expectations. On one hand s/he is expected to satisfy clinical requirements mandated by the ACGME in order to become a practicing subspecialist. For pulmonologists, a minimum of 18 months of clinical training is required in order to qualify for the pulmonary and critical care boards. On the other hand, budding academicians seeking to establish an independent research career need to learn how to perform high quality research, obtain independent funding and publish in respected journals.

It is impossible to accomplish all of this during a standard three-year pulmonary fellowship. In fact, the average fellow needs at least 5 years (Figure 1, below) before s/he is ready for an independent faculty position. Another four to six years is then spent building the research, teaching and service portfolio necessary to gain tenure. The purpose of this column is to provide you with a general career roadmap and give you a relative timeline against which you can assess and discuss your progress with your advisor.

An Overview:

In many pulmonary research training programs, the majority of or the entire first year is spent on the clinical services. Most, if not all, of the second year is spent pursuing research training while the third year is divided between completing clinical training requirements and continuing research. Years 4 and 5 are devoted to strengthening the research skills learned in years two and three. During this time, a senior fellow focuses on publishing and learning the fundamentals of project management. Importantly, this is also the time to apply for an NIH K award or other equivalent career development award.

Navigating certain transition points can be uncertain and occasionally treacherous, For instance, salary support for the 4th year is an important issue. NIH funding covers only three years of fellowship. Hence, it is important to know how your program funds fellows who plan to stay in academics and require additional years of training. Another, often tricky, transition is from fellowship to first independent faculty position.

Year I: Finding a Mentor

It is imperative that you identify a research mentor and project as early as possible during this year. Ideally, you should select a mentor by the third or 4th month, no later than the sixth month. (See Mentors and Mentoring July 2002 Career Talk).

Spend one or two meetings discussing potential research projects with your research advisor. You should have chosen your project by months 6-8. Some programs expect their first year fellows to submit a one page proposal outlining their proposed project by the 10th month. It is extremely important to have done some background reading and formulated a working hypothesis so that you can begin acquiring the technical skills and/or start collecting data as soon as you begin your second year.

Year II: Starting your research career: "Hit the ground running…."

In many programs, the entire second year is devoted to research. Ideally, this means no clinic and no or minimal call. This is your chance to immerse yourself in your new life. Focus, focus, focus. A year is barely enough time to get a new research project up and going, especially if you have to learn new skills and techniques in the laboratory or obtain additional training in public health/epidemiology. You need to generate enough preliminary data by the early fall to apply for additional fellowship grants that will provide salary support for year IV and possibly V. Both the NIH (http://grants1.nih.gov/grants/oer.htm) and ALA (http://www.lungusa.org/research) have October or November deadlines for funding that starts July of the following year. Consider alternative organizations that may be interested in your work. For instance, the American Heart Association funds a great deal of research related to acute lung injury, pulmonary hypertension and other areas of overlap. Checkout grantsnet (http://www.grantsnet.org) to search for other fellowship grants.

Year III: Preparing a Manuscript, think about applying for a career development award

By the fall of your third year, you should have accumulated enough data to begin preparing a manuscript and to prepare a research seminar. Look for local or regional meetings at which you can present your work and hone your presentation skills. Getting feedback from others not directly involved in your field/research can provide an invaluable perspective on your work and raise interesting questions that may open up fruitful areas for future research. Also, there is no better way to learn effective public skills than through practice! Finally, meetings also provide an invaluable opportunity to network.

Do not underestimate the importance of networking. Getting to know people in your area of research will provide important scientific contacts that will facilitate collaborative relationships so critical to productive science, help promote your independence and reputation. Networking also means building positive relationships with colleagues in pulmonary in general, both nationally and internationally, enabling you to build a professional support system that can be of immense help during promotion time and during grant/manuscript reviews.

You should be thinking about applying for a K08 or equivalent mentored career development award sometime during your 3rd or 4th year. Hopefully, you have or will have at least one first-authored publication under your name. Ideally, the K08 will pick up when your ALA or other fellowship funding runs out, i.e. at the end of your 4th or 5th year. Remember, the K08 is a mentored grant. It is as much a grant to your sponsor and your institution as it is to you. In addition to preparing a research proposal, you will need to start preparing statements and obtain letters of support. Get started early! (See June 2002 Career Talk). Other career development awards to consider:

• American Heart Association Scientist Development Grant or Fellow to faculty Transition Award (http://www.americanheart.org/presenter.jhtml?identifier=1200050)
• American Cancer Society (http://www.cancer.org/eprise/main/docroot/RES/RES_5_1?sitearea=RES)
• Parker B. Francis Fellowship Program (http://www.hsph.harvard.edu/pbf/guidelines.html#guidelines)
  
  Other search engines:
• Grantsnet (http://www.grantsnet.org)
  The Foundation Center (http://www.fdncenter.org)
  The Grantsmanship Center (http://www.tgci.com)

Lastly, the VA has its own career development program through the Medical Research Service.

Year IV-V

The beginning of your K08 starts another sort of clock ticking. You have 5 years to learn how to be independent. This means not only knowing how to develop and manage a research project, but also learn how to hire and manage people. It means learning about how to set up a laboratory. You need to continue to be productive, to show future employers that you are capable and focused.

Knowing when it is time to leave is a very complex issue that depends on you, your mentor and your program's philosophy. The best advice we can give you at this point is: If you are in a productive research situation, don't be in a hurry to leave. Some institutions look upon a K award as a bridge to independent faculty position and may expect you to start looking for a job as early as your second or third year into the grant. Timing is key, since most job searches take at least a year. As a mentored career development award, a K08 or its equivalent is as much awarded to your mentor and institution as it is to you. You need to identify a suitable mentor at your new institution. Consider also that you will likely have at least one year "down-time" during which the demands of moving and setting up a new laboratory will seriously diminish your productivity. Negotiating a suitable start-up package that covers this period as you transition to an R01 then becomes critical (and the topic of a future column).

If finances are an issue, consider light moonlighting to supplement income rather than taking on a full-time faculty position for more money. Many programs are very creative about creating pseudo-faculty positions that cover this period of super-fellowship. Often titled "Clinical Instructor" or "Senior Instructor" etc… these titles enable you to continue to focus on your research, sheltered from the additional, time-eating demands placed on faculty. The key is to avoid starting the tenure clock, while enabling you to earn a higher salary in exchange for light clinical duties. You will never again have the same time or "leisure" to focus on research as you do now, so make good use of it!

The authors thank Dr. Douglas Conrad for his critical reading of the article.