November 16th, 2013
Advice for Fellows-in-Training: Focus, Persistence Are Keys
Reva Balakrishnan, MD, MPH
Several Cardiology Fellows who are attending AHA.13 in Dallas this week are blogging for CardioExchange. The Fellows include Vimal Ramjee, Siqin Ye, Seth Martin, Reva Balakrishnan, and Saurav Chatterjee. You can find the previous post here. For more of our AHA.13 coverage of late-breaking clinical trials, interviews with the authors of the most important research, and blogs from our fellows on the most interesting presentations at the meeting, check out our AHA.13 Headquarters.
This year, unlike the last time I was at AHA, I arrived a day early and attended some sessions that I hadn’t been able to in the past: the fellows-in-training early-career sessions. The most memorable quote from the sessions came from Robert Califf —”A research career is more like a game of basketball than a game of golf” — emphasizing the importance of a team approach and collaboration with mentors in advancing your career goals.
There were many pearls from these sessions for those interested in pursuing an academic career, and some of the best advice came from an afternoon panel. Robert Harrington encouraged fellows to think outside the box in an era of dwindling NIH funding and to look for nontraditional sources of funding such as foundation grants. He emphasized that we need to rethink how research is funded altogether — pointing to the TASTE trial done in Sweden on aspiration thrombectomy, which was done with minimal funding, compared to multi-million-dollar randomized controlled trials.
Sanjiv Shah encouraged fellows to focus on their specific interests, not to overcommit to too many projects and papers (emphasizing that two focused papers are better than ten that are all over the place), and to form relationships with mentors and sponsors early.
Overall, the most common theme emphasized was that of persistence — learning to never give up in the face of rejection, as grant writing can be a difficult and overwhelming process with an often disappointing rejection rate.
Today was an informative day for fellows in all stages – and even for young faculty early in their career, important advice in the changing landscape.
What other pearls of wisdom did you obtain from these sessions, and how did you feel leaving them?
3 Responses to “Advice for Fellows-in-Training: Focus, Persistence Are Keys”
NEJM Journal Watch — Recent Cardiology Articles- Anticoagulation in Patients with Cancer-Associated Pulmonary Embolism: How Long is Long Enough?
- Spironolactone Use After Percutaneous Intervention for Acute Myocardial Infarction
- CRISPR/Cas9 Gene Editing for Transthyretin Cardiomyopathy
- Does Colchicine Reduce Cardiac Events After Myocardial Infarction?
- First-Line Therapy for Ventricular Tachycardia After MI: What's the Best Approach?
The truth about the funding and the environment is that it is tough – but there are plenty of exciting things to do – and if you can find something that thrills you – and you would do for free if you could – then you will be fine because you will find some way to make it work. And be willing to take some risks for it.
And for all of us, the good thing is that in medicine we can always find something great to do – we will not be unemployed – and we always will have a chance to go home at night and feel that we have contributed to the lives of others. So no one should feel sorry for us. If it doesn’t work out, then it is because we did not have the courage and imagination to take advantage of the possibilities.
And if you want to know how fortunate we are, look at what it is like to try to have a clinical research career in other countries.
While I like the optimistic (shall I say, even idealistic?) tone of this piece, I do think that times are particularly tough for researchers. Increasingly, academic centers are realizing they have a huge amount of overhead and that research salaries don’t help pay the bills, so more and more of them are tying salaries to productivity. Add to this is the very real sense that most of the Phase I trials are too difficult to pass regulatory muster here in the US, so more and more of them are heading overseas where the regulatory climate is less formidable. Our new “accountable care organization” construct is anti-innovation in many respects, especially when the bar for adoption of even the most innovative procedures (think TAVR/Mitra-clip) must demonstrate superiority rather than equivalency before payment for the procedure is granted by CMS. Further, some payments for the procedure don’t even exceed the cost of the newer devices these days. How does that work? Finally, there are increasingly limits on funds available to attend heady conferences like the AHA, ACC, and SCAI, unless, of course, industry funds you. Many clinical docs are left to attend once conference a year – tough to become a researcher that way.
No, it’s not pretty. Not pretty at all. And we should not pull the wool over anyone’s eyes.
I love working on research projects, but I also love taking care of patients. I think the important thing is to be honest with yourself on what you find fulfilling, which means still being able to enjoy what may seem mundane, whether it’s reading ECGs or revising an aims sentence for the 20th time.
So yes, although funding for both research and clinical activities are both tighter now, at the end of the day we are still fortunate to have had great training and to have picked a field that will always be relevant. If we ever get to the point that cardiologists can’t make a comfortable living, I dare say there’d be much bigger problems to worry about than salaries and productivity!