Guide to Academic Research Career Development

Abstract

Objectives/Hypothesis

Development of an academic career easily follows a clinical course for which there are multiple role models; however, development of an academic research career involves few role models, and rarely do instructional guides reach out to the new faculty. The purpose of this article is to present the cumulative experiences of previously and currently funded authors to serve as a guide to young as well as older faculty for developing their research careers.

Study Design

Cumulative experiences of research‐dedicated faculty.

Methods

This article is the result of lessons learned from developing a Triological Society National Physician‐Scientist Program and Network, as well as the cumulative experiences of the authors.

Results

Table I illustrates key elements in developing a serious research career. Table II records the career courses of five surgeon‐scientists, highlighting the continued theme focus with theme‐specific publications and progressive grants.

These cumulative experiences have face validity but have not been objectively tested. The value added is a composite of 50 years of experiences from authors committed to research career development for themselves and others.

Conclusion

Crucial elements in developing a research career are a desire for and commitment to high‐quality research, a focus on an overall theme of progressive hypothesis‐driven investigations, research guidance, a willingness to spend the time required, and an ability to learn from and withstand failure.

Level of Evidence

5.

INTRODUCTION

As individuals begin their academic surgical careers, clinical role models are highly visible and prevalent, but role models for the development of a research career often are rare. This constraint reflects the foundation upon which otolaryngology–head and neck surgery is built: patient‐centered diagnosis and treatment. Senior faculty concentrate teaching and expectations toward these ends; local and national meetings emphasize these goals in presentations, posters, published articles, and conversations.

New faculty is understandably drawn to the effort to give clinical talks and publish clinical articles–and of course for an academic career, the more the better. Clinical challenges excite the interests of young faculty, and before long clinical problem solving can take on the aura of research. After several publications on a variety of clinical issues, young faculty begins to feel quite comfortable with their career development and direction.

Perhaps too late, the young academician realizes that the world of the physician‐scientist has another dimension, one offered by systematically pursuing a lifelong research objective founded on a cogent series of hypotheses. This added dimension is a requisite, for example, for membership in the Collegium Oto‐Rhino‐Laryngologicum Amicitiae Sacrum, which has an age limit of 50; the National Academy of Medicine; and the Association of American Physicians. A thematically developed research career is also crucial to be considered for an appointment as department chair in large research‐oriented universities.

Although many are not interested in developing a research career, the purpose of this article is to offer guidance to young academicians with an interest in and passion for research.

Prevalence of NIH‐Funded Otolaryngologists

For the purposes of this article, we have defined a physician‐scientist as a practicing otolaryngologist who has obtained or is trying to obtain funding from the National Institutes of Health (NIH). This group is small. As of 2012, 10,642 practicing otolaryngologists in the United States held membership in the American Academy of Otolaryngology–Head and Neck Surgery, with membership from all countries approaching 12,000. Using NIH Reporter (https://projectreporter.nih.gov/reporter.cfm), only 127 otolaryngologists (1.2%) have had or currently have NIH funding at the time of this writing. Of those, 69 (0.65%) have had R01 funding and 39 (0.37%) have a current R01. These proportions mirror data based on all practicing physicians in the United States: of the one million physicians, only 14,000 (1.5%) consider research as their primary focus and only 8,200 (0.82) have NIH research funding.1

Members of the largest group of NIH‐funded U.S. physician‐scientists have an MD as their only professional degree. For example, of the 8,278 physician‐scientists who held an NIH Research Project Grant (RPG) award in 2012, 4,192 (50.6%) were MDs without a PhD. This trend has remained stable for more than a decade, despite the increasing number of graduates from MD/PhD programs and the increased debt burden of MDs outside of MD/PhD programs.1

For otolaryngology–head and neck surgeons, it is important to consider clinical commitments; surgeons rarely use the on‐service/off‐service model that is the cornerstone for clinical‐scientists in medicine and pediatrics. Rather, the otolaryngology–head and neck surgeon must coordinate a weekly scheduled time for the clinic, the operating room, administrative duties, teaching, and research. In addition, leadership opportunities may present themselves to surgeon‐scientists and require additional time and effort on an ongoing basis. Once planned, these commitments must be maintained; dependability is crucial for building a high‐quality career.

In an effort to improve the pipeline for physician‐scientists, there is a national organization dedicated to developing physician‐scientists: the American Physician Scientists Association (www.physicianscientists.org). Interested readers are encouraged to explore this organization. At the very least, it is likely to expand one's parochial view of what physician/surgeon researcher are all about and also enhance collaborations of thought.

As mentioned in the excellent article by Yin et al.,2 good continuing mentoring is crucial to an efficient research career development. To assist in that, The National Research Mentoring Network (NRMN) is a nationwide consortium of biomedical professionals and institutions collaborating to provide enhanced diversity networking and mentorship experiences in support of the training and career development of individuals. One program is dedicated to train good mentors. Readers are encouraged to review the NRMN website (https://nrmnet.net).

The NIH sponsors a working group to address ways of preserving and enhancing the physician‐scientist pipeline. Their latest report in 2014 enumerates suggestions for NIH to consider.3 A two‐page editorial by Executive Dean Feldman (Temple University School of Medicine, Philadelphia, PA) capsulizes the original 143‐page report.4

The NIH asked for responses to a considered program via NOT‐OD‐15‐009, Request for Information: Physician‐Scientist Specific Grant Program to Facilitate the Transition From Training to Independence (https://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-009.html). The American Association of Medical Colleges responded (https://www.aamc.org/download/412848/data/aamccommentsonnihrequestforinformationonphysicianscientists.pdf). Study of both documents provides some understanding of national efforts to improve physician scientist entry and retention.

What Works in Developing an NIH‐Level Research Career

An article by Milewicz et al.1 recommends implementation of four action items to improve the physician‐scientist pipeline: “1) integrate medical and research training, share best practices, collect outcome data and acquire strong institutional support. 2) Shorten the time to an independent research position by establishing clinical training programs that better integrate research and improve transition to independence awards with earlier grants better tailored to physician‐scientists. (The average clinician‐scientist is now 45 years of age when the first R01 is received.) 3) Achieve greater diversity and numbers in physician‐scientist training programs. 4) Centralize mentoring and oversight of physician‐scientist trainees at all levels to reduce attrition. Milewicz et al. recommended the establishment of institutional physician‐scientist career development offices tasked with overseeing career development programs for physician‐scientists to help overcome barriers to success. Included in this concept was a national physician‐scientist mentoring network”.1

In 2012, a proposal was submitted to the Triological Society executive committee and council to approve the development of a National Physician‐Scientist Program and Network. Over the last 3 years, this initiative has begun to emerge as a viable entity and will soon be referenced on the Triological Society website. Its implementation reflects our belief that two components are essential for a successful research career: 1) a broad supportive infrastructure, and 2) a person‐ and time‐specific continuous mentor–mentee relationship. Observations by the senior author (j.g.n.) over the last 50 years have culminated in an appreciation of the crucial components for personal research success (Table 1). Clinical practice is generally qualitative, whereas research is particularly quantitative. Most practicing otolaryngologists are excited by the challenges of diagnosis and treatment planning. However, taking a novel concept and making the transition from a clinically or laboratory‐based good idea to a validated clinical application and a change in practice behavior requires the talents of a physician‐scientist using techniques specifically designed for such ventures.

Table 1.

Crucial Components for Personal Research Success.

Personal desire and drive for investigation (for one's own satisfaction, not for external reward)	Fundamental to the whole enterprise is a strong, unswerving visceral and intellectual desire to investigate. The primary driver and reward system must be the investigator's internal excitement and stimulation from the research question(s). Without this, nothing works.
Focus on a research theme	This issue is often overlooked. The long‐term goal or theme of progressive investigations is quite different for a single research project. The conclusion of one series of theme‐based projects necessarily leads to a whole new series of hypotheses for testing.
Guidance/mentoring (person‐ and time‐specific continuous personal mentor–mentee relationships)	Just as expert surgical skill requires continuous exposure to a mentor, a research career is vitally dependent on expert guidance. From the start, the mentor and mentee must set a progressive course of study and productivity, being as specific as possible. One cannot do this alone.
Dedicated time	Clinical duties will always consume precious time. In order to make progress in a research career, one has to be rather hard‐nosed about protecting the necessary time to understand and do the research. It is very important to remember that the mentor, too, is very busy and should not be abused by other things drawing the mentee away; this is often fatal to the enterprise.
Research writing (articles and grants)	Writing is fundament to research. A well‐constructed plan and sensible research conduct are crucial to science. Grant writing focuses on the quantitative measure of all the variables; this takes considerable thought and preparation. Writing up the results demonstrates that you can do the work; it is a substantive part of progressive grants.
Seek funding source(s)	This point is also overlooked. When working with a seasoned mentor, an early search for funding clarifies the issues and ultimately gives very important external review of your ideas. Few things improve the research as much as this.
Consider NIH funding early in planning (target the highest level of research credentials and credibility)	Appropriately, NIH funding can be daunting, and submitting an inadequate application is not a good idea. However, few things are more clarifying than thinking of NIH opportunities early in the process. This is a great stimulus for mentor–mentee thinking and discussion.
Persistence	Failure is certain. Persisting through disappointment and refining the research is fundamental to success.

An example of progressive research careers is the actual de‐identified research career paths of five surgeon‐scientists at high‐level research universities assimilated as a convenience sample from five subspecialty areas of otolaryngology (Table 2). Three key aspects highlighted by these pathways are: 1) formal research training is highly valued by grant reviewers and improves time efficiency and success; 2) a steady stream of research publications linked by a common theme that defines the research interest is fundamental to the process; and 3) skilled mentoring is crucial to improve the efficiency and productivity along a focused pathway. Research training may be acquired in a variety of ways; grant reviewers understand that not all programs offer a Institutional National Research Service Award (T32) program and not all Clinical Investigation Award (K08) applications are awarded. But the value of some sort of research education, and of published research productivity, cannot be overemphasized. Clinical case series and book chapters are useful to pad the résumé for promotions and reputation‐building, but they add nothing to the research credentials unless they are directly related to the primary research theme. Table 1 does not capture two crucial components to research success: 1) a personal excitement and interest in the guiding research theme, often informally stated as “I would do this work even if they did not pay me”; and 2) guiding help, mentoring, and collaborations, not only at first but also throughout the research career. In particular, strong mentoring is paramount to enabling the surgeon‐scientist to successfully navigate challenges in 1) time‐management; 2) grantsmanship; 3) professional relationships; 4) laboratory/program‐management; and most importantly, 5) the effective development of a sustainable and relevant research theme.

Table 2.

Five Physician‐Scientists’ Research Career Courses.

Item ID 1	During Residency	Zero Time: Finish Residency, Instructor			Assistant Professor			Associate Professor								Professor
Years		0	1	2	3	4	5	6	7		8	9	10	11	12	13
Researchtraining	2 years: T32 and 2 society grants
Theme articles (no.)	7	1	4	1	5		4	5	1		6	5	2	6	8	6
Miscellaneousarticles (no.)	3				1	2		2	2		3	1	5	3	5	10
Theme grants		2 foundation grants and 1 intramural grant			K08					R01
					Spanning and partial overlapping foundation and intramural grants

Item ID 2	During Residency	Zero Time: Finish Residency, Instructor	Assistant Professor									Associate Professor
Years		0	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
Researchtraining	MD/PhD, then study throughout with research mentor
Theme articles (no.)		0	0	2	0	0	2	1	0	3	0	1	1	5	1	2	2
Miscellaneousarticles (no.)		0	0	0	0	0	1	0	1	1	1	0	1	0	1	0	3
Theme grants				K08						VA Merit Review Award						R01
	Foundation grant						Institutional grant				Foundationgrant

Item ID 3	During Residency	Zero Time: Finish residency; Instructor	Instructor	Asst Prof								Assoc Prof										Professor
Years		0	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25
Researchtraining	Research fellow 1 year										MBA								BS			MA			PhD
Theme articles (no.)	0	0	0	0	0	0	0	0	1	2	2	3	3	0	1	1	0	0	0	2	2	1	1			2	6
Miscellaneousarticles (no.)	3	0	0	0	1	1	0	1	0	2	2	0	0	1	1	0	1	3	5	3	3	8	3		6	2	2
Theme grants					VA Advisory Group Grant					R03				U01		VA Merit Review Award						R01
											Foundation grant																Foundation grant

Item ID 4	During Residency	Zero Time: Finish Residency; Instructor
Years		0	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
Researchtraining			Research fellowship
Theme articles (no.)						1	2	3	1	2	2	4	1	3		5
Miscellaneousarticles (no.)	2	1	2	1	1	1	2	3	3	7	3	3	3	3	4	6
Theme grants								R01								R01
								R25			R25					U01

Item ID 5	During Residency	Zero Time: Finish Residency; Instructor
Years		0	1	2	3	4	5	6	7	8	9	10	11	12	13
Researchtraining	Foundation grant	Research fellow grant
Theme articles (no.)					2	1		1				1
Miscellaneousarticles (no.)	1		2	1	1		2	1	3	2	4
Theme grants						Institutional grant	Institutional grant		R03
											R01

K08 Clinical Investigator Award; R25 Education Projects; U01 Research Project–Cooperative Agreements; R03 Small Research Grant R01 Research Project; R21 Exploratory/Developmental Grants.

Even in the best of circumstances, it takes much more time than often thought. In these five examples, the averaged time increment from completing residency to the first R01 was 11.4 years.

Researchers rarely obtain R01 funding as their first grant. An absolute requirement for an R01 is pilot data; the reviewers must be convinced that the idea is feasible and that the researcher can actually carry out the proposed experiments. Some funding is required in order to obtain pilot data, so where does the young academician begin? Options include academy grants (e.g., core grants), foundation grants, and specialty society grants; departmental funds and dean's startup funds; grants from the Department of Veterans Affairs; and small grants from the NIH (R03, R21 mechanisms) that provide a reasonable amount of startup funds.

Support of the department chair is also critical to enable the young academician to maintain time protected for research. Protected research time and lab space should be included in the recruitment negotiations, alongside salary and other benefits. It often becomes challenging, if not impossible, to do so effectively after an offer has been signed. Then it is up to the clinician‐scientist to vigorously protect these vital assets.

Once a surgeon‐scientist has started in their faculty position, there will always be clinical work that will be tempting, including requests to see a few more patients or do an extra surgical procedure during their lab time. The successful academician learns to just say no. Clinical practice‐building is important, and the young clinician‐scientist should work to develop a clinical reputation and referral base—but not during protected research time. Having the support of a dedicated nurse or advanced practice provider can be critical in allowing the surgeon‐scientist to both optimize the efficiency of their time spent in clinical pursuits while also protecting their research time from the incursion of patient care‐related activities that are omnipresent.

Early NIH Perspective and Focused Long‐Term Goals

The titles of NIH R01 grants held by practicing otolaryngologists describe how clinically relevant questions are approached in a stringently scientific fashion. Too often, young investigators overlook or inappropriately delay considering the NIH as a source of funding, not just for the research costs but salary compensation as well. Salary support is important for chairpersons, deans, and departmental clinical colleagues. A good mentor will try to guide the mentee from the start to design and conduct all research as close to an NIH level of precision as possible so that progressive work along the theme will eventually sum to an appropriate NIH application.

Lessons Learned From Mistakes

The senior author (j.g.n.) made some telling mistakes in his career, including the following: 1) Failure to focus and consider the results of one study as a hypothesis‐generating study to inform the next series of projects and thereby a corpus of work. Consequently, he would finish one interesting project and rapidly jump to another unrelated project. 2) Failure to ask for help. Surrounded with expert investigators, j.g.n. did not seek mentoring advice and erroneously assumed that he could do it himself. When the thought of seeking a mentor arose, it was quickly abandoned because no one easily seemed to be doing the kind of work that j.g.n. wanted to do. Rather than persisting in finding a proper mentor and using those at hand to identify one that would be just right, j.g.n. stopped the search. He did have the passion and desire to investigate and was more than willing to spend the time; however, j.g.n. did not recognize these crucial mistakes and kept on in his Brownian (random motion) movement from one idea to the next. It is the too‐late realization of these mistakes that fuels his desire to help others avoid them.

CONCLUSION

A physician‐scientist practices clinical medicine and complements this work with high‐quality fundable research. One of the highest levels of research credentials, and an indicator of research independence, is an NIH R01. Independence in research is much like clinical independence identified by board certification. The critical factors leading toward research independence are shown in Table 1. These observations derive from 50 years of experience and highlight what works and what does not, and what mistakes obstruct progress in becoming a physician‐scientist. As important as good infrastructures are to research success, the most important way to improve the physician scientist pipeline is by developing excellent mentoring processes. Person‐ and time‐specific mentor–mentee arrangements are indispensable for time‐efficient and theme‐focused productivity. One is never too old to benefit from good scientific collaborative conversations.