In an age when biomedical research and clinical practice have become intricately intertwined, training physician-scientists has become an aspiration at most academic medical institutions. Yet while many students dream of linking discoveries at the bench with interventions at the bedside, evaporating grant funds and the burden of medical school debt seem poised to dash their hopes. Recognizing that guidance and inspiration are essential ingredients for the success of the next generation of physician-scientists, a host of organizations and the medical students whose research they support recently converged on the National Institutes of Health campus to participate in the Clinical Investigator Student Trainee (CIST) Forum VII.
Like many others, I arrived with two main questions: What are the research opportunities available to individuals possessing an MD degree alone? and What kinds of funding sources will help bolster my early research career? With more than 200 of my colleagues, I heard a slew of presentations and lectures geared to address these concerns.
The initial batch of speakers discussed the spectrum of awards available to fledgling scientists—an alphabet soup of grants, as Stephen Katz, director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, quipped —and the NIH’s initiative to support their careers. Indeed, citing an increase in the average age at which investigators first receive an R01 grant—up to 42.6 in 2007—the NIH recently announced a commitment to “early-stage investigators” who have completed their training within the past 10 years and have not yet been awarded a substantial grant. Specifically, review committees will home in on the merits of the grant proposal and focus less on preliminary data and track record when evaluating such investigators.
A second series of speakers discussed funding opportunities such as the NIH Loan Repayment Program (LRP), an attractive option for all students interested in academic medicine since it offers a less lucrative career path than medical practice. The LRP provides up to $35,000 per year for young investigators at NIH or a participating institution who are conducting qualifying research for at least 20 hours per week. In 2008, 35 percent of applicants were successful in securing a two-year contract, while 69 percent successfully renewed their contracts.
While these programs allayed some trepidations, I was more encouraged by a panel presentation from a group of young physician-scientists. They provided tangible examples of sources of assistance, stressing the value of good mentorship and expounding on how developing connections and successfully networking had provided them with new options. Several also discussed how family considerations had affected their lives during the earliest and most stressful parts of their training. The message was clear: if combining research and clinical practice is your passion, it is a goal that must be followed—and one that is not as difficult as it is often made out to be.
This message was also imparted by the Howard Hughes Medical Institute–sponsored keynote speaker, Vamsi Mootha, associate professor of systems biology at HMS and of medicine at Massachusetts General Hospital. A young physician-scientist renowned for solving pivotal problems in the field of mitochondrial medicine, Mootha spoke for more than an hour about his journey from discovering number theory in high school to becoming a principal investigator. As he conceded, if one were to google his career, it would appear as if his path was almost predetermined from a young age. Yet he recounted how he spent days agonizing over decisions such as whether to enroll in a residency program or pursue a postdoctoral fellowship, decisions undoubtedly crossing the minds of many in the audience.
Mootha stressed that our major dilemma would not be how to balance a medical and research career, but rather deciding if we wanted to. He capped his narrative with a description of how his work recently achieved the pinnacle of translational success: using pre-implantation genetic diagnosis to screen for mutations he had discovered, his team was able to offer a couple whose children had died of a mitochondrial disease the opportunity to bear healthy children.
In essence, the CIST Forum provided opportune encouragement for those who were serious about pursuing a career as physician-scientists. If the forum accomplished anything, it was to demonstrate that support on this path can be found at every step of the way.
Amar Kishan is a third-year medical student at HMS and a recipient of the 2009–2010 Howard Hughes Medical Institute Research Training Fellowship for Medical Students.
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions or Harvard University.
