Watch the AMA Research Challenge video "How to plan a career in academic medicine." This video initially aired on Oct. 20, 2022.

 

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Supporting you today as a medical student. Protecting your future as a physician.

Stephanie Strohbeen, MD, leads a discussion with Ricardo Correa, MD, EdD, and Stuart M. Greenstein, MD, about how to plan a career in academic medicine.  

Speakers

  • Ricardo Correa, MD, EdD, program director, Endocrinology, Diabetes and Metabolism Fellowship, director for diversity in graduate medical education, University of Arizona College of Medicine
  • Stuart M. Greenstein, MD, professor of surgery, Albert Einstein College of Medicine (AECOM) and Montefiore Medical Center

Host

  • Stephanie Strohbeen, MD, Medical College of Wisconsin combined internal medicine-geriatrics program, AMA-RFS on the AMA Council on Long Range Planning and Development

Dr. Strohbeen: Good evening and welcome to the 2022 AMA Research Challenge “How to plan a career in academic medicine” forum. My name is Dr. Stephanie Strohbeen. I am currently a second-year resident at the Medical College of Wisconsin's combined internal medicine and geriatrics program. I represent the AMA-RFS on the AMA Council on Long Range Planning & Development, and I'm serving my second term as the chair of Wisconsin Medical Society's resident fellow section.

I am happy to be here tonight with you serving as your moderator for this evening's event. Before we get to business I just want to remind everyone of our commitment to be courteous, respectful and collegial in the conduct of AMA events. This event is governed by the AMA Code of Conduct and claims of harassment and conflicts of interest are taken seriously. Violations of the code of conduct may be reported confidentially via phone or web to our partner, Lighthouse Services. Thank you for your attention to ensuring this is a safe and welcoming and professional meeting.

Before we get underway with this forum, I'd like to provide a general orientation to our event platform. To ask a question please use the Q&A feature or Raise Your Hand feature. You can find both of these in your toolbar. We solicited questions from the participants in advance of this forum, but we want this event to be as interactive as possible. If you do not have the Q&A feature, please see the chat box as you are also able to drop questions there.

Now I would like to introduce our panelists. Dr. Ricardo Correa is the program director for endocrinology, diabetes and metabolism fellowship, and the director of diversity in graduate medical education at the University of Arizona College of Medicine. He is staff clinician and researcher at Phoenix VA Medical Center and health equity fellowship director for Creighton School of Medicine in Phoenix. He is an editor and peer reviewer of multiple journals and endocrine research and medical education. Dr. Correa has served in a variety of leadership positions across the AMA sections and is a member of the AMA's Research Challenge advisory council and serves as chair of the IMG's Governing Council for the 2022-2023 term.

We also have Dr. Stuart Greenstein with us. He is a board-certified surgeon and is a UNOS-certified transplant surgeon who has been a dedicated senior member of the Montefiore Medical Center kidney transplant program for more than 20 years. Prior to joining Montefiore, Dr. Greenstein served as the acting director of the kidney transplant program at Hahnemann University. He is a member of more than 20 medical societies. He currently serves on the editorial board of transplantation. Dr. Greenstein has been the principal investigator in more than 20 trials and has written numerous articles on kidney transplantation.

Thank you both for being here. And welcome, our audience tonight includes medical students, residents and fellows, and international medical graduates. And I'm thrilled to have your expertise available and guiding us through this important topic. Thank you for your time and your willingness to join this evening.

To get started, we'll start with Dr. Greenstein. What has motivated you to choose the path of academic medicine?

Dr. Greenstein: That's a very loaded question. But I guess it started in medical school where I was fascinated by medicine just in general and I had lots of questions in my mind and the people that mentored me were clearly researchers.

I had the privilege of going to Harvard Med so I was really excited by all the research that was going on. And I knew that I wanted to go into academic medicine based upon how I saw medicine going. It's an interesting question because I think that more and more people are leaning towards academic medicine just because there is less and less of private practice out there and people are realizing that they're going to be associated with institutions, whether it's the universities or the medical centers.

I didn't feel that way. I just knew right away I wanted to be an academic surgeon. I didn't know I was going to be a transplant surgeon, but I did know I wanted to be an academic surgeon.

Dr. Strohbeen: Thank you. And Dr. Correa, I'll ask you the same question. What led you to a career in academic medicine?

Dr. Correa: Thank you so much, Dr. Strohbeen. And thank you to the AMA for the invitation at this panel. So very similar to Dr. Greenstein, I think, since medical school, prior to medical school, I have a passion for education and medical school just flourished that. And really I went to medical school and when I finished it, I wanted to continue my pathway in education. I did a Masters in Education. And as an international medical graduate, but this was before coming to the U.S. But I always see myself in a place where I can teach any kind of medical students, or residents, fellows, or any kind of teaching, that was something that I was really trying to look to in my future.

And then, definitely, I came and did all the residency and fellowship and all of that just flourished more during my years of residence and fellow, trying to make myself more aware of where education was going, how can I improve medical education, how can I contribute more.

And something important, I think, in the pathway is that, it's not an easy pathway to continue in academic medicine. The way that how it looks like right now, in a place where really there is a lot of clinical work when you are in a clinical setting and a lot of clinical work, and then on top of your clinical work, you have to find some time for teaching.

And then it's not really protected by the health care system. Even all of the mission, all of these institutions say, oh, clinical research and education, really, the research and education are extra than the clinical.

And then I found myself like, yes, I wanted to do medical education and I do research, I train at the NIH, continue with my research. But then without grant and funding, it was difficult to survive in that research world. And then trying to make myself available for education and research has been not an easy pathway.

I think that the most important thing that I have learned is that you need in your career to change a little bit of the things that yes, you can achieve your goal. But to achieve that goal isn’t a straight line. It's sometimes some other pathways.

I start with doing a lot of research and then moving to a lot of medical education. Then in the last year all my research and medical education has been in health equity. So I found a pathway where the two things comes together and there some protected time that I got. But very important to think about every time that we mention academic medicine is, thinking how it looks for you. Because the health care system will make it totally different. And I call this clinician that teach. So there are clinical people that teach.

This is not what we really, really want in academic medicine. Academic medicine we want people that really are prepared, that teach, that produce research in merit and then at the end, promote this.

So I think that there is a hope. We have to continue being an advocate for academic medicine. I think that the AMA has been very strong on this. But just sorry that I jumped from your question of how I get into and then just blurb about this other thing.

But I think that it's just, in my case, was really the passion that I had from the beginning to be an educator. And I think that the best way for me was being in this pathway of academic medicine. I now see, and I think like, should I go to private practice or should I go to another type of practice and I don't see myself. Everybody's individual. Everybody's different. And that was my main driver in medicine has been trying to educate the next generation.

Dr. Greenstein: I'm going to add to what Ricardo said because I agree with him. In academic medicine, the teaching, the research is separate from the clinical aspect. And that's what you have to recognize. You do your clinical research, assuming, let's say, it's not basic science research, basic science that you have to do during the regular hours. But if it's clinical research, outcome research, that you're going to do after hours. Then that's what you have to recognize in academic medicine. You're going to be doing 9 to 5, let's say, or whatever, 7:30 to 5, clinical medicine, taking care of patients, and then afterwards you're going to sit down and do your … clinical research, non-basic science research.

And one of the things that you have to recognize is that, it is very, very difficult to do basic science research unless you're going to do it full-time. If you're going to do it, it's very difficult as a surgeon, for instance, to be a basic science researcher and be a surgeon. You're going to have to be a surgeon who also does something else on the side.

And that's how I made my career. I can remember many a night being in the hospital, just before 1 o'clock doing chart reviews and things like that after hours because during the hours it was all about doing surgery and taking care of the patients.

And one final thing I wanted to say that, in academic medicine, I think, if I had to really look back, I think my love for academic medicine started in college. Because in college, many of us did research because that was one of the ways you got into medical, you have to do research.

And with the research came the love for having a question and then getting an answer and realizing, wow, now there's another question from that. And then there's another. So it really starts probably in college.

But in medical school, it was the same thing. All the questions that would arise, you would try to find time to do actual research. And some people take time off during the research year. I've had students who've taken a year off from medical school between third and fourth year, spending a whole year in block time with me.

And that meant not only just doing research, but actually following me around in the operating room, seeing patients. And they got a true sense of what it was like to be an academic surgeon, which meant, having not a 24-hour day but a 28-hour day, beyond normal days.

Research and teaching in academic medicine

Dr. Strohbeen: Thank you. I noticed you both are talking a lot about research and teaching as part of academic medicine. Can individuals have one without the other? If someone is really passionate about education, can you do that without necessarily tying yourself to research? And what might that look like?

Dr. Correa: I can start. Definitely. So if we think about what we dream of, it's doing the three of that, research, clinical and education. And I think that that's very difficult to achieve because the day only have 24 hours. And it's difficult.

So what I have seen is that there is many people that really dedicate themselves to research. And when I say research is that they are really researchers. They are clinician scientists that dedicate their time.

Usually, these are people that get grants are 80% of their time protected for research. And then there are all the 20% of their time is when they do the clinical part. Probably half day per week, something like that. And this are really the physician scientist people. The ones that are doing a lot of clinical research. And they have grants.

The combination of research and teaching, it's more for the clinical educators that really are not doing this hardcore research but they are doing some kind of scholarly activity. They have some publications. They have some work on merit. They can do some clinical trials. And then on top they are doing some more teaching and education for those students. So more likely, that's what the person that is in academic medicine looks like when you don't have protected time.

And then there is the other group that are clinicians. And that we need them a lot. So we need the clinicians that are doing clinical work. And then, on top of that, they teach a little bit to the resident fellows and students.

I think that if the pathway that you want is research, you will have to invest at least the beginnings of your year in dedicating 80% of your time to research. And that means that probably you have to leave a little bit away the education, a little bit away the full clinical part because you want to create your career in that research area.

Later on, probably, when you have a lot of your grants and all of that, the protected time, then probably you can go back. But for the researchers, it's a little bit more―or my recommendation―it's a little bit more focused on those first years in research.

The educators, I think that we have three things together definitely. Whatever your passion moved to. Sometimes it's more in education. Sometimes it's more in administration of education, and that's something totally different.

Because I remember when I was as a fellow, as a resident, I saw the program director and said, oh my god, I want to become a program director. It should be very easy because I didn't see my program director doing a lot of things. And now when I became a program director I'm like, oh my god, all the things behind the scenes that you have to do as a program director, to report, writing many things, and all of that. It takes you a lot of the time.

So when I came from to my second job that I became a program director, I said like, OK, they were giving me, I remember, 70% protected time. And I say, eh, 70%, so I will use probably 60% of research and 10% to be the program director and all of that. Nah, at the end of the day, I used my 70% for being the program director.

Because you have to move the program to your way and all of that. And then, of course, I was having some research behind the scenes, as Dr. Greenstein mentioned, after hours. So my after hours was the research part because I couldn't handle clinical research and the program director.

So the administration on medical education, it's intense. And depends, if you want that career, that's perfectly fine because you can grow in that career. People don't know that sometimes, oh, people focus in academic medicine, a lot of research. Yeah, but there is merit.

And then this is a part where would you say program director. Then you become a GME officer, and you become DIO, and an associate dean for greater medical education, or you enter to the college of medicine and you start with clerkship director and then grow there as an associate dean for students affairs or faculty development.

So there is a lot of need in that area that is also important. So I always tell the fellows and the residents that, it's wherever your passion tells you to go. We need everything. We need everything. In academic medicine, we need everything. We need strong clinicians, as we need strong educators, as we need strong researchers. And we need people that do that three things, or one, or two of the three. So I think that it's where your passion takes you.

Dr. Strohbeen: Thank you, I just want to remind folks too, that there is an option to submit questions either through the Q&A feature or through the chat as well. We'll continue on.

Find a residency that offers research

Dr. Greenstein, I'm going to ask you the reverse question of that. For folks who are interested in a research-heavy career, how do you go about finding a residency that can offer that?

Dr. Greenstein: I think you have to step back and ask yourself if you want to do research, do you want to do basic science research versus more translational clinical research?

If you want to do basic science research, you're going to have to find residency that is very heavy in that, and it's not going to be every program. One of the best places is to go to the NIH, clearly, to do and get into research with them. And that will then lead you to other places.

But no matter what, wherever you go. I mean, when you go for interviews for residency, you want to find out are there people in that section, whatever you're going for initially. Well, let's say, you're going to interview in surgery. We have interviews coming up soon.

They're going to ask, well, what do the attendings do? Do they have a research lab? Do they do clinical research? And then you start googling the people that you have there and seeing what their CVs are like, first of all. And you can get a sense of what people are doing.

But the bottomline is, you have to, at the interviews, really, ask the questions. There's no way I don't think you can assume that if you go to, first of all, a community hospital, you can assume that's not going to be a research-oriented program. But if you go to a hospital at a major institution, they're going to want to do research.

In fact, a question that you should be asking is, can I do research? Can I take a year off, or two years off to do the research? Because that's the best way to get into a research career. First of all, you make connections. And you get a sense of what it's like to really do the research.

I know in our department, in surgery, there are several residents every year who take two years off to do research. And it doesn't mean only doing research at our institution, they can go to other places just as easily.

Dr. Strohbeen: I like your point of following-up your question. Trust, but verify it, right? Go check out those CVs. See what's being produced as well. Dr. Correa, what kind of activities do you think is important for trainees at any level to get involved in if they're thinking about a career in academics?

The importance of scholarly activities

Dr. Correa: I think that the most important thing is producing scholarly activities. And what scholarly activity means is, just a broad spectrum of things. I think that in the past, it was a lot of focus on people that wanted to continue doing an academic medicine as research.

If we think about the past, it was not so difficult to get a grant to continue your career. So we are talking about 40 years ago, whenever you have an idea, you put that idea in a protocol. And then most likely you will get approved. Nowadays, we know that only, probably, less than 30% of the grants that are submitted get funded, and every day is difficult.

So at that time, there was research-oriented to stay in academic medicine and that was the purpose of, whenever you wanted to look something, you needed to do a lot of the research part.

Nowadays, I always see more about the scholarly activities. And what scholarly activity means is, wherever you want to do it. A lot of the things, for example, quality improvement projects. There are a lot of educators, clinical educators, that do quality improvement projects. And this is a type of scholarly activity that you can grow. That it can make you grow in academic medicine.

Now we are doing a lot of health equity projects. And health equity is a mix of the quality improvement and the research part. So we are doing a lot of health equity projects that can be.

Definitely, if you want to stay in academic medicine, you have to be proactively involved in these scholarly activities. From research to the others, and then definitely that will bring your portfolio to stay in there.

The other part is, for example, if your focus is more towards medical education, start in residency trying to find ways where you can start teaching. There's many opportunities in many programs for the residents to start like residents as educators and then start teaching.

If that is what you want, try to get into that pathway. And then start building your portfolio because that is the entrance, the door to entrance the pathway in academic medicine.

Usually, they will ask you whenever you apply for a job, or depending if you have some background, probably, you can enter as an assistant professor, in other places as an instructor. But all of that kind of things will be important to put into your future.

So I think that things to consider is being active during training, during medical school, and during residency and fellowship. Being active in the pathway that you want to be. It doesn't need to be exactly that you are doing this clinical trials.

Nobody expects also that if you are in residency, and you finish residency, and start a job, that you were the first author of the big trial that is happening right now. So you don't have the time to do that.

But people definitely expect when you apply to academic jobs that you have some productivity during those years. That something is, you publish, you have some presentations, you were active.

I also, finally, I want to mention, I think that leadership positions in organized medicine, we are seeing more and more right now that even it was not so much valued in the past, now there is a lot of value coming from leadership positions in organized medicine.

So if you are part of an organization, try to be part of the committees. Try to grow in the organization. Be part of chair's committees, things like that. That will help you a lot.

And you will see, for promotion in academic medicine, they will ask you, in many places, which committee you were chair, of which organization? How many guidelines you have been involved? They ask you these kind of things that really sometimes we don't think about it. But I think that we need to evaluate a lot of leadership positions.

And finally, sorry, I think that something that now we are trying to move, this a movement of some group of us that we are trying to move is, how to recognize the things that you do in social media to promote science, and medicine, and things like that. How to be recognized in academic medicine.

Because many people are doing a lot of things in social media that are helping science, that are helping medicine, and has not been yet recognized. So there is a movement of bringing that to the portfolio of promotion.

And probably soon, it will be approved. There are some places already recognize things that you do in social media as part of your promotion package. So try to move in that area too.

Choose the right mentor

Dr. Greenstein: I'm going to add one thing. I think one of the things that is critical in getting into a research career is to find the right mentor. If you don't find the right mentor, you will just waste away. And you can start in medical school. Or you can wait till you're in your residency. You can find somebody that provides the passion of what their work is about, whether it's clinical and/or research.

And with that, first of all, you can then get excited about it. And when you have a really good mentor, that mentor will work to help open up doors for you. That mentoring though, doesn't stop when you finish residency. I think that mentoring is just as critical as a surgeon, for instance, to mentor the junior surgeons who come through for their academic careers.

And I know for myself, when I'm asked to write chapters, I will ask my junior colleague if they would like to participate to write the chapter for us. I don't need it for my CV anymore, but they need it. And they need to go through the process of growth, which I think is critical. And I think that one of the most important things I can say about academic medicine, you need a good mentor.

Build a network

Dr. Correa: And one last thing I want to add, sorry, it comes to my mind when Dr. Greenstein was mentioning this. Besides the mentorship, it's your network. It's very important to have a network. Where you get it? I always promote that you get it in organized medicine, in medical specialties organizations, and the AMA because that's where your neighbor is.

Because many of the jobs that are open in academic medicine, we are not commonly promoting in places when you look for jobs. The chair open the job and then people from the division knows others and start telling, hey, there will be something open. Or your program director knows. And then the program director tells you.

Many of the jobs in academic medicine usually is by word of mouth. That's how you get it. And then you apply for that job. And then you get it. So that. And where do you get all that contact? It's participating in these kind of things.

I remember my personal experience, I was very involved. When I applied for my first job when I went in academic medicine, really, I got it because of the organization that I was involved. People knew me. People knew that I work. I applied to the job. And then people from the division say, hey, I worked with him in this organization and they were promoting me.

So I think that having that network. Since medical school, nurture that network during residency and fellowship. And then that, definitely, with the mentorship. That your mentor is the main part of your network. He or she will introduce you to many people. And then you start.

And sometimes the people that you introduced now, you can follow in social media but also keep track. Sometimes, send one email a year like, Merry Christmas. I don't know, something at that time. And just to keep … so whenever you need that person, that person is like, oh, I remember this person. And then that keeps your network growing.

Dr. Strohbeen: I think the point you make about mentors is very true. One of our former AMA presidents actually cited a quote about, "leaders don't create leaders." Or sorry, "leaders don't create followers. They create more leaders." And I think that's exactly what we need in our mentor. So thank you both for commenting on that.

Determine what type of research interests you

We have a couple of questions coming in too. One is, if we want a future career in basic science research, is it necessary for us to do basic science research during medical school, or is any type of research going to be OK? Dr. Greenstein?

Dr. Greenstein: Short answer is, any kind of research is OK. But if you get into basic science research in medical school, that will probably jump you into basic science research in residency. And it's not easy, I believe at least, to get into basic science research, once you're out as an attending, to just jump back.

Unless you have, as Ricardo was mentioning, protected time. And that happens less and less now because medicine is numbers driven, and it's all about how many patients can you see. Whether it's in surgery or medicine in an hour. So unless you have basic science research going on when you get out, you probably won't be able to get into it.

I mean, I had basic science research when I started my academic career. I didn't have protected time. I had the nerve of writing to people and asking them to send me their drugs before they ever made it into the world, so to speak. And I was able to have some funding from the department to have a researcher do some basic work for me.

But because I didn't have the time to sit and write NIH friends, I never did go to the next step. And that only happens if you have protected time.

Dr. Correa: Yeah. And I would agree. Sorry.

Dr. Strohbeen: No please, continue.

Dr. Correa: Oh, thank you. I would totally agree that you can do it any time in your career. But I think that you will be more successful, if you want to do basic science research in your future, if you start in medical school doing basic science research.

Because that will open the doors for having―this is the most important thing―having the protected time. Basic science research will require a lot of your time. And if you don't start with that since medical school, then getting that protected time later on in life, it's a little bit difficult.

I did some basic science research in my fellowship at the NIH. And definitely, it was something that I wanted to do, but it was so difficult after that to continue doing. As Dr. Greenstein mentioned it, without that grant, that's it.

It's easier to do clinical research because you are seeing patients, and then you can do database analysis, and you can do these things after hours, and that kind of thing. But the basic science, you cannot do it after hours.

The mice wake up a certain time and they go to sleep a certain time. So you need to do PCRs. You have to go three or four times to the lab. Because it's hours. So it's not … things I remember, being a fellow, trying to do clinical. And then basically, I'd run from seeing one patient because I have to change the table from the PCR to another and run back to … it was craziness.

So it's a different world. And I think that if that's your passion, start from medical school. Even now you're a resident or a fellow, you can do it but start now. Don't wait later. It's difficult to start later.

Dr. Greenstein: The only time, I'll add to that, that you can theoretically jump into basic science research, if you haven't started early on in career as I say it, as you we were mentioning medical school, is if you take time off during your residency. One or two years, preferably, two years of research where you can do basic science research. And that could ignite your academic career in the basic science.

But if you have no basic science work going on during your residency, you won't be able to do pure basic science research when you get out without that protected time. And you'll be starting from scratch, teaching yourself everything. And unless you have a mentor that is going to show you everything, you can be knocking your head against the wall all the time.

Dr. Strohbeen: Dr. Greenstein, do you have recommendations for folks who are maybe in a community program or a different program where maybe academics isn't as strong or there's not real access to somebody that has this research and academic background?

Dr. Greenstein: Well, my short answer would be, switch to a academic program. Because it is very, very difficult to do research in a community hospital system because it's not geared for research. It's very, very difficult to do it. They don't give you the time or the space to do that.

The only kind of academic research you can do in a community program is clinical trial review stuff, which is OK. That's needed. But you're not going to be getting the tertiary level of patient care that may be important in your research. If you're going to be looking at, taken from a surgical point of view, all right, that's leading to our talk about transplants. You're not going to be able to do transplant research, even clinical research, at a community hospital. They won't have the volume that you can pull from.

So you really have to, if you want to go that route, you switch if you can. And it's not going to be that easy,  to do a more academic program. Or recognize that you're not going to be doing basic science research. Or the final thing is, again, see if they'll let you take two years off. And then go to a place like NIH, Memorial, or any of the big systems where you can do two years of research in basic science.

Dr. Strohbeen: Dr. Correa, do you have anything to add to that?

Dr. Correa: Nothing to add. The thing is that, if you want to do research, it's what Dr. Greenstein mentioned. Think about that academic medicine is more than research. And if you want to stay in academic medicine and see that you are doing a resident fellowship in a community hospital, try to potentiate whatever you find there.

Because you can find there, as I mentioned, quality improvement projects. You definitely will not be a research academic medicine but will be a merit academic medicine. Try to see if there is opportunity for teaching. Try to see, at least in the community, always will get case reports. Always you will get the opportunity for publication.

As Dr. Greenstein mentioned, find mentors in that place that sometimes, they get reviews. They get authorships in chapters in books. That kind of things that, whenever you get out of there, you get out of there with the majority of the things that you can continue your career.

Definitely, basic science research is another place. Definitely, if you want to do your grant after that, it will be a little bit harder, even in clinical medicine research. But there is other opportunities in those places. If you are right now in those places, there's other opportunities where you can really build your career and be an academician later on if you are in a community setting hospital.

Leadership positions in academics

Dr. Strohbeen: Dr. Correa, I have another question for you coming in through the chat as well. How difficult is it to acquire a leadership position in academics? Feels like this could maybe be challenging to obtain as a younger faculty member.

Dr. Correa: Yeah. And this is the big elephant in the room, it's leadership in academic medicine. If we look, we will see that there is not a lot of diversity in leadership. The gender diversity is not there, even though we know that almost 55%-60% of the medical students right now are females.

And then also the race ethnicity diversity is not there. When we look at how many deans of medical school are from underrepresented minorities, we can say between―right now between 20 and 25 deans. So it's difficult to grow.

But what I always say is that, if that is your goal in life, you'll work through that. And for underrepresented minorities at any level, it will be harder to do it, but it's possible to do it. And then you start working. Sometimes we have to work two or three times harder. But if that is your goal that is what we want to build.

So that's I think that one opportunity that it's changing. And we need to move to that change and increase leadership. You have to start working since the first day in whatever you want. Some jobs offer you that opportunity to sit down with a mentor. They assign you a mentor. Other jobs do not offer that opportunity. So you have to find it by yourself.

But I think that, if your goal is to grow in academic medicine and to become a leader in academic medicine, you have to start working from that the first day that you start your job. And it will be possible. It's harder, as I mentioned, for underrepresented minorities and for some diversity. But it's not impossible. And many people have done it. So this is the time to start making the change.

Dr. Greenstein: Leadership, by the way, I'll also just to add to what Ricardo said, doesn't only mean in the medical school, the hospital. Leadership also involves joining committees and the organizations that you're training in.

Let's say, again, I'm going to bring it back home to transplant surgery. The residents can, if they are going to go into transplant, join up earlier on in these societies, whether it's the transplant surgical society or the Medical Society of Transplantation.

And then once you join up, you get onto the committee. Because they want the youth of today to be involved, so to speak, on these committees. By doing that, you then also meet other people. And you advance your career that way. But you also can advance up in the committee chair ladder type of thing, where you go from a committee leader, to a counselor, to secretary, president, whatever.

And finally, it involves also, for the residents to be involved on the AMA side. I came late to be involved, but I'm luckily now involved on the active position section on the governing council and I'm doing things like that. So that's how you do it. It doesn't only mean in the university or medical school.

Transitioning to academics after private practice 

Dr. Strohbeen: Thank you. And Dr. Greenstein, you mentioned coming into this organized medicine space a little bit later maybe. What about starting an academic career after choosing, maybe, starting out in private practice or starting out in a different capacity. Is it possible to then transition into academics later on?

Dr. Greenstein: Anything is possible, but it's very, very difficult, bottomline. I mean, because if you're looking to do, as a true academician, research, teaching and clinical, you may find it very, very difficult to do the research because you're studying … you don't have any background in it. The clinical, that you're going to be strong in, and the education, I mean, I think even those who are not quote, "academic physicians," are educators because many programs have residency. And even if you're in private practice, you're expected to teach students in residency, whether it's in medicine or surgery.

But the research aspect would be very, very difficult. And I don't mean research about age reports or things like that. I'm talking about quality research, outcomes research, anything along that line. It can be very, very difficult. It's easy to go from an academic, by the way. It's easy to go from academics into non-academic than the reverse, at least in my mind.

Dr. Strohbeen: Dr. Correa, do you have anything to add to that?

Dr. Correa: I think that the first phrase of Dr. Greenstein was important, it's about nothing is impossible. That is more difficult. It will be. But for example, I can tell you the experience for the majority of the international medical graduates.

If they are coming, for example, from other countries and then they have to do what we call the waiver, the J-1 visa waiver, most likely that's going to be in a non-academic place. There's few of us that did achieve going to an academic place. But many will not go to an academic place.

And then, I always tell this to them. It's like, if you after you finish your waiver, you want to come back to academia during those two or three, or three to four years, continue doing academic things. After hours, in your weekends. I have some friends that what they did was that, they were not in the university hospital but they were some close to the university hospital. And they were going after they finished their clinic in that place. They were going to university hospital.

Everybody in the university hospital knew them. They were working in different research teams. And finally when they finished, they were able to jump to that and be part of the other team.

So at the end of the day, you put your own limitations. And I think that if this is what you want in whatever, it's the route that you take. If that is your final end goal, you can achieve it and then, definitely, will take more time. But it's possible. But definitely, is easier to switch from academic to non-academic than from non-academics to academic.

Protected time

Dr. Strohbeen: Thank you. A couple of questions coming in from folks watching. How do you get protected time off for advocacy and health care policy related activities such as those in the AMA? Haven't you found it challenging? Also, how do you balance that with all of the research and academics that you're doing as well? Dr. Greenstein, you're unmuted so I'll let you go first.

Dr. Greenstein: It's not an easy answer because I don't think you can get protected time that easily. Because as a resident, you're going to be expected to have clinical hours. And protected time is what you have after hours, that's protected.

Because they can't expect you to do things after hours. And therefore, it's protected. You can now, after hours, do whatever you want. And that means doing the research that you want to do.

But otherwise the only other way to get protected time is by asking to take time off, a year or two. And during that time period that's when you can do the hardcore research. Otherwise I think it's very, very difficult to get protected time. I don't have protected time.

Dr. Correa: Totally agree. It's another elephant in the room. We want and we promote people to like let's do advocacy as part of medicine. But how do you put that in your 24 hours? It's very, very difficult.

Sometimes some ways is that getting, for example, there is some research or some grants coming from fellowships. For example, the AMA has a fellowship on health justice. I'm right now involved in one fellowship that they pay in a year, some time to get you protected time. That is very minimal but they'll give you in climate change and health equity.

So things like that where you can find and apply, and see if you can get it. But the majority of the advocacy time, you can see physicians doing this, it's their own time.

Sometimes, I remember as a resident and as a fellow, and now sometimes when I attend to meetings, many times I take vacation. And I'm doing work because I'm advocating, I'm creating policies and all that. But definitely, finding protected time in that area is difficult.

And then when you mentioned doing advocacy and research, and I know that we want to do … if you are in this webinar, I think that the thing is that you want to do everything. You want to do advocacy. You want to do leadership. You want to do research. You want to do education. You want to be a clinician. So we want to do everything.

We have to realize that if you want to master in something, sometimes at the beginning of your career, you have to do only one thing. And for example, for those that want to do basic science research and want to be very researcher-focused, they will not have time for a lot of the things, the advocacy and all of that. It will be very difficult.

Because at the beginning of your career, you need that publication. You need the grant that you got, requires publication, requires data. And then whenever you have the data, then you need to apply for another grant. And that takes probably majority of your time.

So always, I think that the best recommendation is follow your passion and try always to find mentors, I think. And then chairs or chief of the divisions, that always you tell them what is that you want to do. If you want to do advocacy in this role that I'm right now, the first thing that I told before I started, I'm involved in this amount of organizations, a lot. And I tell them I want to continue doing this. And whenever I was looking for a job, I want to continue.

And when they say no, we cannot allow you to participate in this, I said, OK, I didn't accept a job until I find the place that I accept the job. But it's different at the point that I am right now. It's just because I was able to negotiate things.

At the beginning of your career, it's a little bit more difficult to negotiate. So try to continue that your passion is advocacy in your own time. But later on, you will find opportunities for getting some protected time. It's difficult.

Grant types

Dr. Strohbeen: We have another question. In research and obtaining grants, are there are certain grants that are more favorable than others? Are there some that are maybe more frowned upon coming from different sponsors or anything of that nature? Do either of you have anything to say on that?

Dr. Correa: So there is multiple ways of obtaining grants. And we do the federal ones and the private funding ones. So if you think about the federal ones, NIH is probably the main source of research grants.

And for training grants, for a person that is starting their career, K awards will be the most important one. And those K awards, as any other grant, it's difficult to get but you get it. And then they protect you for five years with a goal that you are still in training. It doesn't mean that you are a resident or fellow. It means that you are still in training, in that process of research. But the objective of that grant is that when you finish those years you become an independent researcher and you can apply for the other type of grants. And the other type of grants called R grants, R awards.

And there are R awards depending on your area; there are numbers R01 or R02 depending on the area. Those are for independent researchers, people that have demonstrated already that they have the capacity to produce research and they are independent.

Again, all these pipelines are decreasing and decreasing and decreasing whenever you get some of them. And also depends on the institution that you are. Because some people within our grant, they get a lot of projected time in one institution and non-protected, very small protected time in another institution. So that's different.

When we talk about the non-federal grants, some of them come from foundations. Some of them come from your specialty societies. Some of them come from pharma. It depends on what is behind the grant. But definitely, to be successful, at least you need to start with your K award, or VA, they call VA. VA has a, I forgot, the VAC grant.

If you are in a VA setting, the VA can have some kind of K award that is called the VAC grant. And then there are awards for the NIH's VA merit awards in the VA. So you get a VA merit award. That's like having an R01 grant and then that helps you in your career.

So sometimes, if you have the opportunity to work on a VA, those grants are a little bit easier to obtain than the NIH grants. So if you have some time in a VA, sometimes it's better to apply for a VA grant, that is a little bit easier to obtain.

But definitely, this pathway, it's intense. The first time that you submit a grant and you get rejected, it's good. Ask anybody how many people have to get their first grant approved. It's minimal. It's good. Rejected. OK, do it again. OK, rejected. Do it again. And then you see what the reviewer comments, improve your grant. And then until you obtain it, finally, you do it. And then continue.

And this is the process in academic medicine. Many rejections, one approved, yes, we live a little bit more. And then another five, six rejections, even for senior researchers, you ask them how many rejections they get, they still get rejection.

And even you think like, oh my god, this person has published a lot. They have all the publication in the world. And you ask them, they still get rejection for their grant. So it's continued. Falling down, standing up, continue. That's our world.

Dr. Strohbeen: Thank you. Dr. Greenstein, Dr. Correa told us about quite a wide array of different grants. Are there ones in particular, I know it was mentioned, pharmaceuticals, that are maybe less favorable in academics?

Dr. Greenstein: Well, I think that actually they’re not less favorable, but I think that you're going to see more and more of those grants because big pharma has the money. And more and more, I think, that's where you're going to see people getting. And I'm not talking about million dollar grants. That they're not going to give. But they will give grants for specific projects that they are tuned into because it may help them to bring something to market, or whether it's some molecule, or things like that.

One of the things that you have to recognize is that it is very difficult to get grant money. And you have to be prepared for that and not be discouraged because that's the way it works. I mean, the grant money is also based on the economy. I mean, the government says we don't have money. They cut back how much money they give to the NIH for the money that they're going to give out.

Pharma though, is not beholden to the government, they're beholden to the investors. So they want to develop things that will lead to profits for the investors. So they will push on things.

And if you're in a field where you have an idea from a research point of view that may help the pharma or any device company, they'll help you. And they will give you the money. But it's not going to be a million. It's not going to be something that you will be able to survive on for your salary. You're still going to have to be a clinician.

Dr. Correa: And just to add to that, this is the true. It's not going to be a thing that you will survive with that grant. But sometimes I feel out that with the grant the pharma will get their own thing. But if you can get your data to then create that grant for the NIH to put it. So it's a win-win. They get their data. They get whatever they want, but in your case you need to always think about, oh, I need to do this for myself or me, this $300,000, $500,000 thing. I will be able to do it. I will obtain data. We publish. And then you submit your big grant. And then you have already a data. Because if you don't get your institutional support to get your initial data, then the big grant will never come.

Conclusion

Dr. Strohbeen: Thank you. We're going to be wrapping up tonight here. I just wanted to give you both an opportunity for final remarks, words of wisdom. Dr. Greenstein, anything you'd like to say?

Dr. Greenstein: I think I'd like to say that academic advancement is a very rewarding career. And that you have to go into it though with your eyes open. Realizing that we are in a struggle right now because we are, more and more, even as academic physicians being pushed to do more on the clinical, pure clinical side as medicine becomes more, shall we say, corporate driven. And that's including institutions.

So you have to recognize that and somehow still produce the research that you want to do. Because there's an excitement. And when you do the research and when you get the publication, and that leads to the next publication, and then people come up to you and say, wow, I remember reading that paper that you wrote on this and that and that. And you feel good about what you've done in medicine because you know you've advanced the medical field and the care of the patient.

Dr. Strohbeen: Dr. Correa?

Dr. Correa: Yes, to add a little bit. It's understanding that when you choose academic medicine as a career, it will not be easy. As I mentioned multiple times you fell down, but multiple times you have to stand up again and continue.

I think that before I started this career, nobody told me that I would fall down. I always thought that it was beautiful, and that I would submit the first grant. I will get it. And then I will continue. I will get protected time and all of that. And that's not true.

Many of the things that I have done is by myself, finding others, writing, OK, get rejection again, writing again, negotiating outside, so things like that. So be very creative. That's probably the final answer. Be very creative because that's the way that if your goal is there, everything will happen. But you need to be very creative.

And if you don't want to have this life that you get rejections, then academic medicine is not the pathway because you will get a lot of rejections, but at the end of the day, something that Dr. Greenstein mentioned is, the joy that you get when you do get final data grant, or you get final data award, or you get the final that thing, it's impressive.

Dr. Strohbeen: Thank you. I want to thank you both for being a part of our forum tonight. And I want to thank everyone at home who submitted questions and joined us this evening. If we did not get to your questions, please feel free to email AMA. There should be contact information in the email that you received.

The AMA is committed to providing medical students, residents and fellows, as well as international medical graduates a best in class opportunity to build and showcase research and engage with the AMA beyond traditional policy and advocacy opportunities.

Please be sure to visit the semi-finals hall to cast your votes for the best research, which is an AMA member exclusive opportunity. The top five voted participants will advance to the finals, which will be held on December 7 for a chance to win a $10,000 grand prize, sponsored by Laurel Road. I want to thank everyone again tonight and have a good night.

Dr. Correa: Good night.

Dr. Greenstein: Good night, thank you.


Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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