Ten years ago, as a new graduate, I sought an academic job that would protect my time for research. I was surprised to find that I was “unqualified”: I had no research funding and few published manuscripts. With these deficits, no institution was willing to give me a research job. Eventually, I was offered a clinical job that would protect my time at 20 percent. With this time, I was free to build a research program without resources, close my research skills deficit without training, and crank out manuscripts and grants without support. Eventually, I could buy down my clinical time and have the support I wanted. Naively grateful for any protected time, I took the job but failed to recognize the trap: After ten years of exclusive clinical training, 20 percent time is insufficient for the clinician-to-scientist transition. In fact, the transition is impossible without major transformation.
Every year, physicians starting new academic jobs are led to believe that they can build research careers on their own time – at nights and on weekends. Unfortunately, many physicians swallow the bait. They reassure themselves that they will make it work in due time. As soon as they find the right mentor, everything will fall into place. And so, they begin the hamster wheel of academic life, struggling to build a research career while simultaneously overwhelmed by clinical responsibilities. They burn the proverbial midnight oil to build a research career while lacking the resources needed to succeed. Eventually, they give up the dream and settle, and their unfulfillment leads to burnout. The rest of the world wonders, “Where are all the clinician-scientists? Where is the promise of better health care? Where are the research breakthroughs?” Unfortunately, like an unmined field of diamonds, the research breakthroughs lay buried in the heart of the academic physician who has settled into a cycle of non-fulfillment and burnout. But it was not always this way.
Throughout history, physicians have occupied the leading edge of key health discoveries: Alexander Fleming discovered the antibiotic properties of penicillin. Patricia Bath invented the Laserphaco Probe® for cataract surgery. Françoise Barré-Sinoussi co-discovered HIV as the cause of AIDS. These physicians had the time and space needed for research discoveries. And the same is possible for all physicians: Physicians have valuable insights into existing knowledge gaps; they ask research questions that address real-world challenges; and they bridge disciplinary gaps that foster productive collaborations. By virtue of their training and experience, physicians may be the best equipped to lead research that is transformative. Unfortunately, many early career physicians are held back from realizing their full research potential. Only a select few who had early access to mentoring are selected for institutional investment. The rest of us are told that we can only succeed as clinicians. Yet, clinicians can do anything with the right training.
Dedicated research training for most physicians is minimal. Compared to our PhD or MD/PhD colleagues, MDs receive little to no research training. Often, our research involvement in medical school, residency, or fellowship prepares us to be participants but not leaders. Physicians who will lead breakthrough research programs need specialized training. We need not only training in research methodology but also training in soft research skills. We need skills to build structures to support consistent scholarly writing; move manuscripts through academic publishing; find optimal funding opportunities; write successful grant proposals; lead research teams; nurture collaborations; and negotiate resources. In our clinical training, these skills are not taught. Therefore, to no one’s surprise, most MDs are unprepared to succeed in research. The hope is that these skills can be taught by mentors. However, would-be mentors, many of whom are still building their own research programs, find that mentoring tasks are unsupported. Furthermore, mentors rarely have the bandwidth to give their mentees all they need. For this reason, many aspiring physician-scientists are left to sink or swim. But we can do better.
For early career physicians, the burden of closing the research skills gap is often borne by academic institutions. However, academic institutions, which have their own financial pressures, are loath to make an investment in an “unqualified” physician. So, when faced with the choice of protecting a physician’s time vs. encouraging them to take on the maximal clinical load, the economics favor “unprotected” time spent seeing patients. So, for an unproven physician, most institutions decline the investment. Or they may make the investment but set a limit of three years. As if three years were enough to both learn the needed research skills and make the transition to independence. Therefore, if physicians are going to transition from clinicians to research leaders, we must be willing to bet on ourselves.
To bet on ourselves, we need to make key mindset shifts: We are responsible for our own career success. We own and lead our career direction. No one, and certainly no institution, can shape our careers for us. Therefore, if others do not invest in us, we invest in ourselves. We deserve careers of our own design. We deserve to work hard doing jobs we love. When we contribute meaningfully, we feel fulfilled. When we answer questions that solve problems, we gain a sense of purpose. When we fulfill our career vision, we win. Therefore, if the win is a fulfilling and successful career, then we should be prepared to pay the price. To achieve personal career fulfillment, we should be prepared to invest our time, money, and energy.
Let’s not wait to create the careers we want. Let’s not wait to end the cycle of burnout and unfulfillment. Let’s start today to make the investments needed to create our dream careers. The greatest gift that may come from designing our dream research careers is not just the research but rather the person we become in the process.
Toyosi Onwuemene is a hematologist.