Steps to your first career development award

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher podcast. I am your host, Toyosi Onwuemene, and it is such a pleasure to be talking with you today. Today I am going to be talking to you about practical advice for getting your first career development award. And I'm actually going to give you five steps, five things you need to do to get your career development award.

1:23 And I need to go back to when I started thinking about research. So prior to undergraduate, I really didn't think about research, but in undergrad, I did think about research. And one of the reasons I thought about research was because they told me that if I did research, it would increase my chances of getting into medical school. And so I said, well, if doing research is going to increase my chances of getting into medical school, then that's exactly what I should do. I should do research. And so I took time to do research, not because I loved research or not because I had any particular research question I wanted to answer, but because research was a means to an end. It was a transaction for me.

2:04 If I could exchange research for admission to medical school, well, it perfectly made sense. Before that reason, it was a transaction. So it perfectly made sense before that reason, it didn't matter what research project I did. All that mattered was that it was mildly interesting and that I could finish the work. Well, I made it. I went into medical school and then in medical school, I was told that doing research helps you get into residency. And I was fortunate enough to go to a medical school that actually had research baked into its curriculum. So at my institution, we took a third year to do a research project and you didn't actually have to do research. You could get a degree, but it just needed to be a scholarly project.

2:46 But for the most part, most of us did research. And you know, it really, again, it was a means to an end. You had to do the research project to graduate and it also got you into fellowship. So again, I was very, very much thinking about research as a transaction, as a means to an end. Okay. So again, I succeeded in research as a medical student, moved on to residency, the same themes. Hey, if you do research, you get into a good fellowship. And so I did a little bit of research here and there and wow, I got into a great fellowship program. Wonderful. And so it wasn't until I got to fellowship where it was like, wait a minute, I actually really do like this research thing and this is what I want to do. And so I did do a project here or there.

3:29 I was able to get published during my fellowship and I also did apply for one or two grants. I didn't get them. And I also did get a master's in clinical investigation. But when it came to applying for faculty jobs, all of a sudden people were asking, well, so you want protected time for research, but you have no funding. You want protected time for research. You don't have much by way of publications. And so all of a sudden I got to my first faculty job interviewing for jobs and people were telling me I was disqualified from research. They're like, you don't have the minimum requirements.

4:10 And in fact, many of the places I interviewed at were like, you know what, research happens, but it happens at night and on weekends. And if that's what you want to do, that's great. But take the clinical job and do the research on your own time. And you know, it just didn't sound right to me. And I finally got to a program where they were like, you know what, we really support research here. Many of our clinicians are funded investigators and you can succeed here, but guess what, you're not qualified. So how about you take this clinical job and we give you 20% protected research time. And you know what, whenever you can make it, whenever you can get the funding, you can become a researcher. And at the time I was naive enough to believe that story and I took the job.

4:52 And I said, I'm so glad to be in an environment where people support research and I'm so glad that I'm going to be supported to expand my 20% research time into a funded research program. I am super excited about this. But what I didn't understand was that you don't do 10 years of clinical training and become prepared to lead a research program without major transformation. And one of the biggest and most important containers for that transformation is the Career Development Award.

5:34 And so the Career Development Award is one of the most important containers that allows a clinician to transform from the clinician who's had no research training to a researcher who leads a meaningful research program. That's why a Career Development Award is really important. And if you are going to get a Career Development Award, there are five steps that you need and they're really important steps. You don't want to skip any of them. And the very first step that I want to invite you to take is to clarify your destination.

6:15 Yeah, you got to know where you're going. Why do you need to know where you're going? Because if you don't know what your final destination is, then the reality is that you don't know how to get there. It's really important. And here's the challenge for us as clinicians who are trying to become researchers, who are becoming clinician investigators or clinician researchers. We have spent our entire career in becoming a physician on autopilot. We have spent our lives on autopilot. And it doesn't feel that way because you've been very active and engaged in your career.

6:55 But think about it, medical school for most of us, for some maybe a little bit longer than four years, but for most of us was four years. But there was a defined endpoint. These are the classes you take to get you past the basic science phase, basic pathophysiology, normal body, disease body, all the learnings you do to be able to move on to the wards. Great. When you get to the wards, these are the milestones that you need to achieve to be able to pass and become and get your certificate as an MD. Right? There's a very, very defined set of steps. You can kind of paint the picture a little bit differently, maybe take a few elective courses. But at the end of the day, it kind of is an assembly line and you're passing through.

7:37 And then you get to your residency program and your residency program is kind of the same. There is an assembly line. It's like, hey, these are the competencies you need between now and the third year of your residency graduation. Go for it. You're going through rotations that are pre-assigned for you. So to be honest, you're not making very many decisions. And then for those of you who do go on to fellowship, you're in the same boat. It's like, here's 12 months of your clinical rotations and then the six months left if you're doing a three year program, which is split 18-18 as far as your research and your clinical. But there is a very prescribed set of things that need to happen for you to graduate.

8:17 There is not much you can really do around that. Yeah, you can extend it. You can do a little bit more, but it's very, very defined. But the challenge in growing to lead your research program is that there is not a defined endpoint. And you look around, there are so many different people doing so many different things. And so there's not necessarily a defined endpoint. So you have to choose what is your destination? What kind of research program are you going to lead? What is the problem that matters to you that you want to solve? But you don't have the training. Your experience has been a cookie cutter experience, so to speak. And so for many of us, we look around and we're like, well, there is my mentor, the only one in the program who has three R1s.

9:01 Well, he's doing prostate cancer research. That's my destination. And then you ask your mentor, and he's doing prostate cancer research. So of course, he's like, well, the destination, the most sensible destination is prostate cancer research. You should totally come here. And everybody's funding prostate cancer research. And so you're like, sure, that's my destination. But because you haven't done the work of peeling off the layers and layers and layers of your abusive clinical training, you don't really know that that's not the destination you want. Let me take a step back and talk about this clinical training that you've had. That is an abusive training. And it's just the way it is.

9:42 It's just the way it is. I'm not saying anything bad about our clinical training, but think about it. You go through your clinical training and you suppress the urge to sleep when you're on call. Many of you suppress the urge to go to the bathroom. You're like, I'm doing this case. I'm not going to the bathroom until this case is done. For many of us, we suppress the urge to eat. You're like, I just don't have time right now to go get a meal. I've got to finish this work. And so we spend our entire careers learning to suppress our feelings, our emotions, our urges because it's part of our training. And so by the time you get to the place where you're like, I now want to lead a research program. What is that research program's destination?

10:24 You have not been trained to think for yourself or to be in touch with your feelings and your emotions. You don't know where you want to go because you have not practiced figuring out where you want to go. What you have practiced is taking whatever senior person is telling you and going with it. And you've done really well. Congratulations. The better your program was, the better you are at being out of touch with your own feelings and where you want to go. And the reason you really, really, really, really need to clarify your destination is because if you are on autopilot pursuing a destination of the most important, most prestigious Nobel laureate at your institution, you will get there because you guys are good at getting to places.

11:10 But you're going to get there and 10, 15 years from now, the layers of your abusive experience in medicine start to peel off. And then you start to discover that, wow, this is not where I wanted to go. Why am I here? And that's why you find people who are highly decorated. They've got three R01s, three U54s. You know, whatever the project is, name it. They've had it. They're on the short list at NIH. They are so successful, but they are so miserable because that's not where they wanted to be all along. And I hear people saying things like, well, you know, I did that and I'm done because they were pursuing a destination that was not theirs.

11:52 So if you're going to be clear about what you're doing and getting your career development award, you really want to know your destination. You want to clarify it. You got to do the work to clarify it. And no, it's not just talking to the mentor who only has one destination, the one that he or she is at right now. But it's really going around and talking to other people, but also most importantly, doing the work of getting back in touch with why you're here, what patient experiences have meant the most to you, what problems you really want to solve. Because if you're going to write a successful career development award, you're going to ask yourself, what is the problem I want to solve over the course of my career?

12:34 And no, you're not going to get to that answer in the first year. It'll take you time to get there, but you got to set the destination. And for many of you, they're like, I could do prostate cancer. I could do breast. I could do immunotherapy. There are so many options, but you got to set one destination and start pursuing that one first. But it's got to be a destination you care about. The reason it needs to be a destination you care about is because there was so much rejection in this space. It is very hard. And you cannot sustain rejection. You cannot do hard work if it is not something you really care about. And so maybe another way to put this, clarify your destination piece is to clarify your why.

13:15 Find your why. Why are you here in the space? Why do you want to lead a research program? What does that get you? You got to clarify your destination. And that really is your first step. The second step is to study the gap. There is a gap between where you are right now at the end of your clinical training and where you're going as a leader of a prominent and important research program. There is a gap. And you got to study that gap. The reason you want to study that gap is that the goal of a career development award is to close the gap between where you are right now and where you're going.

13:57 But if you don't understand the gap, you cannot explain to anybody how the gap can be closed. You cannot even figure it out for yourself. That's why you got to study the gap. And what do you mean study the gap? Well let's think about it. If you're a clinician and you've come through and you've done maybe similar to what I did, you did a little bit of research here, a little bit of research there, maybe you were fortunate to have two full years of your fellowship to do research. You had two years uninterrupted. Good for you. When you tally up all the time that you have had to do research, goodness, you'd be doing really well if you have four years in there.

14:39 You'd be doing really well. Most of us can say, okay, maybe it's three. For many of us, it's really one or two. One or two years of actually doing the research. When you really drill down on the kind of research you're doing, you really, really, really pay attention. You're like, what kind of research are you doing? Were you leading research or were you just participating in research? If we think about people who are lab technicians or research assistants, oh, they're participating in research, okay, but are they leading research? Because where you're going is to become a research leader. So you've been participating for maybe three or four years, but you've not been leading for three or four years. Now let's go to our research colleagues, the PhDs.

15:21 Okay, you think about a PhD program. And a PhD program, first of all, starts with a basic program of study in a specific area of expertise. So maybe it's cellular biology or maybe it's microbiology. Maybe it's genetics, but there's a very, very defined period of we're taking classes, we're taking exams, and you end that period with qualifiers. Like, are you sufficiently an expert in this field? And then once you take your qualifiers, you start going around to look at different labs. And so you're kind of like rotating through different mentors to see, is this the lab I want to be in? Or is this the research program I want as the vehicle for my PhD?

16:02 And then you finally choose a lab, you choose a research program, and that's the research program as a PhD that you're in for three to four years of the remaining part of your career. And so by the time you are at the point where you are getting your PhD, where you're like, congratulations, doctor, you are a PhD, you've done at least five to six years of research focused training. And then when you had summers, you didn't even take those summers off. You did graduate assistantships so that you were really focused on research for a solid five to six years of your career. And then at the end of your PhD, you don't just go get a faculty position, you go do a postdoc and you're like, well, now I'm going to go focus on this very, very, very, very narrow area and get these methodologies.

16:49 And you do a postdoc for about maybe two, three years. And some people go and get a second postdoc and then they do the postdoc for about another two to three years. And so you do all your postdocs, at least one, but maybe two or three. And now you're like, I am now ready to apply for a career development award. Wow. Do you see the mismatch? So as an MD, you've done 10 years of clinical training, barely any research and certainly not as a research leader. What I mean about the research leadership training, okay, let's go back to the PhD example. So when you start off in somebody's lab, you're like the junior graduate student. You're just like at the very beginning. The most that your PhD mentor will let you do is just help other people on their project.

17:32 You are not leading a project when you first start in the lab. But over the course of your time in the lab, you become the more senior PhD person. You start to lead your own projects and other graduate students come and they help you. You are already learning to lead research because leading research is not about doing a project all by yourself. Leading research is about leading others to help you do the research while you are directing what experiments, what questions need to be answered to answer a research question. And so these PhDs do six years of their PhD degree and then they do the postdocs, the graduate assistantships before their graduation, all the things that they do. And then they're still like, I need a career development award.

18:14 And you as an MD have barely done any research leadership and you're like, I also need a career development award. So I need to tell you that you are already 10 to 13 years behind your PhD colleagues in terms of research training. And so when someone tells you this career development award is going to be for five years and you're like, what to do? Five years are projected time. It's like, no, no, no, no, no. Five years in which you need to fit in 13 years of experience. And then you kind of calm down and you're like, whoa, that's not enough. Exactly. You need to study the gap and understand the gap. The reason you study the gap and understand it is because you need to understand the five years is not a big enough container. Five years at 75%.

18:56 So when we break it down, you're barely getting three years of research training out of this career development award. You need to have crystal clarity on how little time you actually have to come out on the other side of that as a leader of a research program. Because the moment you understand that you don't have much time, you can get very serious about what that three years, five years at 75% protected time can do for you. You got to study the gap and understand the gap. So that when you get to a place where people are like, hey, come take this job and you have 20% protected time, you're like, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, 20% protected time is not going to be enough because here's what they do.

19:37 They give you this package. They say you have three years to get yourself funded. Go three years and you have three clinics and no nursing support. How are you going to do that? That's why you got to study the gap because you need to understand exactly what resources you need. And at this point, number three, you got to determine your needed resources. You need resources because if you are going to take 13 years of research study, squish it into five years at 75% protected time, wow, what are you going to need to get there? Let's think about the resources you need. Number one, you need mentoring. But what does that mean? Many of us are looking for the guru, Nobel laureate mentor, who's like going to save us, going to take us from neophyte in research to research leader.

20:26 And I want to say yay and thank you for all our mentors who are so awesome, have seven R01s. We're going to take us to Nirvana. But what do you exactly need from this mentor? And do you have all the mentoring you need in this one person? Well, what areas do you need mentoring in? Well, I told you, you are a research neophyte. You don't have experience even in leading the research. Okay, so you need experience in the research leadership. But here's the other piece you don't have. You don't have training in actually writing about the research, promoting your research. You don't have training in writing grant proposals. You don't have training in the process of writing.

21:06 But what about the process of writing? When do you do the writing? What time of the day do you do the writing? How do you set up structures to protect your writing time? You need mentoring in doing that. And then you need mentoring to actually go through the process of writing something and then publishing it. Or you need mentoring around the whole process of publication, which is crazy. It takes you five months to submit a great paper. You need mentoring around that. So here we are, we're choosing one mentor and we feel like we're done and you're like, well, does this mentor meet all your needs? And studying the gap helps you understand all the resources you need. So that's mentoring. What about the other resources? Well, you need financial resources. Because here you are big time ND.

21:48 One of the things that I think people struggle with is like, you mean I have to pay for myself? Whatever you choose as an MD, you will always be paying for yourself. Nobody tells you exactly how much you bring in. If you have a week of clinic and you have three full days of clinic, whoa, you're bringing in revenue that more than pays for your salary. And the moment you say, well, I want to do this research thing where I'm not going to be bringing in the kind of revenue that three days of clinic brings in, they're like, whoa, whoa, whoa, whoa, whoa, who's paying for that? And all of a sudden, who's paying for your salary becomes more front and center. But you're always paying your salary. As long as you're a clinician seeing patients, you are always paying your salary, always. Because if you didn't, you would be out of a job.

22:29 And so the moment we say we want to do research, people are like, wait, wait, wait, wait, wait, wait, who's going to fund that? Because all of a sudden it's like, whoa, whoa, whoa, the clinical revenue is not coming in. Where's the money coming from? You need to know how much is needed to support your salary for you to do this thing that's called a career development award that doesn't bring in clinical revenue. And that's why hospital systems are always telling you how they're losing money over research. That's one of the reasons. Because MDs who should be bringing in money in the clinical space are now going to do research. And so you need to know what resources you need financially. And then on the financial piece, the side that's really easy is salary. You know, someone's like, well, you want to do research, we can no longer pay you the doctor salary you want. You need to know what your financial needs are.

23:13 And then you also need to know who your people needs are. So we've talked about the mentoring, but what kind of support do you need to be successful in this container called a career development award that you're only going to be able to squeeze five years, less than five years worth into? You got to understand that. The reason you determine the resources you need is because you're going to need to negotiate. Oh my goodness. When you think about negotiation, many people are like, yeah, I negotiate my salary. Good for you. But I have to tell you that if all you're negotiating is your salary, you're not negotiating very well. Because I just told you that you need a cadre, not one, not two, you need a cadre of mentors to help you in this process.

23:59 I've told you that you need people resources. So I didn't mention, do you need to buy a statistician? Do you need a graduate research assistant to help you as a new faculty member? What are the things you need? You got to negotiate that. And I told you about how much little time you have in these five years to do your research. And if someone says, yes, I'm giving you 75% protected time and you'll be in clinic for three half days a week on Monday, Tuesday, Wednesday. When you understand, you're not going to accept that. Like, yeah, I have protected time. I only have clinic three half days a week. And it's like, wait a minute, it's Monday, Tuesday, Wednesday. And everybody knows that a half day of clinic is never really a half day of clinic.

24:40 And so when you understand that and someone gives you three half days of clinic, you'll say, wait, wait, wait, how about I take a full day and a half? Because a full day of clinic is not the same as two half days of clinic on different days of the week. It is not the same. There is more time investment in two half days of clinic than there is in one full day of clinic. But if you don't understand the gap, you can't negotiate it. You got to negotiate. And here's the reason you need to negotiate. Because when you go to write this career development award, if you don't already have the protected time, you can't get the grant. Your institution needs to demonstrate that they are sufficiently invested in you as a researcher before you can convince anybody else to give you money to do a career development award.

25:22 And so you better have that. You better be thinking about negotiating it when you go to your faculty job. So don't be excited. You're like, oh my gosh, they give me $400,000. I'm going to be so, so rich. It's like, really? And there's no MA in your clinic? And there's no scheduler to help you schedule patients? How are you going to do that? Can't succeed in research at the same time. Understand the resources and then you got to negotiate for them. You got to negotiate. When you finally negotiate the resources you need, you are now ready to write the grant. You are. Because here's why you need to understand your destination.

26:03 When you're writing the grant, you're telling people here, this is where I'm going. And then you're going to tell people, hey, this is the gap. This is the gap that these five years are going to fill. These are the people. The next step is the resources. These are the people who are going to help me get there. They are five mentors. This is exactly what they do for me. And you know, I want to pause and just talk about this mentoring piece. You know, sometimes you look around and you're like, well, of course I chose prostate cancer, even though I was on my way to breast cancer, because the mentor who's available has funding. The prostate cancer mentor is funded. The breast cancer mentor is not. That's okay. Defining your destination allows you to say, what is it this person is giving me that I can take for myself?

26:46 So you're not just going with the flow, doing all the projects that the mentor throws at you. Like do this one, do this. You're like, no, no, no, no, no. These are the tools I need to lead my research program. So this is the mentoring I need to lead my research program, taking these tools from you. Defining your destination and understanding what you need allows you to do that. Allows you not to get stuck and labeled as a prostate cancer person when you really want to be a breast cancer person. It's really important. And now you're able to write the grant. Now you're able to explain the story of how you ended up in a prostate cancer lab when you were really wanting to do breast cancer research. You're able to, you're like, this is the mentor who had XYZ resources. And I went after that and look at how I'm going to now take these resources and build my breast cancer research program.

27:33 You get to do that because you've already done the earlier work. So now you can write the grant because you know your destination. You understand the gap. You know the resources you need and you can negotiate. You've negotiated the resources you need and now you're negotiating how this career development grant further protects your time to do that. Those are the five things that are really, really, really, really important in getting your first career development award. Because if you cannot be convincing, you don't get the award. But you're not just selling a story. You're not just trying to get money. You have a plan for yourself.

28:16 And so really writing a career development award is about a mindset shift. It's about stopping this autopilot life you've been on, which has been great to get you to the end of your training program, but doesn't lead you to succeed as a faculty member. And I have to tell you that this is the kind of mindset work that you need to do alongside a coach. I favor coaching. Coaching is really important because what you really need is to peel off all the layers of abusive training. You literally need to sit down and do that work of peeling back all the layers of the autopilot, the things you had to do just to get by so that you could figure out what you really want to do, so you can figure out what the resources are that you really need.

29:06 Because if you follow the crowd, if you just do what everybody else is doing, you negotiated a great salary, but oh my gosh, are you even able to do any research with the way you've negotiated everything? Do you even have any resources to allow you to lead research, not just to do it in a corner? And so writing and getting your first grade award is really about shifting your mindset from how you started in your clinical training to really thinking about what do I need to become the leader of a research program? One of the ways you do this is by coaching. And I just want to stop and say, I really recommend you get a coach to help you in this transition.

29:50 It's a really important transition. And if you don't know somebody who can help you, we should talk and we should work together. You should sign up at our website so that we can have a consulting call and we can figure out what kind of resources you need to support you on this journey and whether I can help you get there. Maybe you don't need a coach, but you know somebody else who does. Maybe you're a mentor and you're like, oh my gosh, yes, I can't mentor this person in all of these areas. It's important because your mentee needs to be able to know what they need so they can go get it. They're really good at going and getting stuff. And so if you don't need the coaching, maybe a mentee does, maybe a friend does, maybe a colleague does, let's connect so that people can get the help they need in becoming the clinician researchers or the physician scientists that they really want to be.

30:46 Because you know how awesome it would be? You know how awesome it would be to look back on your career and feel fulfilled, feeling like you actually enjoyed the journey because you weren't living somebody else's life. You weren't living somebody else's dream. And that even though you got so many rejections along the path, you could see the progress you were making because you understood your why and you could see that you were always failing forward, always prototyping towards your success as a clinician researcher. How awesome would it be? To look back on a career and say, I really enjoyed this. This was so awesome. And that career is really within reach as long as you have the right mindset about what a career development award can do for you and you are actually prepared to make the case so that you can get the award.

31:37 And you're actually prepared to make the case so that you can get the award. I look forward to that. Now if you are looking for more resources, definitely sign up for our weekly newsletter at our website, docsleadresearch.com. It's packed with so many important tips to help you make the mindset shift to become the researcher that you really want to be, that you are destined to be, that you really, really want to be. But you only get there if you make it happen. And you get the right resources that you need to make it happen. So thank you for listening to me today.

32:18 It's been such a pleasure to talk with you. Reach out to me. Have a great day. Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it. As you share this episode, you become part of our mission to help launch a new generation of clinician researchers who make transformative discoveries that change the way we do healthcare.