Article In Brief
Physician scientists share advice about how to start such a career in the neurology field and the benefits it offers.
Spending 80 percent of his time in the laboratory and the rest in the clinic allows Puneet Opal, MD, PhD, director of the Ataxia Clinic at Northwestern Memorial Hospital in Chicago, to stay focused on a single neurodegenerative condition.
“I often see rare patients with genetic forms of ataxia, for which we really need treatments, so that requires research,” said Dr. Opal, a professor in the Ken and Ruth Davee department of neurology and department of cell and molecular biology at Northwestern University Feinberg School of Medicine. “It's quite rewarding to see patients in the clinic, but I also get to work with mouse models and stem cells from human patients and do translational work because we are trying to find a biomarker.”
As director of the department's physician-scientist training program, Dr. Opal also serves as a mentor to neurologists who seek to have a career similar to his own. He and other physician scientists spoke with Neurology Today to share their advice about how to get started as a physician scientist in neurology.
Is a PhD Required?
Many neurologists have productive research careers without a PhD, and Roger Albin, MD, the Anne B. Young Collegiate Professor of Neurology and associate director for research at the VA Ann Arbor Health System Geriatrics Research, Education, and Clinical Center, is one of them.
Dr. Albin, whose primary research interest is the clinical manifestations of basal ganglia disorders, also is director of the University of Michigan Udall Center of Excellence in Parkinson's disease and the University of Michigan clinical neuroscientist training program, a National Institute of Neurological Disorders and Stroke (NINDS)-sponsored research education grant program for neurology, neurosurgery, and neuropathology residents and fellows.
While he has had a successful career without a PhD, he thinks having one offers some advantages.
“I would not say a PhD is indispensable, but if your interest is in doing bench research, I think it's really important,” Dr. Albin said. “It's not just the concentrated research experience that you have during a PhD program, but also because of the tremendous advances in methods in modern neuroscience. To do good bench research these days, there are a lot of technical skills that you should have, and the PhD [training] period is the time when you can acquire those skills.”
When Logan D. Schneider, MD, participated in the Howard Hughes Medical Institute-National Institutes of Health Medical Research Scholars program during medical school, he started mapping out his career trajectory.
His long-term goal is to refine the understanding of normal and dysfunctional sleep, and he knew he would do postdoctoral training to launch his career. He agrees that pursuing a PhD provides time to establish a publication record, acquire important technical skills, and learn about the world of scientific research, but that is not the only path to do so.
“The three years of a postdoc potentially counts as equivalent to a PhD,” said Dr. Schneider, clinical assistant professor (affiliated) of sleep medicine at the Stanford Sleep Center and a consulting neurologist at the Stanford/VA Alzheimer's Research Center.
Ana G. Cristancho, MD, PhD, a pediatric neurologist with the division of neurology at Children's Hospital of Philadelphia, was a senior in high school when she decided to pursue an MD/PhD. After obtaining her bachelor's degree, she enrolled in the University of Pennsylvania School of Medicine's MD/PhD program.
The first two years of an MD/PhD program are devoted to preclinical classes and, in Penn's case, clerkships in which medical students begin seeing patients in the hospital. After that, students break from medical studies to complete a PhD, which typically takes three to five years. Then it's back to medical school for two years before picking a residency.
While her goal of being a clinician scientist was always clear, Dr. Cristancho did not focus on neuroscience—her PhD is in cellular and molecular biology—until she completed her research training.
“My first rotation back in med school was in child neurology, and I fully fell in love with it,” she said, “and that's when I decided I was going to become a child neurologist.”
That required a bit of rework. “I was still committed to being a physician-scientist and doing basic science research in this field, but I had to start from scratch to learn some things that weren't part of my education because I had never focused on neuroscience,” she said.
She stayed at Children's Hospital of Philadelphia for her residency, followed by a fellowship in fetal neurology and research. Today, her clinical practice is in fetal and neonatal neurology, and she studies prenatal brain injury in the lab using animal models to understand transcriptional mechanisms.
Dr. Cristancho thinks the time required to pursue a PhD is well-spent for individuals who want both clinical and research careers.
“The nice thing about the PhD is that it's the only time that is bookmarked in your life where you are only going to be a scientist, so you have protected time to hone those critical skills,” she said. “If you come to research later or decide to skip the PhD, you still have to invest the time in learning how to ask the science questions, which are really different from what you learn in med school. So I don't think (skipping the PhD) saves you time in eventually becoming an R01-funded scientist.”
How to Get Funding
Clinician scientists must be excellent grant writers to secure research funding. Even for those who are, the declines in the National Institutes of Health (NIH) research budget can present a major challenge, Dr. Opal said.
“The success rate for NIH grant applications is becoming tougher, so that is a structural pressure that makes it very difficult to maintain a research career,” he said.
Dr. Albin said that like the program he directs at the University of Michigan, the Northwestern program—and several others around the country—receive the R25 NIH National Institute NINDS grant for research education programs for residents. These programs accept trainees who have a PhD or who have otherwise obtained significant research experience.
“The goal of the program is to position the trainee to compete for an NIH career development award,” Dr. Albin said.
The NINDS funding supports trainees to receive mentored research training and protected research time during and after their residency, preparing them to submit a junior investigator grant application to help launch their careers.
Dr. Schneider said the funding level of grants that support young researchers—his post-doc was funded by a NIH T32 grant—may not be enough to live on.
“The career development awards and (NIH-supported) post-docs do not keep up with the cost of living,” he said. “I had to actually supplement my research time with a lot of clinical time in order to support my family out here in California.”
After seeing colleagues a few steps ahead of him in their training receive career development awards but without adequate institutional support, he decided to pursue a career in industry. He is the clinical lead for sleep health at Alphabet, the parent of Google, where he uses machine learning to analyze the vast amount of longitudinal sleep and biometric data collected via wearable devices.
“It's a hard money position instead of a soft money position that depends upon the next grant,” he said. “So that's ultimately why I chose that path from a research standpoint.”
Finding the Right Mentors
Lenora Higginbotham, MD, was first exposed to research at Emory School of Medicine, where the medical school curriculum provides six months dedicated to research. She was interested in neurology, so she searched for Emory's leading clinician scientists in neurology and found Allan Levey, MD, PhD, who is internationally recognized for his work in Alzheimer's disease and related disorders.
“He actually ended up being one of my mentors for that six-month period, and I did a lot of proteomic work in Alzheimer's dementia,” she said.
That turned out to be a pivotal experience. Today, Dr. Higginbotham, an assistant professor in the department of neurology at Emory, works in that same lab, looking for novel protein biomarkers that can aid in diagnosis and treatment of Lewy body dementia. In the clinic, she sees patients with parkinsonism.
Her career trajectory has not been a straight line, however. Dr. Higginbotham moved to another program for a research-intensive residency and returned to Emory for a two-year fellowship in movement disorders. The research she did during those years is unrelated to the current focus of her career. The throughline is her Emory mentors.
“The mentors I had during that short period were great,” she said. “Once I finished training and fellowship, I circled back to them because by then I was in a position to bring something a little bit more unique to the lab and actually head up research into a disease that nobody in our lab had been working on until then.”
Over the years, Dr. Higginbotham has learned that the best mentors are active champions for a mentee's career. Not all mentors fit that description, in her experience, but having true champions is essential support for launching a career as a clinician-scientist.
“They find opportunities for you to, say, give a talk or join a project that might be helpful to your career,” she said. “They are accessible and helpful but also give you some independence to learn things on your own.”
“Mentorship really is what got me to where I am,” Dr. Schneider said. “It's not only because mentors can have funding (that supports trainees) but also because they know the people who can be important for your career.”
He points to a mentor from Stanford whose guidance has been invaluable. “Having a mentor that mentors rather than a mentor that needs to be forced to mentor is truly essential,” he said. “She had a vision and a plan for me and asked, ‘Is that the plan that you have for yourself? And if not, how do we make those align, and how do I advocate for that?’”
While mentors typically are assigned to trainees at various points in their training, Dr. Schneider followed early advice he received: Clinician-scientists need to proactively create a suite of mentors that play different roles in their career development.
“You need to have an aspirational mentor, the ‘I want my career to look like this’ person,” he said. “And you need that mentor that gets you connected—the ‘oh look, we have all these resources. I know exactly where you need to be, and I know how to get you there’ person.”
He uses the term “junior mentors” to describe individuals just ahead on the career track who can share advice and lessons learned based on their experience. “And then you have peer mentors that you should be benchmarking yourself against,” Dr. Schneider said.
The mentee's responsibility is to understand how to leverage each mentor appropriately. In some cases, that will simply mean modeling a mentor's behavior; in others, it will be interacting with a mentor in ways that are mutually beneficial, making sure that your professional success reflects well on the mentor.
“It's a two-way street, and it takes a whole suite of people to fill all the needs that you need for a successful career,” Dr. Schneider said.
Tips from the Frontlines
It's important to choose a neurology subspecialty in which you have both clinical and research interests, so the two aspects of your work complement one another.
“Aligning them prevents you from getting whiplash switching back and forth,” Dr. Opal said.
If your ideal job would be a 50/50 split between seeing patients and conducting research, the clinician-scientist career is probably not for you. An 80/20 split is typical because the research demands it, Dr. Opal said.
Scientists must be driven by their quest for new knowledge.
“If you see patients and sometimes wonder, ‘Why can't we fix this yet? Am I a person who could potentially do that?’ that's a sign that a career in research might potentially be right for you,” Dr. Cristancho said.
During residency years after completing an MD/PhD, keep reading in your scientific area and write book chapters or reviews to keep your research skills sharp even if you don't have time to work in the lab, Dr. Opal said.
Although residents may have little time to conduct research, think about how your future research could affect the patients you see.
“You never know where your next ideas will come from, and some of the best ideas come from our patients,” Dr. Opal said.
Embrace the lengthy education and training period rather than focusing on a far-away endpoint.
“Each stage is really different, but it's kind of fun in its own way,” Dr. Cristancho said. “Don't try to rush to the finish line where you are running your own lab, but enjoy the fact that you get to learn something different all the time.”
Being able to communicate your scientific findings in writing and speaking will be important to your career, so work to build effective communication skills, Dr. Opal said.
Finally, stay in touch with the mentors who mean the most of you.
“If you find a good mentor who is really invested in your career and inspires you and has all the necessary traits, never let them go,” Dr. Higginbotham said.