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Getting Closer to the Clinic

In a career session at the AAAS Annual Meeting in San Diego yesterday, Associate Dean for Physician-Scientist Training at UCSD School of Medicine Ajit Varki and Eric Topol, Director of the Scripps Translational Science Institute, discussed job opportunities for Ph.D. scientists in clinical and translational research and related topics.


If I had to convey just one message from the workshop, it would be: if you are passionate about alleviating the burden of human disease and are willing to step onto new ground, there has never been a better time to enter clinical and translational research.


In the last several decades, a unique culture has developed in the United States in which many medical doctors pursue research. This culture has been well supplemented by M.D.-Ph.D. dual-degree programs. But the number of physician-scientists has been declining sharply over the years, and even if they were to expand, M.D.-Ph.D. programs would find it difficult to fill the open slots. The resut: “There are huge opportunities for Ph.D. scientists who want to train and affiliate with medics,” Varki said.


Increasingly, disease-specific programs and Clinical and Translational Translational Science Awards (CTSA) programs are being put in place to help nurture careers in translational science among Ph.D. scientists. The Burroughs Wellcome Fund (BWF) also offers Career Awards at the Scientific Interface for scientists with a background in the physical, mathematical, or computational sciences addressing biological questions. Still, “there is not a very good mechanism in place right now” to get into the field “if you haven’t got an M.D.,” Varki said. As a Ph.D. scientist, “You have to make it up for yourself.”


This is not necessarily a bad thing, pointed out Jim Austin, Science Careers Editor and PI of CTSciNet, the Clinical and Translational Science Network, who was moderating the session. This also means that opportunities are wide open: “Start with a disciplinary training, see how it relates to medical applications, and go and find it.”


Look for “opportunities where you feel you can have an impact,” Topol said. For example, you could develop a particular area of expertise related to a disease or a biological pathway, and build up on that, he added.


Importantly, don’t sell yourself short if you have no specialized training in a medical-related field, intervened Bill Galey, of the Howard Hughes Medical Institute, from the audience. Other scientific disciplines, like chemistry, physics, computer sciences, and mathematics are all be relevant to translational research. Medical imaging and nanotechnology are two examples of emerging areas needing physical scientists, and “as biology gets more quantitative, there is a greater need for people trained with that kind of quantitative skills,” Galey said.


The best way to get in is to find a postdoc in the lab of a top-notch physician-scientist, Varki said. “You have to convince them that you really care, are serious, and want to give it a shot,” Austin added. Also key is to spend some time in medical schools or in the clinic. At UCSD, for example, Ph.D. students are attached to clinical divisions for 3 months “to really feel… and smell what goes on at the medical side,” Varki said. Some medical departments are too busy to do research, but more and more of them are now looking for researchers, Topol added. “It could be a department that doesn’t do intensive research, but supports the research.”


As you progress in your translational research career, make sure to remain open-minded about opportunities as they come up. “Keep it flexible because you never know where science and medicine [will] get you,” Varki said. For example, Topol, who trained as a cardiologist, pioneered the clinical use of tissue plasminogen activator (tPA), an enzyme involved in the breakdown of blood clots, after hearing about tPA in a journal club. When that project “hit the wall,” Topol started thinking: “‘Why not get into the genetics of heart attack’,” he says. “You’ve got fantastic project opportunities,” Topol added. You just have to go and find them.


Another topic that came up for discussion during the workshop was the leaky pipeline for women. While during medical school, there is gender neutrality, but there is “never parity in those interested in research,” Galey said. There is a general perception among women that combining an academic career with a clinical career and a family is very hard, he added. But “research is not inconsistent with family.” Galey said, “It is much easier to tell your lab that you need to leave” to take your kid to the doctor “rather than a waiting room with lots of patients.”


“Women need to stand up and say what needs to be done rather then having a few guys” trying to raise the issue, said Varki, who wrote an opinion piece on the need for on-site childcare facilities in the American Society for Cell Biology (ACSB) Newsletter a couple of years ago.


“The more you move towards patients, the more complicated it gets,” Varki said. And getting a physician-Ph.D. position is in no way as competitive as getting a faculty position in the more traditional disciplines, he added.


Certainly, “The most exciting time in biomedical research is now,” Topol said.