On behalf of the Physician-Scientist Workforce Working Group (PSW-WG), Catalyst Research & Communications conducted qualitative research with early career physician-scientists with mentored K awards to explore how they think about a career in research. The original plan for this research was to conduct a series of telephone-based focus groups. One focus group was conducted; however, it became too difficult to recruit enough young faculty with K awards into groups because of conflicting schedules and the 90-minute focus group format. Therefore, the methodology shifted to 30-minute individual telephone-based key informant interviews. This worked better as the interviews could be scheduled when it was convenient for each individual. OMB clearance was obtained to recruit and collect qualitative data either via a focus group or key informant interviews, using a standard set of questions. Thapproved instrument appears at the end of this report.
A list of MD, DDS, and DVM researchers with K awards from the National Institutes of Health (NIH) was provided by another NIH contractor for recruitment purposes. Catalyst originally planned to take a random sample of current K awardees, but this list was not up-to-date and had many errors. Therefore, names of K awardees were obtained from a search of the Internet, including specific NIH Institute sites and/or university sites, as well as by referral from members of the Physician-Scientist Workforce Working Group . This resulted in a convenience sample for the study.
One telephone-based focus group of four (4) MD/PhD K awardees (one K23 and three K08 awards) was conducted in February 2014. The focus group lasted approximately 90 minutes. The focus group was audio- taped and transcribed.
During February, March and April 2014, 13 key informant interviews were completed with physician-scientists and clinician-scientists with K awards.
Between the focus group and key informant interviews, 17 physician-scientists and clinician-scientists with K awards were interviewed. The breakdown is as follows:
Although Catalyst contacted individuals from a list of young dentist-scientists with K awards, we were not successful in recruiting any dentist-scientists to the study.
In keeping with the definition adopted by the PSW-WG, the term “physician-scientist” is used in this report to refer to scientists with professional degrees, who have training in clinical care, and who are engaged in independent biomedical research. Those who engage in this type of research could include individuals with an MD, DO, DDS, DVM/VMD, or nurses with research doctoral degrees who devote the majority of their time to biomedical research.
Across the board, each K awardees interviewed for this study desired to spend that the majority of his/her career as a physician-scientist. Not one was interested in pursuing a dedicated career in clinical practice; among this group, only the nurse-scientists had spent a significant portion of time solely in clinical practice, and they had done so at an earlier point in their careers. These early career investigators were frustrated, however, with the precarious funding situation for physician-scientists and were resigned to the fact that they may end up pursuing a career as a clinician if they are not successful in procuring adequate grant funding.
Since K awards are mentored research awards by definition, mentors were very important to these physician-scientists. Mentors were defined in the K award proposal and are valuable assets to the K awardees. Most of those interviewed reported that they had protected research time. In some institutions, some physician-scientists were asked to take on a greater share of clinical duties and that could be problematic for the individual.
The physician-scientist track for those with a medical degree (MD, MD/PhD) was seemingly more competitive and less collegial than for those in other segments of the workforce (DVM, RN/PhD). While team science was preferred by all, the physician-scientists felt that the academic medicine culture was not in tune with team science. Physician-scientists understood they needed to publish first-author papers to be successful in competing for R01 awards and were less willing to share their data with others.
The physician-scientists interviewed for this study expressed anxiety about being under multiple running clocks during their K award years. Within the timeframe of the K award (3-5 years), they need to successfully conduct the proposed research, collect and analyze the data, publish as many papers as possible, and write a successful R award application. Competing work demands, such as clinical, teaching, and other responsibilities, can erode into protected research time.
Most physician-scientists with K awards were in the stage of life where they were married, with small children. Work/life balance issues were quite pressing, particularly for the MD/PhD scientists who are in very competitive institutions.
Three-year K awards made it very difficult to finish data collection and publish in time to put in a proposal for an R award. Five-year awards gave them more time to finish their research and amass needed publications to be competitive for an R award.
Because physician-scientists with a medical degree and veterinarian-scientists were notably different from nurse-scientists in terms of age and career history, the following analysis discusses these two groups separately.
Physician-scientists in this study reported that they became interested in research early in life, most often before high school and college. The challenge and fascination with science and discovery is what motivates them to continue in the research arena. They talked about wanting to find out something unknown and apply it in practice. Physician-scientists want to do research that is relevant to human health and disease; DVM/PhD scientists expressed a desire to do research relating to the human-animal bond.
Each physician-scientist interviewed had mentors for the K award and were happy with their assigned mentors, but most found additional mentors that they need for success, identifying these other mentors at work, during scientific meetings, or by referral.
Most expressed fear and frustration about the possibility of not being able to continue their research careers if they are not able to secure an R award. They expressed the fear that they have invested so much of their adult life preparing to do scientific research and it could all be ended by not being successful with an R award. They have sacrificed both a lucrative clinical salary, as well as precious time in the hopes of being able to continue to build a research career.
Although most stated that on paper they have 75 percent or more protected research time, in reality many other things erode into that time, including clinical service time, academic responsibilities, teaching residents, and mentoring journal club. If they have a KO8 award, there may be patient-oriented research built in, such as bench-to-bedside research elements. Even with a KO8 award, there are often clinical responsibilities.
Balance at work becomes more of an issue as time goes on. Clinical responsibilities never shrink and most likely increase. Research time tends to increase as time goes forward. One needs to write more grant proposals and write more papers to support applications. And the extra duties, such as teaching, mentoring, and presenting at conferences, tend to increase over time.
Since most K awardees are at an age where they are starting families or already have young families, the stresses of life start to increase at about the same time when the stresses of work and research are increasing. Men and women both reported this. Women, in particular have more of a difficult time because they reported having to make time for obstetric appointments, maternity leave, and childcare, which does not fit in well with a hectic research career. Supportive spouses are crucial to help with the work/life balance. The men in the focus groups did not report having major child care chores, other than their interest to be home in the evening early enough to have dinner with their family and help with bedtime childcare.
One woman reported:
"If NIH could give us some information on their feelings and whether we should be open about these things in light of women leaving research. 'Tips for young parents facing NIH challenges' would be helpful! In my initial K23 application-- we draft our own letters of recommendation and then the mentors edit them. Mine said look at all she has done while having 3 kids in 4 years. My recommenders took ALL that out of my letters. It didn't make me 'special.' There is then tension between having a slower trajectory because of maternity leave, but not wanting to admit that you have these pressures."
Another frustration for younger physician-scientists is equity in pay. Salaries for physicians who are primarily clinicians are often twice or more what a physician-scientist makes.
Most physician-scientists at this stage are attempting to procure grant monies from several sources, such as foundations and other research organizations, to make up salary deficits and help pay for the costs above what the K award covers, such as lab needs.
Dual degree and MD physician-scientists reported a sense that they may not be as successful as a PhD-only scientist in obtaining an R grant. All thought that combining clinical training and experience with research should be more valued.
One physician-scientist described the research system as a funnel: You start in medical school, then fewer go to residency, fewer get a K award, and ever fewer get an RO1. He found this to be very discouraging.
Student loan debt was reported as a big concern among the veterinarian-scientists.
Most of the physician-scientists in this study would like to stay in research and are working diligently to make that happen. They would also like to combine academics, research, and some clinical practice in their careers; most would like to eventually move into a leadership position.
Typical comments include:
"I love what I do with research, and can't see myself doing anything else."
"It is not a terrible thing to be, you know, an academic clinician, essentially an educator, within my department and to just do that. I mean, you still get to interact with fellows. You still get to teach and you make a reasonable salary. So it wouldn’t be the worst thing in the world. It is definitely not, you know, what I want to do. I would much rather be doing research. But if it came down to it, and I just couldn’t sustain my research with funding, then I think that would be the way I would go. I think I am definitely not going to quit. They will have to kick me out."
Provide bridge funding, if needed. Several of the informants thought that the focus should be on retaining as many researchers as possible between the K award and the R awards. This is a time where many promising researchers drop out if they do not get funded for an R award right after the K award ends. This potential gap in funding is problematic and gap or bridge funding is needed. Some researchers need a little more time to obtain funding to become an independent investigator.
Increase mentor collaboration. Bring K awardees together and give advice on research careers. Protect mentor time. They are being asked to do too much, in many cases.
Consider the use of the K24 mechanism to not only train other clinical researchers, but to also mentor new physician-scientists, regardless of the type of research they are doing.
Increase K08/K23 funding to cover research technicians. K awardees reported needing funding within the KO8/K23 to pay for a research technician to keep continuity in the lab and keep the research going, especially if they are pulled out to do clinical work. Oftentimes, the lab work stops if the physician-scientist has to do clinical or academic work.
Increase all K award to five years. Three years is not enough for a K award. K awards should be at least 5 years duration.
Define protected research time in hours, not percentages.
Score proposals for R awards from K awardees, rather than triaging them. NIH has put a lot of money into K awards with the hopes that the physician-scientist will be successful in research. The young physician-scientist has sacrificed time and potentially a better salary to stay in the research track. To be able to successfully reapply for an R award, the scores and comments are very helpful in resubmissions.
Increase direct support for veterinary research. The DVM/PhDs recommended, more direct support of veterinary research that has a bearing on human health, as well as efforts to increase awareness of the availability of NIH resources/awards to DVM scientists.
Increase loan repayment options for veterinarian-scientists.
Nurse-scientists in this study reported that they love to generate new knowledge and discovery. While working previously as a clinical nurse or clinical nurse specialist, these individuals observed many research questions that were not being answered. They initially decided to get a master’s degree and while in graduate school, mentors encouraged them or they became interested in continuing on to earn a research doctorate.
As one described her perspective:
"I love knowledge generation and discovery. I totally embrace that I might not be at the bedside making an impact, but that research will make an impact. This can be hard for nurse clinicians because most people don't become nurses to be researchers. Medicine and research are tied together, but not as much in nursing. It is changing a bit as we see younger nurses getting their PhDs."
These nurse-scientists reported that there isn't a pipeline at most universities to encourage promising nursing students to consider and embark on a career in research. They also reported a absence of programs that spark an interest in nursing-related research prior to college. Nurse-scientists tend to seek out their own mentors, based upon their research interests, even before they received their K awards.
Nurse-scientists in this study were older when they decided to return to school to get a PhD. They first worked as either a clinical nurse or clinical nurse specialist, and then went back to earn a PhD. They were in their 40/50s when they got their K award.
Work/life balance was definitely top of mind for those with children currently at home. They did report that they have support from their colleagues and are able to resolve any work/life balance issues that may arise.
A three-year K award, which is typical for those from the National Institute for Nursing Research, is too short of a time frame to get research up and running, collect and analyze data, and then write and get manuscripts accepted in journals. Nurse-scientists reported that this has to be all done before one can write a successful proposal for an R award.
The K award does not always cover lab resources. Nurse-scientists in this study felt they needed more support in the form of lab equipment and lab space. Lab assistants are also not covered in the K award.
Nurse-scientists have to carry a larger teaching load at universities to make up salary deficits from grant funding. This can make it difficult to keep research projects moving forward. But other career options are less available:
"Nurses who want a research career are tied to academia. Some large hospitals are doing some nursing research, but not as much."
All of those interviewed liked the idea of team science. They felt they were in a collegial atmosphere where team science works well. The nurse-scientists worked in an interdisciplinary atmosphere where team science was being used.
The nurse-scientists interviewed for this study would like to stay in the research arena and teach in a university research setting. If that does not work out, they said that they can always teach and fall back on their clinical skills.
Some, but not all, have plans to apply for an R award, continuing the research they have started.
Develop an intermediate grant that can serve as a bridge between the K award and the R grants. The K awards provide the basis for the next grant, but it may be a big jump from a K23 to an R award.
Expand K awards to five years. Three years is too short to be able to publish and reapply for the next funding grant.
Expand the K award to allow research funds to pay for laboratory-related expenses.
Institute team science in research funding opportunities. Encourage nurses and physicians to work together in team science.
Educate nurse-scientists about how to get research funding.
OMB Number 0925-0648
Expiration Date 1/31/2015
We’re exploring how physician-scientists like you think about their research career decisions, and we’d like to ask you some questions about your experiences and the decisions you’ve made. The aggregate findings will be used to inform the deliberations of the Physician Scientist Workforce Committee at the National Institutes of Health about how to improve and support a sustainable and diverse physician-scientist workforce.
This focus group will last about 1½ hours.
A few ground rules for today’s discussion:
Any questions before we get started?
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Then let’s begin. First, let’s go around and briefly introduce ourselves. Can you share with us three pieces of information?:
Thank you very much!