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.
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'm your host Toyosi Onwuemene, and I'm excited to be on the show today because I have a very,
very, very, very, did I say very special guest, Dr. Julia Warren, and I'm just excited to
have her on the show.
Julia, welcome to the show.
Thank you so much for having me.
It's great to be here.
I'm going to ask, if you don't mind, introduce yourself to the audience, especially with
regard to your role as a clinician scientist.
Yeah, so I'm Julia Warren.
I'm an assistant professor here at the University of Pennsylvania, Perelman School of Medicine,
and I'm also an attending hematologist at the Children's Hospital of Philadelphia, where
I see patients in the Comprehensive Bone Marrow Failure Program, and also have my research
laboratory.
My research lab focuses on how we make blood cells, also known as hematopoiesis.
I love it.
You know, Julia, one of the things you didn't mention is how accomplished you are.
Uh-oh.
You know, everybody seems to miss that, and maybe because we're kind of on the journey
to believing that we're accomplished at all.
I love that you said that, yes.
All right, so I want you to tell me about how you came to recognize and accept, or maybe
you're still on the journey to accepting, your role as a clinician scientist.
What was a defining point in your career where you said, oh, I am?
I love that question so much because I think when you do training that's so dichotomous,
okay, this is your MD time, this is your PhD time, and ne'er the twain shall meet, when
they're, you know, so separate feeling, at some point they do come together.
I think for me, I had a moment in my intern year at St. Louis Children's Hospital.
It's a pediatric intern, and there was a child with RSV outside my wheelhouse, so you know,
what I've come to have expertise in, and we only give kind of prophylactic treatment for
RSV to some infants and not to others, but other children, really small children, can
really suffer from RSV infection.
So I went back to PubMed, and I looked up what is happening in this space, this space
that I know nothing about, what's happening in the RSV space, is there an immunization
that's really going to be able to be accessible to all children?
Is this a reality?
What are the barriers to this?
And then we had to give journal clubs.
A lot of times the journal club morning reports were more clinically focused, and I thought,
forget this.
I'm putting up a crystal structure, I'm putting up a ribbon diagram, I'm giving some history
about why we haven't gotten there yet, what's being done to get there now.
And even though it wasn't pipetting and it wasn't being in the lab, it was really one
of the first moments where I thought, I'm using that part of my brain to think about
patients that are right in front of me, and I'm so excited that very soon that's what
I get to do just all the time.
I love it.
Julia, it was almost like you were in rebellion in that moment.
I did have to say, bear with me, it's a ribbon diagram, but it's going to be okay.
That's really awesome.
That's really awesome because I think you're correct.
What a false dichotomy.
We are one person, and to say that this is a time when you're a clinician and this is
the time when you're a scientist is not real, and how amazing for you to just own that in
your intern year and to say, I'm not doing this anymore, I'm going all in.
That's so awesome.
Now, let me ask about what was the internal struggle to get to that moment?
Because it sounds like you hesitated.
It wasn't something you did automatically.
To get to the moment of saying, I'm a physician, I'm a scientist, I am both.
Yeah, it's right, not a straight road to get there for sure.
And we were just in a training where someone was talking about how you talk in a space
where you might feel like this is a space where I'm the outsider.
And so when you're doing your training, I really think you have those moments as, you
know, for me doing MD, PhD combined training, sometimes I'd be in my med school classes
and I'd think, wow, all my colleagues, they are just so good at sitting down and memorizing
and they were really great pre-meds.
And, you know, I was never that kind of a student.
I wanted to do the pathway.
I want to think about it.
I thought memorization was a waste of time.
And then during my PhD, you know, it was almost that you wanted to be taken seriously among
your PhD colleagues.
You didn't want other PhD students saying, oh, well, you're in this special program and
they kind of make things easier for you.
You know, they kind of help you get through your PhD and we got to go it on our own.
I wanted to be, I'm the same.
My PhD is the same.
You know, I'm working just as hard.
I'm trying just as hard.
So let me just not talk about the fact that I'm an MD, PhD student.
When we try to put that MD part of me, bury it away, you know, maybe a great moment is
if somebody doesn't even realize that I'm in an MD, PhD student, I'm just one of them.
And then you go back to, you know, your medical training and you, again, you don't want to
be the outsider.
You don't remember what a normal potassium is, right?
All your other medical students just went straight through and they're so knowledgeable
and they're really on top of their game and you're kind of scrambling to get caught up.
So you almost don't want to talk about, oh, I took a break for four years.
You want to say, how can it get as good as all these other students around me as quickly
as possible?
So yeah, I think it really took until that moment where it was, I don't have to hide
that I'm a physician and I want to be a gosh darn good physician.
And I'm a scientist.
Like, I can't turn that part of my brain off.
I'm bringing it here to the hospital every day.
So I love it.
You speak to one challenge that I think people face in different spheres of life.
It's like you're in the PhD space and you're feeling like an outsider, but you're also
in the MD space and feeling like an outsider.
So it's almost like you have to create your own space where you're just your whole person
right there.
And I wonder, you know, you're bringing it all together into one space because both spaces,
at least individually, seem to reject you.
That's hard.
I wonder how you manage that.
And I also wonder, where did you find those spaces that were more welcoming to your dichotomous
personality, so to speak?
Yeah, how I'm managing it or kind of working through it, I'd say it's probably still a
work in progress.
It is one incredibly refreshing thing about working with children, especially with teenagers,
is they can smell it when you're not being your authentic self.
They can just tell us, you know, the teenagers, if you show up, and if I would try to talk
to a teenager about sports, they're going to know right away.
I'm faking it.
I don't know.
I have no idea.
To me, it's all sports ball.
I can't tell you.
And so I want to relate to my patients, but I'm going to find something else that we can
relate about that is not whatever team is playing a sport right now because I truly
have no idea about it.
And it's that I know that sounds like a funny example, but really working with teenagers,
actually, I think really helps you to embrace who you are and present your authentic self
because they just do not tolerate it otherwise.
They're not going to respect you.
They're not going to want to listen to you when you tell them they have to take medications
that make them feel sick, that they have to go through testing, that they have to go through
inpatient admissions, they have to call you with fevers, you know, all these things.
So I think that really is something that continues to help me remember to show up as my authentic
self.
And then as far as spaces, places that really promote you being who you are as a physician
scientist, in a way, I think it's almost a numbers game having a lot of physicians, scientists
around and having physician scientists who are doing really serious science and are incredible
scientists first and foremost, but who you then work with clinically and you think you
are an incredible clinician, you are an amazing doctor, you're top of this game too.
And I think that being surrounded by that and just the sheer numbers of that at the
institutions I've been at really, really helps.
I really, really appreciate what you said about the thing about authenticity.
And I love that you shared this about the teenagers.
Yes, I think it's perfect.
Because when you were talking about kind of beating these two spaces in one space, you
kind of have to adjust to fit in and the other space you have to as well.
So it's almost like this feeling like you're always pretending to be someone that you're
not.
And I think if you want to speak to this whole thing, I think about imposter syndrome, there's
a sense that you're just not who you're supposed to be or you're not in the right place.
And what you share about the teenagers helping you to be your authentic self, I wonder if
that's not part of that, trying to like recognizing that you can only be yourself successfully,
trying to be someone else is very hard and probably something we should abandon.
Absolutely.
Do you want to speak some more to that?
Well, and that pressure to feel that, you know, are you doing what you're doing?
That pressure to feel, are you being who you're supposed to be right now?
Are you enough physician?
Are you enough scientists?
Are you enough of both combined?
Are you combining them well?
Or what is your ratio of how things are going?
It's a lot of pressure.
And I do think that sometimes as women, we have a more critical lens on ourselves.
And maybe that does come from, you know, we get criticized more, just to be honest, and
I don't know that it's fully internal or there are some external components to it too.
And so I really think for me, there's moments where that comes, that cup feels a little
emptier and you got to fill that cup back up.
And so being somewhere where you can say to yourself, look, here's a talk by this incredible
physician, scientist woman.
We just had somebody visiting, if I can name drop her, Ashley Steed from Washington University,
just have so much immense respect for her and for the work she does and for the clinician
she is and the scientist she is and kind of the person, she's like a wonderful person
too.
And so she was coming to give a talk here at campus and I just thought, well, this is
not in my research domain at all.
But if my cup is feeling a little empty, I'm going to go fill that cup back up.
I'm going to go hear from another female physician scientist who is out there hustling and making
it work and crushing it and doing a great job.
And so I think having the opportunity to, you know, just kind of tank back up and say,
okay, great.
Yes.
I'm going to go fill some number of years ahead of me, if you will, in our prescribed
trajectory who is just making it all work and just doing a fabulous job.
I love it.
I love what you talk about, the concept of filling your own tank, right?
I think that many times we abdicate that responsibility to someone else and they don't even do a good
job of it.
And so for you to say, this is what I need and I'm going to go do that and you fill your
own tank and at the end you feel satisfied and fulfilled because you did that.
You took that step for yourself.
And I just wonder how many of us do that enough and whether we're encouraged to do that.
Because you speak about community and the power of community and being surrounded by
people who are doing what you want to do.
But even within that community, there are gaps.
You're going out and finding what you need and filling your own cup, which allows you
to keep being successful.
Yeah, and so much of the time, the programming that we get offered, especially as female
physician scientists, is how to have a work-life balance.
I think it's just this theme that it's very important, but it's almost that we get told
more that this is important for us.
It's not important for everybody.
It's really important for women.
We have to figure out how to have work-life balance.
We have to figure out how to be satisfied with our work time and our family time.
And we've got to figure out that balance.
And here's a seminar on how to accomplish that.
And really, we have to figure out how to be great physicians and we have to figure out
how to be great scientists.
And that's a universal problem that a physician scientist has.
And I don't think we all get equally pressured to also have a nice life, figure all of that
out.
So yeah, for me, I just want to see other women out there crushing it.
And there's a lot of great examples around me.
That's awesome.
And you are a great example yourself.
Thank you.
All right.
I want to...
I know you taught you a lot of things that I feel like we should talk about, but we're
going to talk about it.
Actually, maybe this is a good time though.
How do we keep women...
How do we keep trainees in general, but especially women committed to the physician scientist
pathway?
One of the things you allude to is that this is hard.
And even when you're surrounded by communities of people who are doing this, there's still
times when you're feeling low and you need more and you need encouragement along the
way.
And you alluded to the fact that it is different for people who identify as women compared
to men in the academy.
Can you speak to how we can support people better at the trainee phase and even as faculty?
Yes.
I think that first we have to recognize that this pathway of trying to have two jobs at
the same time is difficult and anybody doing it knows that.
And I think that outside of really living in it, really living that moment where you
are writing a grant and getting a page at the same time and you have to make a decision,
is this an urgent page?
Do I need to call somebody back?
Oops, it's too late.
My brain's already clinical.
How to do those two things at exactly the same time.
I think first we just have to start with the recognition that it's very hard.
And with that recognition can then come sort of extra support.
And for me, I had these funny moments along my training pathway where I sort of fell into
some opportunities to get support that, okay, well, I could say fell into it or I could
say earned it, whatever.
You know, these moments in my training path where I was presented with opportunities that
I seized, let's say it that way.
I love that.
Okay, yes.
And you know, one of them, honest to God, it sounds so small, but very early in my postdoctoral
training I got to work with a technician.
And I don't know that I would be sitting here talking to you right now if I didn't have
that opportunity.
But yes, it was me training another person.
And yes, that person had their own long-term goals and why they had come to the lab.
But for me, what it allowed me to do was I had a patient relapsing and I wanted to go
talk to them about their treatment plan and my work didn't have to stop.
Or I didn't have to be there.
I was there until midnight plenty of times, but it didn't mean, oh, now I'm going to have
to be here until midnight because I can't even start my experiment until 5 p.m.
It really meant, okay, well, here's somebody who I've invested a lot of time training.
I've gotten that experience of training and mentoring someone.
And also, this is a person who it's very reasonable to turn to and say, let's come up with a plan
for what your afternoon is going to look like.
I need to make a small adjustment because of an emergency that's happening for the other
part of my job.
And that was huge.
It was great to be able to train someone.
It was great to have that experience of mentorship.
And it was hugely helpful for the type of clinical work I was doing to be able at an
earlier stage than I think a lot of people get the opportunity to do to walk away from
the lab at random times to do my second job.
And right, I think that was a really great thing to help keep me on this path.
But it's so uncommon.
And it really is so variable from lab to lab.
And we pay technicians so little that I don't think it would be, okay, that's its own problem.
But in academics, that's its own problem.
But I don't know that it would be some massively huge investment to say, okay, what kind of
clinical work are our fellows doing as they're trying to get postdoctoral serious scholarly
research done?
What would it take to say, hey, host laboratory, mentor laboratory?
We're going to provide half an FTE worth of salary for a technician if you're willing
to dedicate at least that half FTE to this fellow.
And at some point, I actually just asked for that.
I thought I'm going to put my big girl pants on and say, hey, my leadership in my division,
I really need this.
I'm really realizing I need this support, this pair of hands in the lab to help me extend
the work that I can get done during the day.
Will you pay for that?
And my leadership said, yes.
And I was very grateful.
I was very surprised.
I was very grateful.
But that is not institutionalized.
And I really think it ought to be thinking how can we say, here's a person who's really
proven through their commitment to this pathway that they want to be a physician scientist.
What can we do to help them get there rather than have these barriers that come with having
two jobs?
So I think that's kind of small potatoes cash that could really go a long way to keeping
people in the pipeline in that critical fellowship period.
Because I do think you can get through an MD, PhD program, or you can get through an
MD where you're doing heavy focus on research and you have research opportunities in your
residency training period too.
And it's really that fellowship time, I think, where you see all your residency friends who
didn't do fellowship training are out in the world making money and doing some version
of nine to five, probably more than that, but some nine to five-ish kind of a job with
more regular hours, benefits, all those good things.
And you're still slogging away as a fellow in the lab and doing your clinical stuff.
And the end is not in sight yet in the sense of you've got to work towards getting an early
career award.
You've got to get a K. You've got to get all these things under your belt.
And then your fellowship colleagues finish and maybe they take a clinical job and you
see, okay, well, not that their life is easy by any means, but their life now, they're
doing what they want to do.
They've already gotten there and they're already sort of, they're seeing patients, they're
contributing to that incredibly important aspect of patient care.
And I'm still working towards my goals.
And if we make that period of time easier, I think more people will say on the pathway.
And then of course, it's another funding thing is just, we need more support for these early
career awards.
And having a K award is so critical.
And the K funding lines at some agency are not what they need to be.
I really want to commend the NHLBI if I can.
They made a K99R00 pilot program that's specific for physician scientists.
And I think recognizing this problem at that transition from fellowship to instructor stage,
they said, listen, we're going to do a look back and we're going to judge you, your competitiveness
for this award based on time that you've have done research in the past, for example, if
you did a PhD and your commitment to this pathway.
And we know that it's really hard in two years of fellowship to already have some big, huge
first author paper that is in Cell Nature Science or whatever other top journal in your
field, but we really want to support people staying in this pathway.
And so they've piloted this program for specifically for physician scientists.
And I think we need more opportunities like that at other NIH agencies.
You have crystallized a problem just, I mean, just perfectly.
I think one thing that is not always obvious to trainees on the journey is that for the
most part, so for you, you did an MBA PhD.
So there's PhD training in the background of that, but nowhere near as much research
training as your PhD only colleagues.
And then when you look at the MDs where there's barely really any research training in any
of that, there may have been time in the lab or time doing research, but not really research
training for research leadership.
And so here we are in the clinical space where we go from intern to being a resident to being
a senior resident in those three or four years of our residency training.
And there's never the expectation that one person is taking care of the patient by themselves.
But then you get to the place of research and then it's like, well, you're on your
own.
I hope you can do all the experiments and still be a physician.
Good luck.
And it's not really realistic.
And I think it's you alluding to something that I feel like the business world knows
well.
It's like, I mean, it sounds bad to say leveraging other people's time, but it really is the
way it is.
It's that what is the benefit of the physician who spends a lot of time pipetting where they
could easily teach someone else to do that and really now enter into the thought leadership
of leading the research program?
That's really what's about.
It's not about doing.
It's about leading the doing.
It's about thinking about the direction of doing.
And I think it is a missed opportunity to support people in that from the beginning,
to almost wait for people to finally either succeed or fall flat on their faces and then
judge them to be not capable, but really how do we resource people so that they can succeed
if that's what they want to do?
And I do think that's a big gap.
And I love your story of negotiating what you need, and I'm big on negotiation.
I think we should ask for everything we want and then some.
But it's like, why?
Why did you have to ask for something that you should have gotten from the very beginning?
Why isn't that baked in?
And so there's opportunity for institutions to get up and really support people.
If you want people to succeed in this endeavor, resource them to succeed.
And our part is we're moving forward.
It's like, well, if we don't have what we need, we should ask for it.
Ask for it.
And it's not always easy, but it's definitely, I think there's opportunity on both sides.
I don't know if you want to speak more about that.
This is such an interesting challenge because I really see as somebody who did a PhD and
my PhD looked like the PhD of my PhD colleagues.
It was not any easier.
It wasn't any different.
I got to get some of my classes out of the way during med school time.
But then I spent just as much time in the lab as my colleagues did.
And so that was hugely, it was a hugely useful experience because I got to think through
how do you design an experiment?
How do you ask a question?
How you design the experiments to answer the hypothesis that you've come up with?
How are you going to make something out of proving your hypothesis right and wrong?
How do you stand up in front of people and communicate your science effectively and write
a grant?
You know, so many things that you get the opportunity to learn in that phase.
And I think especially when you get to your postdoc training that's happening during a
clinical fellowship, it's hard if you've never had those experiences.
You want to bake that in, right?
Those are incredibly rich experiences that you need to bake in.
But you also have to become the leader of a lab where experiments are being done.
So you need to know how to do the experiments.
But do you need to do those experiments yourself personally as the only person for years in
a row?
Does that have to be the system or can it be, okay, I'm putting my hands on this right
now and I'm learning it and I'm mastering it.
And then I will teach somebody how to do it and I will move on so that when that person
has questions, I understand how this works.
I understand the ins and outs of this.
When I'm the lab leader, I can direct the questions.
I can think about the science.
I can do this.
But I can also, you know, know how to point someone in the right direction experimentally
or I can hire a lab manager or a staff scientist who I can feel confident knows how to direct
people and those things experimentally because I'm comfortable with it.
And that is it's almost that those two things are, you know, at odds with each other that
you want someone to really become a good experimentalist in that way and be able to, you know, lead
their people.
But you want them to also be using the part of their brain where they can critically think
about big questions, how to answer them.
And if somebody has not had PhD training, you're asking a lot out of somebody in a very
small period of time before you then have them have access to institutional or, you
know, national fellowship awards to help support their additional time to foster that experience
and then throw in the mix that so many institutions are moving towards models where they want
to de-invest from big pieces of equipment, complex pieces of equipment, lots of labs,
having lots of pieces of equipment by themselves to things happening in core facilities.
That makes a lot of sense to me from the business world of why ask a hundred labs to be replicating
the same infrastructure and the same, you know, every PI or every fellow or every, you
know, lab manager takes a new person who comes into the lab and that person has to, you know,
learn this over and over and develop from zero to expertise in, you know, some technical
pipetting thing.
Why don't we just put that expertise into a core group of people with a core set of
instruments that are highly well maintained or highly trained people and we'll get the
work done faster.
And so I think that's great and it makes a lot of sense.
But it also could, I see why people feel some concern about them saying, okay, well, welcome
to the lab.
Here's a technician.
We're going to send most of your stuff to a core facility and three to four years from
now you can run your own group.
You're going to know exactly how to get everything done.
And that's a simplification of, that's a simplification, but I think there are some people who worry
is that what this end of somebody's training is going to look like and are they really
going to be ready to do all the things you have to do as a lab leader, as a physician
scientist where, you know, you can truly think about the science, think about the questions
and know how to answer the questions and be critical of the data that people are walking
into your office with.
And I don't know how, I don't know what the right answer is, but I definitely see where
there's some tension there.
Absolutely.
It's a lot of, it's complex.
It's that you are as a clinician scientist, really an emerging leader.
That's who you are.
And part of that leadership is getting your hands dirty and learning how to do it, is
getting your hands dirty and learning how to do it so that you can support other people
to do it.
But if a lot of that getting your hands dirty is that the opportunity is not available,
it's being siphoned away to another group.
How do you do that and still become an effective leader that you need to be?
And are we raising people who are disconnected from being able to do the good science?
Like you're right.
If all the data is being generated outside, do I have the training to be able to analyze
the data and say, do I accept this?
Is this real?
Is this credible?
Is this authentic?
Is this quality data?
And those are challenges.
I'm not sure that the answers are readily apparent.
I agree.
Yeah.
I wonder though, it's like looking forward into the future, if you could have a blank
check and fix like one thing, major thing in this clinician scientist training pathway
and faculty development pathway, what would that be and why would that be the thing you
choose?
If I could get one thing to fix, I could fix one thing.
That is such a tough question because we've got to fix a few.
If you want to cluster them, that's okay.
No, I mean, not to be redundant.
We just need more funding.
We just need, we need people to know, look, I think back to my time being a post-doc during
the pandemic, I was getting up at 3.30 in the morning so that I could get to the lab
by four for my shift because I had to be out of my bay by noon.
Right at the beginning, I wanted to get the work done.
I didn't want to not get the work done.
Yeah.
I mean, when you have somebody who's got the dedication, who's got that commitment to this
pathway or you have somebody who's just coming with all this skill and all this intelligence
who wants to know what does it mean to be a scientist and this is their first opportunity
to do it and the road in front of them is, okay, well, come work incredibly hard, have
two jobs, have all the challenges that go along with being both a physician and a scientist,
I don't know rewards, but all the challenges that go along with that.
And at the end of the day, you might have done enough.
You might be able to access this funding mechanism that's just so critical and you might have
done all the things you need to be able to get an early career award from the NIH and
that's the gold shining light and the pay line is whatever it is, 10%.
So asking somebody to stay committed to that pathway when they feel that, well, maybe I
have a one in 10 or maybe a one in five chance of getting this award, that's a stepping stone
in and of itself.
That's not the guarantee that I'm not going to get scooped and instead of having a nice
cell nature science or my field blood in some high impact publication that I need to have
in order to be marketable to an academic institution, all these things have to line up.
You almost have to be both intelligent, motivated, a great leader and lucky and making that happen
really requires a lot of working hours every day, every week, every traditional working
day and maybe some non-traditional working days as well.
So good luck on your journey and we'll see you at the end in a few years and hopefully
you've done enough to get this career award that you need and we just have to fund more
of those.
We just have to make it so that the path doesn't seem so improbable that you would spend all
this extra time and effort relative to people who choose a path where they have, and I hate
to say just one job because it's not that being a clinician is easy or being a scientist
is easy, but that you are really being asked to do so much to have two jobs at one time
and the end of the road is kind of can seem like a very improbable chance for success
and it really I think comes down to money.
We've just got to fund more of those early career fellowship awards.
I really commend programs like Burroughs Welcome, Doris Duke, who are really recognizing that
there are gaps that the NIH with the constraints that it has of not being able to come up with
its own budget that with those constraints there are gaps that need to be filled and
are trying to step up and to fill those gaps for exactly this time in physician scientist
careers.
Thank you, Julia.
I think that this is like a call to the billionaires out there.
This is why we need funding and we need more support for physician scientists.
It's important.
It's the only way healthcare advances and it's hard.
It is very, very hard.
And as you say, it's almost like it's like good luck.
We hope we see you on the other side.
Yeah, exactly.
And there's a cry about how there's such a shortage of physician scientists and it's
like, well, of course there's a shortage.
It's very difficult.
It's hard to make it through.
And so then that begs the question, Julia, how come you're still here?
This is such a hard journey.
It's been hard so far.
The road ahead still seems hard.
How is it that you're still here?
What is keeping you in the game?
Yeah, that's a great question.
And you know, for me, it's what keeps me in the game is why we are here as physician
scientists.
I get to come to the lab in the morning and think, okay, there's questions I want to answer,
that part of my brain that I love using.
I love coming to the lab.
I love mentoring people.
I love thinking about questions that need answering and coming to love grant writing
and all that entails, but really to synthesize your thoughts and say, am I on the right track?
Am I answering questions correctly?
What a fun way to spend your day.
Young people coming through the lab who are never been in the lab before and want to know
what doing science is all about.
It's so satisfying.
And then I just walk down the hall and I see children who I can help and I can help them
right there in that moment.
And I can look at the problems they're having and saying, is there something I can be doing
back in the lab to help you with this problem?
So I think about a patient who unfortunately passed away, who had a invasive fungal infection
after having a really long period of not having any neutrophils.
And it was so heartbreaking for so many reasons, but primarily because I think we could have
cured that child of their cancer.
And to me, that moment where we need more, we need to offer these children more.
We need to offer these families more.
We need to be able to look somebody with a new cancer diagnosis in the eye and say, you're
going to be at risk for infections, but don't worry, we got this.
We're actually going to fix that problem.
So let's focus on beating the cancer as aggressively as we possibly can.
And I care for patients too, who just their whole life they can't make neutrophils.
And the incredible impact on their quality of life, having this fear from the time that
your child is born that at any moment they could have a life threatening infection.
I mean, we just have to do more for these patients.
We just have to.
And being poised to contribute to the care of those kids and their families is really
a special privilege.
And I can't right now imagine doing anything else.
Though, I know many people take different trajectories in their long careers, so stay
tuned.
But for right now, it's really feels like a privilege to have this job.
Absolutely, and I love you light up as you're talking about this path and it's hard, but
you're having fun and you can see the impact in what you have the potential to do.
And so it's really awesome and it's interesting.
It's like, yeah, this is hard, but it's like the struggle.
It's hard to picture being without it for sure.
All right, so we are coming to the end of the show and I wanted to ask you if there
is someone who is a clinician early, early, early on in their career and they're struggling
and they're like, I'm not even sure this is worth it anymore.
How would you encourage them?
Yes, right.
Because yes, how would I encourage them?
Because it is really a hard pathway.
And there is that desire to not just tell people, well, the only right way forward is
to be just like me.
The only way that you will be a success at the end of the day is if you're doing exactly
what I'm doing, because that shouldn't be true.
And if somebody is really struggling, for me, I think it's a good opportunity to reflect
and to say, well, why did you come to the lab in the first place?
What brought you to the lab?
What did you want to get out of your time coming to do a research project?
And for some people, I've heard them say things like, well, I never got a chance to do research
before and I just wanted to know what it's like.
And the more time I spend here, the more I really just wish I was in the clinic.
Maybe that's a person who shouldn't keep pushing themselves down a path that they really are
just feeling a pull away from.
And the road ahead would be, I think, for that person, a very difficult road.
But if somebody says something more like, well, I really wanted to be able to think
about problems that are impacting these patients that I care for.
And I think somehow my project is not moving forward or I've moved far away from that or
I got into the lab and I thought I was going to work on one thing and instead I'm working
on another, sit down and almost write a mini grant for yourself.
What do you want to do?
What did you want to get out of this?
What were your aims coming to the lab?
And is there a way that you can now address those questions?
How can I help my patient who has sickle cell disease, who has alloreactive antibodies,
and we don't have good transfusion options for them?
If that's what's keeping you up at night and you've gotten away from that questionnaire,
you're not moving forward towards that question, sit back down and say, how can I get back
to that?
I've built almost certainly, if you've been in the lab for one or two years already, you
have built skills.
And if you feel like those skills aren't taking you where you want to be, I really wish young
people could hear that the people training you want to know.
They want to hear from you that you're having these doubts.
They don't want you to go to apply for your K, for example, and put together something
that you don't even feel proud of, or you felt like it was fighting tooth and nail just
to get it written because you're not passionate about what you're working on right now.
People training you want to hear from you if you're having these struggles and be able
to say, okay, let me move you to a different project, or okay, let's, you feel like you
haven't had a success yet.
What is this one thing that just needs to be completed?
Let's get it done because this is up and running and working in the lab.
And let's just have you put your hands on this to get some rejuvenation for a month
or two, and then we'll come back to this.
And I think a lot of people don't advocate for themselves in that way because they think
they might come off as, I don't know what, as weak or uninterested or somebody it's not
worth investing time in.
And if somebody's accepted you into their lab, put you maybe on a T training grant and
supporting your career development, sat through scholarly oversight committee meetings with
you, like they're invested.
They want you to succeed.
So speak up if that's where the mode you're at, not, I just wish I was in the clinic,
but if your mode is more, I'm feeling stuck, I'm feeling I'm spinning my wheels.
I feel like I haven't gotten the experience I want to get.
Say something and I think say it as early as you can because you really don't want to
be in a three year fellowship at the end of year two in the lab, you know, at the end
of your fellowship asking for instructor time when you're not even sure if you want it.
Wow.
That's a lot to unpack in that answer.
I don't even know where to start, but I love what you talk about.
I think what you're saying is you got to do what you love.
And I know people say that it's almost like a cliche.
This is hard work.
And if you're going to work so hard, please do something you actually care about.
Don't do something that drains you because it's too hard to invest time and energy in
something you don't even care about.
And I appreciate what you talk about the importance of self advocacy because sometimes there's
this sense of like, well, I don't want my mentor to be upset with me, but it's like,
look, this is not your mentor's journey.
This is your journey.
And years from now, your mentor is going to be out of your picture.
And what are you going to be doing?
Are you going to be that person who's so successfully miserable?
And that's not worth that struggle.
And actually you may not even end up being successfully miserable because you just might
not even get that you're so miserable.
But I do appreciate that.
It's almost cliche.
It's like, do what you love, but it's real.
It's like, don't do things you hate because it's just too hard to sustain a career that
way.
It's impossible actually.
Well, and having an Eliza that you can't troubleshoot is very different than I don't like research.
But when you're been on call because you also have a clinical job and you haven't slept
for some period of time, and maybe you also have family obligations and you're going into
the lab and you're just thinking one more day that I have to get this thing to work
that isn't working.
And I don't even know what I'm doing with my life.
And my colleague is doing a chart review in their pajamas at home and having a great time,
but really, I mean, and that's important work too, but it's, yeah, I think it's very
easy to get discouraged and to stay discouraged for two years.
And then your fellowship's up.
And then all of a sudden it's, well, you told us you wanted to do lab.
You never told us that you were struggling.
And we didn't sort of move things around or come to an understanding of maybe we need
to shift your focus.
Maybe you do want to do more clinical activity.
And now you're not marketable from a lab standpoint and you're not marketable at an academic
institution that's going to expect hardcore clinical work to have come out of a fellow.
And so nobody has been coming into a clinical position.
They're going to expect that you've done hardcore clinical work during your fellowship.
So nobody's helped by not speaking up.
And yeah, I think really, I almost wish that in fellowship you got a chance to rotate in
a lab that you almost got like graduate students do.
The expectation that you're going to spend six weeks somewhere, six weeks somewhere else
and six weeks in a third place, and you're going to see what's the right fit for you.
Because we, you know, we ask people to commit to mentors.
They don't know them at all.
They don't know the lab environment.
And this is the beginning of the rest of their career.
Now you're in a field that you're going to be in that field for at least, you know, for
the foreseeable future.
And I think that's an interesting that we just ask people to sort of jump in.
Yes, so to our audience, if you are feeling miserable on your trajectory, you need an
intervention and you can't give it to yourself.
You can engage your mentor or find someone outside of your mentorship circle, but please
don't try to do it alone.
And build that.
I wish I could come up.
Maybe you know the name of this kind of map that you make.
It's not a mentorship map because mentor is one word, but who are the people you're going
to need different things from to support you on this?
You know, you need a research mentor.
You need a clinical mentor.
You need a mentor to help you with the life part of doing this job.
You need peers for peer support.
You need a sponsor that is often, if it's also your research mentor, isn't that so great?
It probably ought not to just be your research mentor.
You need a sponsor.
You need someone who's going to open doors for you.
And you need role models.
You know, these are different people who are going to give you these different things and
you have to build that team for yourself.
And there are these diagrams you can download online if you're a visual person where you
then just fill the names in.
Really sit with it and ask, who is in each of these buckets is my person?
And in this moment, I'm having these feelings of doubt, you know, disconcertment.
I'm not sure if I'm doing the right thing with my life.
Which of these people can I go talk to about this?
And maybe I start with one person and move to a different one.
Maybe I, you know, meet with a peer first who's a few years ahead of me who might have
had these same moments.
Maybe I just bounce ideas off of them and then I go to my research mentor.
Or I, you know, I go to my sponsor and I say, do you think I have what it takes?
You're someone who's been my champion.
You know, do you think I'm a person you see continue to be able to champion in the future?
What do I need to accomplish now?
And how do I get to accomplishing that?
So yeah, sit down and make a map for yourself and then reach out to those people.
Absolutely.
You speak to the importance of mentoring networks.
I mean, it's like one person cannot be all of it for you.
It's not even possible.
Don't do it.
Don't, don't try to make it fit.
But yeah, no, that's, this has been so awesome, Julia.
I mean, just so much wisdom.
I feel like we need to do like a part two because there's so much that could still be
said.
And I just just shared so much wisdom and I just want to thank you.
Thank you for being on the show.
Of course.
Thank you so much for inviting me.
All right, everyone.
You've heard Julia.
You've got to share this episode with someone else.
Someone is struggling and they need advice and they need to think a little bit more broadly
about that mentoring networks.
Think about that one person and forward this episode to them.
All right, everyone.
It's been a pleasure to talk to you again the next time.
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
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All right, thanks for tuning in.