1 00:00:00,000 --> 00:00:05,860 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills 2 00:00:05,860 --> 00:00:11,260 to build their own research program, whether or not they have a mentor. 3 00:00:11,260 --> 00:00:17,340 As clinicians, we spend a decade or more as trainees learning to take care of patients. 4 00:00:17,340 --> 00:00:22,380 When we finally start our careers, we want to build research programs, but then we find 5 00:00:22,380 --> 00:00:27,780 that our years of clinical training did not adequately prepare us to lead our research 6 00:00:27,780 --> 00:00:29,200 program. 7 00:00:29,200 --> 00:00:35,480 Through no fault of our own, we struggle to find mentors, and when we can't, we quit. 8 00:00:35,480 --> 00:00:40,580 However, clinicians hold the keys to the greatest research breakthroughs. 9 00:00:40,580 --> 00:00:46,200 For this reason, the Clinician Researcher podcast exists to give academic clinicians 10 00:00:46,200 --> 00:00:51,800 the tools to build their own research program, whether or not they have a mentor. 11 00:00:51,800 --> 00:01:01,060 Now introducing your host, Toyosi Onwuemene. 12 00:01:01,060 --> 00:01:03,460 Welcome to the Clinician Researcher podcast. 13 00:01:03,460 --> 00:01:08,660 I'm your host Toyosi Onwuemene, and I'm excited to be on the show today because I have a very, 14 00:01:08,660 --> 00:01:15,940 very, very, very, did I say very special guest, Dr. Julia Warren, and I'm just excited to 15 00:01:15,940 --> 00:01:16,940 have her on the show. 16 00:01:16,940 --> 00:01:18,660 Julia, welcome to the show. 17 00:01:18,660 --> 00:01:19,820 Thank you so much for having me. 18 00:01:19,820 --> 00:01:20,820 It's great to be here. 19 00:01:20,820 --> 00:01:25,180 I'm going to ask, if you don't mind, introduce yourself to the audience, especially with 20 00:01:25,180 --> 00:01:27,580 regard to your role as a clinician scientist. 21 00:01:27,580 --> 00:01:29,380 Yeah, so I'm Julia Warren. 22 00:01:29,380 --> 00:01:34,300 I'm an assistant professor here at the University of Pennsylvania, Perelman School of Medicine, 23 00:01:34,300 --> 00:01:38,940 and I'm also an attending hematologist at the Children's Hospital of Philadelphia, where 24 00:01:38,940 --> 00:01:44,420 I see patients in the Comprehensive Bone Marrow Failure Program, and also have my research 25 00:01:44,420 --> 00:01:45,800 laboratory. 26 00:01:45,800 --> 00:01:49,980 My research lab focuses on how we make blood cells, also known as hematopoiesis. 27 00:01:49,980 --> 00:01:52,420 I love it. 28 00:01:52,420 --> 00:01:56,420 You know, Julia, one of the things you didn't mention is how accomplished you are. 29 00:01:56,420 --> 00:01:57,420 Uh-oh. 30 00:01:57,420 --> 00:02:04,160 You know, everybody seems to miss that, and maybe because we're kind of on the journey 31 00:02:04,160 --> 00:02:06,740 to believing that we're accomplished at all. 32 00:02:06,740 --> 00:02:09,540 I love that you said that, yes. 33 00:02:09,540 --> 00:02:17,700 All right, so I want you to tell me about how you came to recognize and accept, or maybe 34 00:02:17,700 --> 00:02:22,460 you're still on the journey to accepting, your role as a clinician scientist. 35 00:02:22,460 --> 00:02:27,540 What was a defining point in your career where you said, oh, I am? 36 00:02:27,540 --> 00:02:33,060 I love that question so much because I think when you do training that's so dichotomous, 37 00:02:33,060 --> 00:02:41,420 okay, this is your MD time, this is your PhD time, and ne'er the twain shall meet, when 38 00:02:41,420 --> 00:02:46,860 they're, you know, so separate feeling, at some point they do come together. 39 00:02:46,860 --> 00:02:51,820 I think for me, I had a moment in my intern year at St. Louis Children's Hospital. 40 00:02:51,820 --> 00:02:59,140 It's a pediatric intern, and there was a child with RSV outside my wheelhouse, so you know, 41 00:02:59,140 --> 00:03:06,260 what I've come to have expertise in, and we only give kind of prophylactic treatment for 42 00:03:06,260 --> 00:03:11,620 RSV to some infants and not to others, but other children, really small children, can 43 00:03:11,620 --> 00:03:14,000 really suffer from RSV infection. 44 00:03:14,000 --> 00:03:18,380 So I went back to PubMed, and I looked up what is happening in this space, this space 45 00:03:18,380 --> 00:03:23,300 that I know nothing about, what's happening in the RSV space, is there an immunization 46 00:03:23,300 --> 00:03:28,020 that's really going to be able to be accessible to all children? 47 00:03:28,020 --> 00:03:29,020 Is this a reality? 48 00:03:29,020 --> 00:03:30,260 What are the barriers to this? 49 00:03:30,260 --> 00:03:32,380 And then we had to give journal clubs. 50 00:03:32,380 --> 00:03:36,380 A lot of times the journal club morning reports were more clinically focused, and I thought, 51 00:03:36,380 --> 00:03:37,380 forget this. 52 00:03:37,380 --> 00:03:42,260 I'm putting up a crystal structure, I'm putting up a ribbon diagram, I'm giving some history 53 00:03:42,260 --> 00:03:46,540 about why we haven't gotten there yet, what's being done to get there now. 54 00:03:46,540 --> 00:03:50,060 And even though it wasn't pipetting and it wasn't being in the lab, it was really one 55 00:03:50,060 --> 00:03:55,140 of the first moments where I thought, I'm using that part of my brain to think about 56 00:03:55,140 --> 00:04:00,220 patients that are right in front of me, and I'm so excited that very soon that's what 57 00:04:00,220 --> 00:04:02,980 I get to do just all the time. 58 00:04:02,980 --> 00:04:03,980 I love it. 59 00:04:03,980 --> 00:04:07,460 Julia, it was almost like you were in rebellion in that moment. 60 00:04:07,460 --> 00:04:16,060 I did have to say, bear with me, it's a ribbon diagram, but it's going to be okay. 61 00:04:16,060 --> 00:04:17,660 That's really awesome. 62 00:04:17,660 --> 00:04:21,060 That's really awesome because I think you're correct. 63 00:04:21,060 --> 00:04:22,340 What a false dichotomy. 64 00:04:22,340 --> 00:04:26,260 We are one person, and to say that this is a time when you're a clinician and this is 65 00:04:26,260 --> 00:04:30,540 the time when you're a scientist is not real, and how amazing for you to just own that in 66 00:04:30,540 --> 00:04:34,180 your intern year and to say, I'm not doing this anymore, I'm going all in. 67 00:04:34,180 --> 00:04:36,180 That's so awesome. 68 00:04:36,180 --> 00:04:43,740 Now, let me ask about what was the internal struggle to get to that moment? 69 00:04:43,740 --> 00:04:45,380 Because it sounds like you hesitated. 70 00:04:45,380 --> 00:04:47,180 It wasn't something you did automatically. 71 00:04:47,180 --> 00:04:53,500 To get to the moment of saying, I'm a physician, I'm a scientist, I am both. 72 00:04:53,500 --> 00:04:58,580 Yeah, it's right, not a straight road to get there for sure. 73 00:04:58,580 --> 00:05:04,520 And we were just in a training where someone was talking about how you talk in a space 74 00:05:04,520 --> 00:05:09,140 where you might feel like this is a space where I'm the outsider. 75 00:05:09,140 --> 00:05:13,580 And so when you're doing your training, I really think you have those moments as, you 76 00:05:13,580 --> 00:05:18,580 know, for me doing MD, PhD combined training, sometimes I'd be in my med school classes 77 00:05:18,580 --> 00:05:24,780 and I'd think, wow, all my colleagues, they are just so good at sitting down and memorizing 78 00:05:24,780 --> 00:05:26,820 and they were really great pre-meds. 79 00:05:26,820 --> 00:05:29,260 And, you know, I was never that kind of a student. 80 00:05:29,260 --> 00:05:30,260 I wanted to do the pathway. 81 00:05:30,260 --> 00:05:31,260 I want to think about it. 82 00:05:31,260 --> 00:05:33,480 I thought memorization was a waste of time. 83 00:05:33,480 --> 00:05:38,200 And then during my PhD, you know, it was almost that you wanted to be taken seriously among 84 00:05:38,200 --> 00:05:39,580 your PhD colleagues. 85 00:05:39,580 --> 00:05:44,620 You didn't want other PhD students saying, oh, well, you're in this special program and 86 00:05:44,620 --> 00:05:46,580 they kind of make things easier for you. 87 00:05:46,580 --> 00:05:51,100 You know, they kind of help you get through your PhD and we got to go it on our own. 88 00:05:51,100 --> 00:05:53,040 I wanted to be, I'm the same. 89 00:05:53,040 --> 00:05:54,300 My PhD is the same. 90 00:05:54,300 --> 00:05:56,540 You know, I'm working just as hard. 91 00:05:56,540 --> 00:05:57,540 I'm trying just as hard. 92 00:05:57,540 --> 00:06:01,660 So let me just not talk about the fact that I'm an MD, PhD student. 93 00:06:01,660 --> 00:06:07,580 When we try to put that MD part of me, bury it away, you know, maybe a great moment is 94 00:06:07,580 --> 00:06:11,940 if somebody doesn't even realize that I'm in an MD, PhD student, I'm just one of them. 95 00:06:11,940 --> 00:06:16,420 And then you go back to, you know, your medical training and you, again, you don't want to 96 00:06:16,420 --> 00:06:17,860 be the outsider. 97 00:06:17,860 --> 00:06:20,780 You don't remember what a normal potassium is, right? 98 00:06:20,780 --> 00:06:24,900 All your other medical students just went straight through and they're so knowledgeable 99 00:06:24,900 --> 00:06:29,900 and they're really on top of their game and you're kind of scrambling to get caught up. 100 00:06:29,900 --> 00:06:33,660 So you almost don't want to talk about, oh, I took a break for four years. 101 00:06:33,660 --> 00:06:37,260 You want to say, how can it get as good as all these other students around me as quickly 102 00:06:37,260 --> 00:06:38,700 as possible? 103 00:06:38,700 --> 00:06:44,740 So yeah, I think it really took until that moment where it was, I don't have to hide 104 00:06:44,740 --> 00:06:51,740 that I'm a physician and I want to be a gosh darn good physician. 105 00:06:51,740 --> 00:06:53,020 And I'm a scientist. 106 00:06:53,020 --> 00:06:56,420 Like, I can't turn that part of my brain off. 107 00:06:56,420 --> 00:06:59,420 I'm bringing it here to the hospital every day. 108 00:06:59,420 --> 00:07:02,300 So I love it. 109 00:07:02,300 --> 00:07:06,420 You speak to one challenge that I think people face in different spheres of life. 110 00:07:06,420 --> 00:07:10,220 It's like you're in the PhD space and you're feeling like an outsider, but you're also 111 00:07:10,220 --> 00:07:12,800 in the MD space and feeling like an outsider. 112 00:07:12,800 --> 00:07:16,660 So it's almost like you have to create your own space where you're just your whole person 113 00:07:16,660 --> 00:07:17,900 right there. 114 00:07:17,900 --> 00:07:22,820 And I wonder, you know, you're bringing it all together into one space because both spaces, 115 00:07:22,820 --> 00:07:25,820 at least individually, seem to reject you. 116 00:07:25,820 --> 00:07:26,820 That's hard. 117 00:07:26,820 --> 00:07:28,420 I wonder how you manage that. 118 00:07:28,420 --> 00:07:34,220 And I also wonder, where did you find those spaces that were more welcoming to your dichotomous 119 00:07:34,220 --> 00:07:36,260 personality, so to speak? 120 00:07:36,260 --> 00:07:41,140 Yeah, how I'm managing it or kind of working through it, I'd say it's probably still a 121 00:07:41,140 --> 00:07:42,720 work in progress. 122 00:07:42,720 --> 00:07:48,340 It is one incredibly refreshing thing about working with children, especially with teenagers, 123 00:07:48,340 --> 00:07:51,740 is they can smell it when you're not being your authentic self. 124 00:07:51,740 --> 00:07:55,740 They can just tell us, you know, the teenagers, if you show up, and if I would try to talk 125 00:07:55,740 --> 00:07:59,340 to a teenager about sports, they're going to know right away. 126 00:07:59,340 --> 00:08:00,340 I'm faking it. 127 00:08:00,340 --> 00:08:01,340 I don't know. 128 00:08:01,340 --> 00:08:02,340 I have no idea. 129 00:08:02,340 --> 00:08:03,340 To me, it's all sports ball. 130 00:08:03,340 --> 00:08:04,340 I can't tell you. 131 00:08:04,340 --> 00:08:08,900 And so I want to relate to my patients, but I'm going to find something else that we can 132 00:08:08,900 --> 00:08:15,180 relate about that is not whatever team is playing a sport right now because I truly 133 00:08:15,180 --> 00:08:16,780 have no idea about it. 134 00:08:16,780 --> 00:08:22,300 And it's that I know that sounds like a funny example, but really working with teenagers, 135 00:08:22,300 --> 00:08:30,260 actually, I think really helps you to embrace who you are and present your authentic self 136 00:08:30,260 --> 00:08:32,420 because they just do not tolerate it otherwise. 137 00:08:32,420 --> 00:08:33,820 They're not going to respect you. 138 00:08:33,820 --> 00:08:37,520 They're not going to want to listen to you when you tell them they have to take medications 139 00:08:37,520 --> 00:08:41,060 that make them feel sick, that they have to go through testing, that they have to go through 140 00:08:41,060 --> 00:08:44,900 inpatient admissions, they have to call you with fevers, you know, all these things. 141 00:08:44,900 --> 00:08:52,160 So I think that really is something that continues to help me remember to show up as my authentic 142 00:08:52,160 --> 00:08:53,420 self. 143 00:08:53,420 --> 00:09:00,620 And then as far as spaces, places that really promote you being who you are as a physician 144 00:09:00,620 --> 00:09:07,460 scientist, in a way, I think it's almost a numbers game having a lot of physicians, scientists 145 00:09:07,460 --> 00:09:15,980 around and having physician scientists who are doing really serious science and are incredible 146 00:09:15,980 --> 00:09:21,340 scientists first and foremost, but who you then work with clinically and you think you 147 00:09:21,340 --> 00:09:27,740 are an incredible clinician, you are an amazing doctor, you're top of this game too. 148 00:09:27,740 --> 00:09:31,820 And I think that being surrounded by that and just the sheer numbers of that at the 149 00:09:31,820 --> 00:09:35,340 institutions I've been at really, really helps. 150 00:09:35,340 --> 00:09:40,420 I really, really appreciate what you said about the thing about authenticity. 151 00:09:40,420 --> 00:09:42,780 And I love that you shared this about the teenagers. 152 00:09:42,780 --> 00:09:45,580 Yes, I think it's perfect. 153 00:09:45,580 --> 00:09:49,420 Because when you were talking about kind of beating these two spaces in one space, you 154 00:09:49,420 --> 00:09:53,900 kind of have to adjust to fit in and the other space you have to as well. 155 00:09:53,900 --> 00:09:56,820 So it's almost like this feeling like you're always pretending to be someone that you're 156 00:09:56,820 --> 00:09:57,820 not. 157 00:09:57,820 --> 00:10:02,580 And I think if you want to speak to this whole thing, I think about imposter syndrome, there's 158 00:10:02,580 --> 00:10:08,180 a sense that you're just not who you're supposed to be or you're not in the right place. 159 00:10:08,180 --> 00:10:13,260 And what you share about the teenagers helping you to be your authentic self, I wonder if 160 00:10:13,260 --> 00:10:18,820 that's not part of that, trying to like recognizing that you can only be yourself successfully, 161 00:10:18,820 --> 00:10:23,220 trying to be someone else is very hard and probably something we should abandon. 162 00:10:23,220 --> 00:10:24,220 Absolutely. 163 00:10:24,220 --> 00:10:26,540 Do you want to speak some more to that? 164 00:10:26,540 --> 00:10:34,300 Well, and that pressure to feel that, you know, are you doing what you're doing? 165 00:10:34,300 --> 00:10:38,100 That pressure to feel, are you being who you're supposed to be right now? 166 00:10:38,100 --> 00:10:40,100 Are you enough physician? 167 00:10:40,100 --> 00:10:42,500 Are you enough scientists? 168 00:10:42,500 --> 00:10:44,220 Are you enough of both combined? 169 00:10:44,220 --> 00:10:45,540 Are you combining them well? 170 00:10:45,540 --> 00:10:47,980 Or what is your ratio of how things are going? 171 00:10:47,980 --> 00:10:49,980 It's a lot of pressure. 172 00:10:49,980 --> 00:10:59,620 And I do think that sometimes as women, we have a more critical lens on ourselves. 173 00:10:59,620 --> 00:11:06,140 And maybe that does come from, you know, we get criticized more, just to be honest, and 174 00:11:06,140 --> 00:11:10,980 I don't know that it's fully internal or there are some external components to it too. 175 00:11:10,980 --> 00:11:16,460 And so I really think for me, there's moments where that comes, that cup feels a little 176 00:11:16,460 --> 00:11:20,020 emptier and you got to fill that cup back up. 177 00:11:20,020 --> 00:11:26,140 And so being somewhere where you can say to yourself, look, here's a talk by this incredible 178 00:11:26,140 --> 00:11:28,580 physician, scientist woman. 179 00:11:28,580 --> 00:11:33,300 We just had somebody visiting, if I can name drop her, Ashley Steed from Washington University, 180 00:11:33,300 --> 00:11:37,660 just have so much immense respect for her and for the work she does and for the clinician 181 00:11:37,660 --> 00:11:41,740 she is and the scientist she is and kind of the person, she's like a wonderful person 182 00:11:41,740 --> 00:11:42,740 too. 183 00:11:42,740 --> 00:11:46,820 And so she was coming to give a talk here at campus and I just thought, well, this is 184 00:11:46,820 --> 00:11:49,620 not in my research domain at all. 185 00:11:49,620 --> 00:11:52,820 But if my cup is feeling a little empty, I'm going to go fill that cup back up. 186 00:11:52,820 --> 00:11:59,060 I'm going to go hear from another female physician scientist who is out there hustling and making 187 00:11:59,060 --> 00:12:02,740 it work and crushing it and doing a great job. 188 00:12:02,740 --> 00:12:07,740 And so I think having the opportunity to, you know, just kind of tank back up and say, 189 00:12:07,740 --> 00:12:08,740 okay, great. 190 00:12:08,740 --> 00:12:09,740 Yes. 191 00:12:09,740 --> 00:12:14,220 I'm going to go fill some number of years ahead of me, if you will, in our prescribed 192 00:12:14,220 --> 00:12:20,460 trajectory who is just making it all work and just doing a fabulous job. 193 00:12:20,460 --> 00:12:21,460 I love it. 194 00:12:21,460 --> 00:12:24,940 I love what you talk about, the concept of filling your own tank, right? 195 00:12:24,940 --> 00:12:30,100 I think that many times we abdicate that responsibility to someone else and they don't even do a good 196 00:12:30,100 --> 00:12:31,360 job of it. 197 00:12:31,360 --> 00:12:36,660 And so for you to say, this is what I need and I'm going to go do that and you fill your 198 00:12:36,660 --> 00:12:41,660 own tank and at the end you feel satisfied and fulfilled because you did that. 199 00:12:41,660 --> 00:12:43,940 You took that step for yourself. 200 00:12:43,940 --> 00:12:49,820 And I just wonder how many of us do that enough and whether we're encouraged to do that. 201 00:12:49,820 --> 00:12:53,820 Because you speak about community and the power of community and being surrounded by 202 00:12:53,820 --> 00:12:56,200 people who are doing what you want to do. 203 00:12:56,200 --> 00:12:58,620 But even within that community, there are gaps. 204 00:12:58,620 --> 00:13:02,380 You're going out and finding what you need and filling your own cup, which allows you 205 00:13:02,380 --> 00:13:03,940 to keep being successful. 206 00:13:03,940 --> 00:13:11,500 Yeah, and so much of the time, the programming that we get offered, especially as female 207 00:13:11,500 --> 00:13:15,820 physician scientists, is how to have a work-life balance. 208 00:13:15,820 --> 00:13:22,700 I think it's just this theme that it's very important, but it's almost that we get told 209 00:13:22,700 --> 00:13:25,420 more that this is important for us. 210 00:13:25,420 --> 00:13:26,420 It's not important for everybody. 211 00:13:26,420 --> 00:13:27,780 It's really important for women. 212 00:13:27,780 --> 00:13:29,780 We have to figure out how to have work-life balance. 213 00:13:29,780 --> 00:13:36,020 We have to figure out how to be satisfied with our work time and our family time. 214 00:13:36,020 --> 00:13:37,740 And we've got to figure out that balance. 215 00:13:37,740 --> 00:13:40,500 And here's a seminar on how to accomplish that. 216 00:13:40,500 --> 00:13:45,340 And really, we have to figure out how to be great physicians and we have to figure out 217 00:13:45,340 --> 00:13:47,300 how to be great scientists. 218 00:13:47,300 --> 00:13:53,020 And that's a universal problem that a physician scientist has. 219 00:13:53,020 --> 00:13:59,300 And I don't think we all get equally pressured to also have a nice life, figure all of that 220 00:13:59,300 --> 00:14:00,300 out. 221 00:14:00,300 --> 00:14:04,060 So yeah, for me, I just want to see other women out there crushing it. 222 00:14:04,060 --> 00:14:07,140 And there's a lot of great examples around me. 223 00:14:07,140 --> 00:14:08,140 That's awesome. 224 00:14:08,140 --> 00:14:10,580 And you are a great example yourself. 225 00:14:10,580 --> 00:14:11,580 Thank you. 226 00:14:11,580 --> 00:14:12,580 All right. 227 00:14:12,580 --> 00:14:13,580 I want to... 228 00:14:13,580 --> 00:14:16,780 I know you taught you a lot of things that I feel like we should talk about, but we're 229 00:14:16,780 --> 00:14:17,780 going to talk about it. 230 00:14:17,780 --> 00:14:19,700 Actually, maybe this is a good time though. 231 00:14:19,700 --> 00:14:21,480 How do we keep women... 232 00:14:21,480 --> 00:14:25,780 How do we keep trainees in general, but especially women committed to the physician scientist 233 00:14:25,780 --> 00:14:26,780 pathway? 234 00:14:26,780 --> 00:14:29,460 One of the things you allude to is that this is hard. 235 00:14:29,460 --> 00:14:33,120 And even when you're surrounded by communities of people who are doing this, there's still 236 00:14:33,120 --> 00:14:37,620 times when you're feeling low and you need more and you need encouragement along the 237 00:14:37,620 --> 00:14:38,620 way. 238 00:14:38,620 --> 00:14:43,740 And you alluded to the fact that it is different for people who identify as women compared 239 00:14:43,740 --> 00:14:46,200 to men in the academy. 240 00:14:46,200 --> 00:14:52,900 Can you speak to how we can support people better at the trainee phase and even as faculty? 241 00:14:52,900 --> 00:14:54,140 Yes. 242 00:14:54,140 --> 00:15:00,460 I think that first we have to recognize that this pathway of trying to have two jobs at 243 00:15:00,460 --> 00:15:06,420 the same time is difficult and anybody doing it knows that. 244 00:15:06,420 --> 00:15:13,540 And I think that outside of really living in it, really living that moment where you 245 00:15:13,540 --> 00:15:20,580 are writing a grant and getting a page at the same time and you have to make a decision, 246 00:15:20,580 --> 00:15:22,440 is this an urgent page? 247 00:15:22,440 --> 00:15:23,700 Do I need to call somebody back? 248 00:15:23,700 --> 00:15:24,700 Oops, it's too late. 249 00:15:24,700 --> 00:15:26,380 My brain's already clinical. 250 00:15:26,380 --> 00:15:30,100 How to do those two things at exactly the same time. 251 00:15:30,100 --> 00:15:35,100 I think first we just have to start with the recognition that it's very hard. 252 00:15:35,100 --> 00:15:40,260 And with that recognition can then come sort of extra support. 253 00:15:40,260 --> 00:15:46,180 And for me, I had these funny moments along my training pathway where I sort of fell into 254 00:15:46,180 --> 00:15:52,540 some opportunities to get support that, okay, well, I could say fell into it or I could 255 00:15:52,540 --> 00:15:54,380 say earned it, whatever. 256 00:15:54,380 --> 00:15:59,900 You know, these moments in my training path where I was presented with opportunities that 257 00:15:59,900 --> 00:16:01,660 I seized, let's say it that way. 258 00:16:01,660 --> 00:16:02,660 I love that. 259 00:16:02,660 --> 00:16:04,300 Okay, yes. 260 00:16:04,300 --> 00:16:10,460 And you know, one of them, honest to God, it sounds so small, but very early in my postdoctoral 261 00:16:10,460 --> 00:16:14,620 training I got to work with a technician. 262 00:16:14,620 --> 00:16:19,100 And I don't know that I would be sitting here talking to you right now if I didn't have 263 00:16:19,100 --> 00:16:20,820 that opportunity. 264 00:16:20,820 --> 00:16:22,940 But yes, it was me training another person. 265 00:16:22,940 --> 00:16:28,100 And yes, that person had their own long-term goals and why they had come to the lab. 266 00:16:28,100 --> 00:16:32,740 But for me, what it allowed me to do was I had a patient relapsing and I wanted to go 267 00:16:32,740 --> 00:16:36,140 talk to them about their treatment plan and my work didn't have to stop. 268 00:16:36,140 --> 00:16:38,100 Or I didn't have to be there. 269 00:16:38,100 --> 00:16:42,100 I was there until midnight plenty of times, but it didn't mean, oh, now I'm going to have 270 00:16:42,100 --> 00:16:47,020 to be here until midnight because I can't even start my experiment until 5 p.m. 271 00:16:47,020 --> 00:16:51,540 It really meant, okay, well, here's somebody who I've invested a lot of time training. 272 00:16:51,540 --> 00:16:55,460 I've gotten that experience of training and mentoring someone. 273 00:16:55,460 --> 00:17:03,420 And also, this is a person who it's very reasonable to turn to and say, let's come up with a plan 274 00:17:03,420 --> 00:17:05,180 for what your afternoon is going to look like. 275 00:17:05,180 --> 00:17:08,700 I need to make a small adjustment because of an emergency that's happening for the other 276 00:17:08,700 --> 00:17:10,740 part of my job. 277 00:17:10,740 --> 00:17:12,980 And that was huge. 278 00:17:12,980 --> 00:17:14,740 It was great to be able to train someone. 279 00:17:14,740 --> 00:17:18,700 It was great to have that experience of mentorship. 280 00:17:18,700 --> 00:17:24,660 And it was hugely helpful for the type of clinical work I was doing to be able at an 281 00:17:24,660 --> 00:17:29,140 earlier stage than I think a lot of people get the opportunity to do to walk away from 282 00:17:29,140 --> 00:17:32,940 the lab at random times to do my second job. 283 00:17:32,940 --> 00:17:38,660 And right, I think that was a really great thing to help keep me on this path. 284 00:17:38,660 --> 00:17:41,140 But it's so uncommon. 285 00:17:41,140 --> 00:17:45,020 And it really is so variable from lab to lab. 286 00:17:45,020 --> 00:17:51,240 And we pay technicians so little that I don't think it would be, okay, that's its own problem. 287 00:17:51,240 --> 00:17:53,460 But in academics, that's its own problem. 288 00:17:53,460 --> 00:17:58,940 But I don't know that it would be some massively huge investment to say, okay, what kind of 289 00:17:58,940 --> 00:18:03,540 clinical work are our fellows doing as they're trying to get postdoctoral serious scholarly 290 00:18:03,540 --> 00:18:05,460 research done? 291 00:18:05,460 --> 00:18:10,860 What would it take to say, hey, host laboratory, mentor laboratory? 292 00:18:10,860 --> 00:18:15,100 We're going to provide half an FTE worth of salary for a technician if you're willing 293 00:18:15,100 --> 00:18:18,980 to dedicate at least that half FTE to this fellow. 294 00:18:18,980 --> 00:18:22,460 And at some point, I actually just asked for that. 295 00:18:22,460 --> 00:18:30,440 I thought I'm going to put my big girl pants on and say, hey, my leadership in my division, 296 00:18:30,440 --> 00:18:31,580 I really need this. 297 00:18:31,580 --> 00:18:36,460 I'm really realizing I need this support, this pair of hands in the lab to help me extend 298 00:18:36,460 --> 00:18:38,920 the work that I can get done during the day. 299 00:18:38,920 --> 00:18:40,580 Will you pay for that? 300 00:18:40,580 --> 00:18:43,580 And my leadership said, yes. 301 00:18:43,580 --> 00:18:45,660 And I was very grateful. 302 00:18:45,660 --> 00:18:46,660 I was very surprised. 303 00:18:46,660 --> 00:18:48,500 I was very grateful. 304 00:18:48,500 --> 00:18:50,700 But that is not institutionalized. 305 00:18:50,700 --> 00:18:55,620 And I really think it ought to be thinking how can we say, here's a person who's really 306 00:18:55,620 --> 00:19:03,620 proven through their commitment to this pathway that they want to be a physician scientist. 307 00:19:03,620 --> 00:19:09,880 What can we do to help them get there rather than have these barriers that come with having 308 00:19:09,880 --> 00:19:11,300 two jobs? 309 00:19:11,300 --> 00:19:17,300 So I think that's kind of small potatoes cash that could really go a long way to keeping 310 00:19:17,300 --> 00:19:21,120 people in the pipeline in that critical fellowship period. 311 00:19:21,120 --> 00:19:24,940 Because I do think you can get through an MD, PhD program, or you can get through an 312 00:19:24,940 --> 00:19:29,500 MD where you're doing heavy focus on research and you have research opportunities in your 313 00:19:29,500 --> 00:19:31,600 residency training period too. 314 00:19:31,600 --> 00:19:36,420 And it's really that fellowship time, I think, where you see all your residency friends who 315 00:19:36,420 --> 00:19:41,000 didn't do fellowship training are out in the world making money and doing some version 316 00:19:41,000 --> 00:19:46,540 of nine to five, probably more than that, but some nine to five-ish kind of a job with 317 00:19:46,540 --> 00:19:51,020 more regular hours, benefits, all those good things. 318 00:19:51,020 --> 00:19:56,940 And you're still slogging away as a fellow in the lab and doing your clinical stuff. 319 00:19:56,940 --> 00:20:01,820 And the end is not in sight yet in the sense of you've got to work towards getting an early 320 00:20:01,820 --> 00:20:02,820 career award. 321 00:20:02,820 --> 00:20:06,400 You've got to get a K. You've got to get all these things under your belt. 322 00:20:06,400 --> 00:20:10,740 And then your fellowship colleagues finish and maybe they take a clinical job and you 323 00:20:10,740 --> 00:20:16,320 see, okay, well, not that their life is easy by any means, but their life now, they're 324 00:20:16,320 --> 00:20:17,660 doing what they want to do. 325 00:20:17,660 --> 00:20:22,960 They've already gotten there and they're already sort of, they're seeing patients, they're 326 00:20:22,960 --> 00:20:25,880 contributing to that incredibly important aspect of patient care. 327 00:20:25,880 --> 00:20:28,500 And I'm still working towards my goals. 328 00:20:28,500 --> 00:20:35,140 And if we make that period of time easier, I think more people will say on the pathway. 329 00:20:35,140 --> 00:20:40,140 And then of course, it's another funding thing is just, we need more support for these early 330 00:20:40,140 --> 00:20:41,880 career awards. 331 00:20:41,880 --> 00:20:45,700 And having a K award is so critical. 332 00:20:45,700 --> 00:20:49,980 And the K funding lines at some agency are not what they need to be. 333 00:20:49,980 --> 00:20:53,980 I really want to commend the NHLBI if I can. 334 00:20:53,980 --> 00:20:59,440 They made a K99R00 pilot program that's specific for physician scientists. 335 00:20:59,440 --> 00:21:05,060 And I think recognizing this problem at that transition from fellowship to instructor stage, 336 00:21:05,060 --> 00:21:09,900 they said, listen, we're going to do a look back and we're going to judge you, your competitiveness 337 00:21:09,900 --> 00:21:14,660 for this award based on time that you've have done research in the past, for example, if 338 00:21:14,660 --> 00:21:18,540 you did a PhD and your commitment to this pathway. 339 00:21:18,540 --> 00:21:25,140 And we know that it's really hard in two years of fellowship to already have some big, huge 340 00:21:25,140 --> 00:21:31,000 first author paper that is in Cell Nature Science or whatever other top journal in your 341 00:21:31,000 --> 00:21:35,540 field, but we really want to support people staying in this pathway. 342 00:21:35,540 --> 00:21:40,420 And so they've piloted this program for specifically for physician scientists. 343 00:21:40,420 --> 00:21:47,380 And I think we need more opportunities like that at other NIH agencies. 344 00:21:47,380 --> 00:21:53,660 You have crystallized a problem just, I mean, just perfectly. 345 00:21:53,660 --> 00:22:00,660 I think one thing that is not always obvious to trainees on the journey is that for the 346 00:22:00,660 --> 00:22:03,620 most part, so for you, you did an MBA PhD. 347 00:22:03,620 --> 00:22:07,820 So there's PhD training in the background of that, but nowhere near as much research 348 00:22:07,820 --> 00:22:10,740 training as your PhD only colleagues. 349 00:22:10,740 --> 00:22:14,380 And then when you look at the MDs where there's barely really any research training in any 350 00:22:14,380 --> 00:22:18,220 of that, there may have been time in the lab or time doing research, but not really research 351 00:22:18,220 --> 00:22:20,540 training for research leadership. 352 00:22:20,540 --> 00:22:26,460 And so here we are in the clinical space where we go from intern to being a resident to being 353 00:22:26,460 --> 00:22:30,820 a senior resident in those three or four years of our residency training. 354 00:22:30,820 --> 00:22:34,300 And there's never the expectation that one person is taking care of the patient by themselves. 355 00:22:34,300 --> 00:22:38,180 But then you get to the place of research and then it's like, well, you're on your 356 00:22:38,180 --> 00:22:39,180 own. 357 00:22:39,180 --> 00:22:42,140 I hope you can do all the experiments and still be a physician. 358 00:22:42,140 --> 00:22:43,140 Good luck. 359 00:22:43,140 --> 00:22:44,140 And it's not really realistic. 360 00:22:44,140 --> 00:22:48,100 And I think it's you alluding to something that I feel like the business world knows 361 00:22:48,100 --> 00:22:49,100 well. 362 00:22:49,100 --> 00:22:52,940 It's like, I mean, it sounds bad to say leveraging other people's time, but it really is the 363 00:22:52,940 --> 00:22:54,260 way it is. 364 00:22:54,260 --> 00:22:58,740 It's that what is the benefit of the physician who spends a lot of time pipetting where they 365 00:22:58,740 --> 00:23:04,100 could easily teach someone else to do that and really now enter into the thought leadership 366 00:23:04,100 --> 00:23:05,460 of leading the research program? 367 00:23:05,460 --> 00:23:06,460 That's really what's about. 368 00:23:06,460 --> 00:23:07,460 It's not about doing. 369 00:23:07,460 --> 00:23:08,460 It's about leading the doing. 370 00:23:08,460 --> 00:23:11,740 It's about thinking about the direction of doing. 371 00:23:11,740 --> 00:23:16,820 And I think it is a missed opportunity to support people in that from the beginning, 372 00:23:16,820 --> 00:23:22,100 to almost wait for people to finally either succeed or fall flat on their faces and then 373 00:23:22,100 --> 00:23:27,740 judge them to be not capable, but really how do we resource people so that they can succeed 374 00:23:27,740 --> 00:23:29,780 if that's what they want to do? 375 00:23:29,780 --> 00:23:32,140 And I do think that's a big gap. 376 00:23:32,140 --> 00:23:36,620 And I love your story of negotiating what you need, and I'm big on negotiation. 377 00:23:36,620 --> 00:23:41,580 I think we should ask for everything we want and then some. 378 00:23:41,580 --> 00:23:42,580 But it's like, why? 379 00:23:42,580 --> 00:23:46,480 Why did you have to ask for something that you should have gotten from the very beginning? 380 00:23:46,480 --> 00:23:48,300 Why isn't that baked in? 381 00:23:48,300 --> 00:23:51,960 And so there's opportunity for institutions to get up and really support people. 382 00:23:51,960 --> 00:23:56,420 If you want people to succeed in this endeavor, resource them to succeed. 383 00:23:56,420 --> 00:23:58,780 And our part is we're moving forward. 384 00:23:58,780 --> 00:24:02,700 It's like, well, if we don't have what we need, we should ask for it. 385 00:24:02,700 --> 00:24:03,700 Ask for it. 386 00:24:03,700 --> 00:24:06,860 And it's not always easy, but it's definitely, I think there's opportunity on both sides. 387 00:24:06,860 --> 00:24:09,420 I don't know if you want to speak more about that. 388 00:24:09,420 --> 00:24:15,820 This is such an interesting challenge because I really see as somebody who did a PhD and 389 00:24:15,820 --> 00:24:19,060 my PhD looked like the PhD of my PhD colleagues. 390 00:24:19,060 --> 00:24:20,060 It was not any easier. 391 00:24:20,060 --> 00:24:21,660 It wasn't any different. 392 00:24:21,660 --> 00:24:26,160 I got to get some of my classes out of the way during med school time. 393 00:24:26,160 --> 00:24:31,700 But then I spent just as much time in the lab as my colleagues did. 394 00:24:31,700 --> 00:24:36,620 And so that was hugely, it was a hugely useful experience because I got to think through 395 00:24:36,620 --> 00:24:37,900 how do you design an experiment? 396 00:24:37,900 --> 00:24:39,020 How do you ask a question? 397 00:24:39,020 --> 00:24:43,820 How you design the experiments to answer the hypothesis that you've come up with? 398 00:24:43,820 --> 00:24:47,760 How are you going to make something out of proving your hypothesis right and wrong? 399 00:24:47,760 --> 00:24:53,100 How do you stand up in front of people and communicate your science effectively and write 400 00:24:53,100 --> 00:24:54,100 a grant? 401 00:24:54,100 --> 00:24:57,780 You know, so many things that you get the opportunity to learn in that phase. 402 00:24:57,780 --> 00:25:03,200 And I think especially when you get to your postdoc training that's happening during a 403 00:25:03,200 --> 00:25:09,160 clinical fellowship, it's hard if you've never had those experiences. 404 00:25:09,160 --> 00:25:11,780 You want to bake that in, right? 405 00:25:11,780 --> 00:25:15,140 Those are incredibly rich experiences that you need to bake in. 406 00:25:15,140 --> 00:25:20,300 But you also have to become the leader of a lab where experiments are being done. 407 00:25:20,300 --> 00:25:22,900 So you need to know how to do the experiments. 408 00:25:22,900 --> 00:25:28,440 But do you need to do those experiments yourself personally as the only person for years in 409 00:25:28,440 --> 00:25:30,060 a row? 410 00:25:30,060 --> 00:25:35,140 Does that have to be the system or can it be, okay, I'm putting my hands on this right 411 00:25:35,140 --> 00:25:38,140 now and I'm learning it and I'm mastering it. 412 00:25:38,140 --> 00:25:42,380 And then I will teach somebody how to do it and I will move on so that when that person 413 00:25:42,380 --> 00:25:44,860 has questions, I understand how this works. 414 00:25:44,860 --> 00:25:46,500 I understand the ins and outs of this. 415 00:25:46,500 --> 00:25:49,940 When I'm the lab leader, I can direct the questions. 416 00:25:49,940 --> 00:25:51,740 I can think about the science. 417 00:25:51,740 --> 00:25:52,740 I can do this. 418 00:25:52,740 --> 00:25:58,560 But I can also, you know, know how to point someone in the right direction experimentally 419 00:25:58,560 --> 00:26:06,180 or I can hire a lab manager or a staff scientist who I can feel confident knows how to direct 420 00:26:06,180 --> 00:26:10,380 people and those things experimentally because I'm comfortable with it. 421 00:26:10,380 --> 00:26:15,460 And that is it's almost that those two things are, you know, at odds with each other that 422 00:26:15,460 --> 00:26:22,100 you want someone to really become a good experimentalist in that way and be able to, you know, lead 423 00:26:22,100 --> 00:26:23,100 their people. 424 00:26:23,100 --> 00:26:27,180 But you want them to also be using the part of their brain where they can critically think 425 00:26:27,180 --> 00:26:31,020 about big questions, how to answer them. 426 00:26:31,020 --> 00:26:36,160 And if somebody has not had PhD training, you're asking a lot out of somebody in a very 427 00:26:36,160 --> 00:26:43,540 small period of time before you then have them have access to institutional or, you 428 00:26:43,540 --> 00:26:50,740 know, national fellowship awards to help support their additional time to foster that experience 429 00:26:50,740 --> 00:26:58,140 and then throw in the mix that so many institutions are moving towards models where they want 430 00:26:58,140 --> 00:27:04,020 to de-invest from big pieces of equipment, complex pieces of equipment, lots of labs, 431 00:27:04,020 --> 00:27:09,540 having lots of pieces of equipment by themselves to things happening in core facilities. 432 00:27:09,540 --> 00:27:16,840 That makes a lot of sense to me from the business world of why ask a hundred labs to be replicating 433 00:27:16,840 --> 00:27:25,060 the same infrastructure and the same, you know, every PI or every fellow or every, you 434 00:27:25,060 --> 00:27:30,260 know, lab manager takes a new person who comes into the lab and that person has to, you know, 435 00:27:30,260 --> 00:27:35,860 learn this over and over and develop from zero to expertise in, you know, some technical 436 00:27:35,860 --> 00:27:36,860 pipetting thing. 437 00:27:36,860 --> 00:27:41,080 Why don't we just put that expertise into a core group of people with a core set of 438 00:27:41,080 --> 00:27:44,520 instruments that are highly well maintained or highly trained people and we'll get the 439 00:27:44,520 --> 00:27:46,360 work done faster. 440 00:27:46,360 --> 00:27:51,100 And so I think that's great and it makes a lot of sense. 441 00:27:51,100 --> 00:27:56,940 But it also could, I see why people feel some concern about them saying, okay, well, welcome 442 00:27:56,940 --> 00:27:57,940 to the lab. 443 00:27:57,940 --> 00:27:58,940 Here's a technician. 444 00:27:58,940 --> 00:28:03,440 We're going to send most of your stuff to a core facility and three to four years from 445 00:28:03,440 --> 00:28:04,980 now you can run your own group. 446 00:28:04,980 --> 00:28:07,740 You're going to know exactly how to get everything done. 447 00:28:07,740 --> 00:28:13,560 And that's a simplification of, that's a simplification, but I think there are some people who worry 448 00:28:13,560 --> 00:28:17,800 is that what this end of somebody's training is going to look like and are they really 449 00:28:17,800 --> 00:28:21,960 going to be ready to do all the things you have to do as a lab leader, as a physician 450 00:28:21,960 --> 00:28:27,140 scientist where, you know, you can truly think about the science, think about the questions 451 00:28:27,140 --> 00:28:32,200 and know how to answer the questions and be critical of the data that people are walking 452 00:28:32,200 --> 00:28:33,920 into your office with. 453 00:28:33,920 --> 00:28:38,840 And I don't know how, I don't know what the right answer is, but I definitely see where 454 00:28:38,840 --> 00:28:40,720 there's some tension there. 455 00:28:40,720 --> 00:28:41,720 Absolutely. 456 00:28:41,720 --> 00:28:43,540 It's a lot of, it's complex. 457 00:28:43,540 --> 00:28:47,600 It's that you are as a clinician scientist, really an emerging leader. 458 00:28:47,600 --> 00:28:49,320 That's who you are. 459 00:28:49,320 --> 00:28:55,000 And part of that leadership is getting your hands dirty and learning how to do it, is 460 00:28:55,000 --> 00:28:57,800 getting your hands dirty and learning how to do it so that you can support other people 461 00:28:57,800 --> 00:28:58,960 to do it. 462 00:28:58,960 --> 00:29:03,680 But if a lot of that getting your hands dirty is that the opportunity is not available, 463 00:29:03,680 --> 00:29:06,200 it's being siphoned away to another group. 464 00:29:06,200 --> 00:29:10,280 How do you do that and still become an effective leader that you need to be? 465 00:29:10,280 --> 00:29:15,160 And are we raising people who are disconnected from being able to do the good science? 466 00:29:15,160 --> 00:29:16,160 Like you're right. 467 00:29:16,160 --> 00:29:21,360 If all the data is being generated outside, do I have the training to be able to analyze 468 00:29:21,360 --> 00:29:23,240 the data and say, do I accept this? 469 00:29:23,240 --> 00:29:24,240 Is this real? 470 00:29:24,240 --> 00:29:25,240 Is this credible? 471 00:29:25,240 --> 00:29:26,240 Is this authentic? 472 00:29:26,240 --> 00:29:27,560 Is this quality data? 473 00:29:27,560 --> 00:29:29,120 And those are challenges. 474 00:29:29,120 --> 00:29:32,800 I'm not sure that the answers are readily apparent. 475 00:29:32,800 --> 00:29:34,360 I agree. 476 00:29:34,360 --> 00:29:35,360 Yeah. 477 00:29:35,360 --> 00:29:41,040 I wonder though, it's like looking forward into the future, if you could have a blank 478 00:29:41,040 --> 00:29:49,880 check and fix like one thing, major thing in this clinician scientist training pathway 479 00:29:49,880 --> 00:29:54,880 and faculty development pathway, what would that be and why would that be the thing you 480 00:29:54,880 --> 00:29:58,600 choose? 481 00:29:58,600 --> 00:30:06,960 If I could get one thing to fix, I could fix one thing. 482 00:30:06,960 --> 00:30:09,800 That is such a tough question because we've got to fix a few. 483 00:30:09,800 --> 00:30:12,960 If you want to cluster them, that's okay. 484 00:30:12,960 --> 00:30:15,840 No, I mean, not to be redundant. 485 00:30:15,840 --> 00:30:17,820 We just need more funding. 486 00:30:17,820 --> 00:30:25,720 We just need, we need people to know, look, I think back to my time being a post-doc during 487 00:30:25,720 --> 00:30:30,160 the pandemic, I was getting up at 3.30 in the morning so that I could get to the lab 488 00:30:30,160 --> 00:30:33,920 by four for my shift because I had to be out of my bay by noon. 489 00:30:33,920 --> 00:30:36,000 Right at the beginning, I wanted to get the work done. 490 00:30:36,000 --> 00:30:38,880 I didn't want to not get the work done. 491 00:30:38,880 --> 00:30:39,880 Yeah. 492 00:30:39,880 --> 00:30:45,400 I mean, when you have somebody who's got the dedication, who's got that commitment to this 493 00:30:45,400 --> 00:30:52,000 pathway or you have somebody who's just coming with all this skill and all this intelligence 494 00:30:52,000 --> 00:30:56,120 who wants to know what does it mean to be a scientist and this is their first opportunity 495 00:30:56,120 --> 00:31:04,840 to do it and the road in front of them is, okay, well, come work incredibly hard, have 496 00:31:04,840 --> 00:31:09,920 two jobs, have all the challenges that go along with being both a physician and a scientist, 497 00:31:09,920 --> 00:31:13,080 I don't know rewards, but all the challenges that go along with that. 498 00:31:13,080 --> 00:31:18,200 And at the end of the day, you might have done enough. 499 00:31:18,200 --> 00:31:26,920 You might be able to access this funding mechanism that's just so critical and you might have 500 00:31:26,920 --> 00:31:32,760 done all the things you need to be able to get an early career award from the NIH and 501 00:31:32,760 --> 00:31:38,920 that's the gold shining light and the pay line is whatever it is, 10%. 502 00:31:38,920 --> 00:31:45,600 So asking somebody to stay committed to that pathway when they feel that, well, maybe I 503 00:31:45,600 --> 00:31:51,760 have a one in 10 or maybe a one in five chance of getting this award, that's a stepping stone 504 00:31:51,760 --> 00:31:52,920 in and of itself. 505 00:31:52,920 --> 00:32:00,320 That's not the guarantee that I'm not going to get scooped and instead of having a nice 506 00:32:00,320 --> 00:32:06,800 cell nature science or my field blood in some high impact publication that I need to have 507 00:32:06,800 --> 00:32:13,880 in order to be marketable to an academic institution, all these things have to line up. 508 00:32:13,880 --> 00:32:24,000 You almost have to be both intelligent, motivated, a great leader and lucky and making that happen 509 00:32:24,000 --> 00:32:29,760 really requires a lot of working hours every day, every week, every traditional working 510 00:32:29,760 --> 00:32:33,740 day and maybe some non-traditional working days as well. 511 00:32:33,740 --> 00:32:38,360 So good luck on your journey and we'll see you at the end in a few years and hopefully 512 00:32:38,360 --> 00:32:43,680 you've done enough to get this career award that you need and we just have to fund more 513 00:32:43,680 --> 00:32:46,960 of those. 514 00:32:46,960 --> 00:32:52,760 We just have to make it so that the path doesn't seem so improbable that you would spend all 515 00:32:52,760 --> 00:33:00,080 this extra time and effort relative to people who choose a path where they have, and I hate 516 00:33:00,080 --> 00:33:04,360 to say just one job because it's not that being a clinician is easy or being a scientist 517 00:33:04,360 --> 00:33:11,040 is easy, but that you are really being asked to do so much to have two jobs at one time 518 00:33:11,040 --> 00:33:18,160 and the end of the road is kind of can seem like a very improbable chance for success 519 00:33:18,160 --> 00:33:20,640 and it really I think comes down to money. 520 00:33:20,640 --> 00:33:25,480 We've just got to fund more of those early career fellowship awards. 521 00:33:25,480 --> 00:33:31,320 I really commend programs like Burroughs Welcome, Doris Duke, who are really recognizing that 522 00:33:31,320 --> 00:33:37,120 there are gaps that the NIH with the constraints that it has of not being able to come up with 523 00:33:37,120 --> 00:33:42,480 its own budget that with those constraints there are gaps that need to be filled and 524 00:33:42,480 --> 00:33:47,400 are trying to step up and to fill those gaps for exactly this time in physician scientist 525 00:33:47,400 --> 00:33:48,400 careers. 526 00:33:48,400 --> 00:33:50,640 Thank you, Julia. 527 00:33:50,640 --> 00:33:54,640 I think that this is like a call to the billionaires out there. 528 00:33:54,640 --> 00:34:00,680 This is why we need funding and we need more support for physician scientists. 529 00:34:00,680 --> 00:34:01,680 It's important. 530 00:34:01,680 --> 00:34:04,400 It's the only way healthcare advances and it's hard. 531 00:34:04,400 --> 00:34:06,040 It is very, very hard. 532 00:34:06,040 --> 00:34:08,960 And as you say, it's almost like it's like good luck. 533 00:34:08,960 --> 00:34:10,920 We hope we see you on the other side. 534 00:34:10,920 --> 00:34:11,920 Yeah, exactly. 535 00:34:11,920 --> 00:34:15,920 And there's a cry about how there's such a shortage of physician scientists and it's 536 00:34:15,920 --> 00:34:17,560 like, well, of course there's a shortage. 537 00:34:17,560 --> 00:34:19,400 It's very difficult. 538 00:34:19,400 --> 00:34:21,080 It's hard to make it through. 539 00:34:21,080 --> 00:34:24,360 And so then that begs the question, Julia, how come you're still here? 540 00:34:24,360 --> 00:34:25,520 This is such a hard journey. 541 00:34:25,520 --> 00:34:26,560 It's been hard so far. 542 00:34:26,560 --> 00:34:28,720 The road ahead still seems hard. 543 00:34:28,720 --> 00:34:30,280 How is it that you're still here? 544 00:34:30,280 --> 00:34:32,280 What is keeping you in the game? 545 00:34:32,280 --> 00:34:37,400 Yeah, that's a great question. 546 00:34:37,400 --> 00:34:43,320 And you know, for me, it's what keeps me in the game is why we are here as physician 547 00:34:43,320 --> 00:34:44,320 scientists. 548 00:34:44,320 --> 00:34:49,320 I get to come to the lab in the morning and think, okay, there's questions I want to answer, 549 00:34:49,320 --> 00:34:51,680 that part of my brain that I love using. 550 00:34:51,680 --> 00:34:53,400 I love coming to the lab. 551 00:34:53,400 --> 00:34:54,520 I love mentoring people. 552 00:34:54,520 --> 00:35:02,080 I love thinking about questions that need answering and coming to love grant writing 553 00:35:02,080 --> 00:35:06,560 and all that entails, but really to synthesize your thoughts and say, am I on the right track? 554 00:35:06,560 --> 00:35:08,880 Am I answering questions correctly? 555 00:35:08,880 --> 00:35:12,400 What a fun way to spend your day. 556 00:35:12,400 --> 00:35:16,040 Young people coming through the lab who are never been in the lab before and want to know 557 00:35:16,040 --> 00:35:17,680 what doing science is all about. 558 00:35:17,680 --> 00:35:19,660 It's so satisfying. 559 00:35:19,660 --> 00:35:27,080 And then I just walk down the hall and I see children who I can help and I can help them 560 00:35:27,080 --> 00:35:29,380 right there in that moment. 561 00:35:29,380 --> 00:35:33,540 And I can look at the problems they're having and saying, is there something I can be doing 562 00:35:33,540 --> 00:35:36,420 back in the lab to help you with this problem? 563 00:35:36,420 --> 00:35:43,140 So I think about a patient who unfortunately passed away, who had a invasive fungal infection 564 00:35:43,140 --> 00:35:48,040 after having a really long period of not having any neutrophils. 565 00:35:48,040 --> 00:35:54,700 And it was so heartbreaking for so many reasons, but primarily because I think we could have 566 00:35:54,700 --> 00:35:57,880 cured that child of their cancer. 567 00:35:57,880 --> 00:36:04,180 And to me, that moment where we need more, we need to offer these children more. 568 00:36:04,180 --> 00:36:05,880 We need to offer these families more. 569 00:36:05,880 --> 00:36:10,960 We need to be able to look somebody with a new cancer diagnosis in the eye and say, you're 570 00:36:10,960 --> 00:36:13,820 going to be at risk for infections, but don't worry, we got this. 571 00:36:13,820 --> 00:36:15,400 We're actually going to fix that problem. 572 00:36:15,400 --> 00:36:20,840 So let's focus on beating the cancer as aggressively as we possibly can. 573 00:36:20,840 --> 00:36:24,840 And I care for patients too, who just their whole life they can't make neutrophils. 574 00:36:24,840 --> 00:36:30,460 And the incredible impact on their quality of life, having this fear from the time that 575 00:36:30,460 --> 00:36:35,020 your child is born that at any moment they could have a life threatening infection. 576 00:36:35,020 --> 00:36:38,420 I mean, we just have to do more for these patients. 577 00:36:38,420 --> 00:36:39,820 We just have to. 578 00:36:39,820 --> 00:36:47,540 And being poised to contribute to the care of those kids and their families is really 579 00:36:47,540 --> 00:36:49,420 a special privilege. 580 00:36:49,420 --> 00:36:52,980 And I can't right now imagine doing anything else. 581 00:36:52,980 --> 00:36:59,460 Though, I know many people take different trajectories in their long careers, so stay 582 00:36:59,460 --> 00:37:00,460 tuned. 583 00:37:00,460 --> 00:37:05,940 But for right now, it's really feels like a privilege to have this job. 584 00:37:05,940 --> 00:37:12,820 Absolutely, and I love you light up as you're talking about this path and it's hard, but 585 00:37:12,820 --> 00:37:18,740 you're having fun and you can see the impact in what you have the potential to do. 586 00:37:18,740 --> 00:37:21,140 And so it's really awesome and it's interesting. 587 00:37:21,140 --> 00:37:25,660 It's like, yeah, this is hard, but it's like the struggle. 588 00:37:25,660 --> 00:37:28,740 It's hard to picture being without it for sure. 589 00:37:28,740 --> 00:37:34,420 All right, so we are coming to the end of the show and I wanted to ask you if there 590 00:37:34,420 --> 00:37:40,220 is someone who is a clinician early, early, early on in their career and they're struggling 591 00:37:40,220 --> 00:37:43,140 and they're like, I'm not even sure this is worth it anymore. 592 00:37:43,140 --> 00:37:45,660 How would you encourage them? 593 00:37:45,660 --> 00:37:50,740 Yes, right. 594 00:37:50,740 --> 00:37:55,860 Because yes, how would I encourage them? 595 00:37:55,860 --> 00:37:58,700 Because it is really a hard pathway. 596 00:37:58,700 --> 00:38:05,980 And there is that desire to not just tell people, well, the only right way forward is 597 00:38:05,980 --> 00:38:08,060 to be just like me. 598 00:38:08,060 --> 00:38:13,220 The only way that you will be a success at the end of the day is if you're doing exactly 599 00:38:13,220 --> 00:38:17,620 what I'm doing, because that shouldn't be true. 600 00:38:17,620 --> 00:38:22,580 And if somebody is really struggling, for me, I think it's a good opportunity to reflect 601 00:38:22,580 --> 00:38:25,780 and to say, well, why did you come to the lab in the first place? 602 00:38:25,780 --> 00:38:27,960 What brought you to the lab? 603 00:38:27,960 --> 00:38:34,060 What did you want to get out of your time coming to do a research project? 604 00:38:34,060 --> 00:38:38,940 And for some people, I've heard them say things like, well, I never got a chance to do research 605 00:38:38,940 --> 00:38:42,540 before and I just wanted to know what it's like. 606 00:38:42,540 --> 00:38:47,860 And the more time I spend here, the more I really just wish I was in the clinic. 607 00:38:47,860 --> 00:38:56,720 Maybe that's a person who shouldn't keep pushing themselves down a path that they really are 608 00:38:56,720 --> 00:38:59,740 just feeling a pull away from. 609 00:38:59,740 --> 00:39:07,260 And the road ahead would be, I think, for that person, a very difficult road. 610 00:39:07,260 --> 00:39:14,340 But if somebody says something more like, well, I really wanted to be able to think 611 00:39:14,340 --> 00:39:18,220 about problems that are impacting these patients that I care for. 612 00:39:18,220 --> 00:39:22,460 And I think somehow my project is not moving forward or I've moved far away from that or 613 00:39:22,460 --> 00:39:26,020 I got into the lab and I thought I was going to work on one thing and instead I'm working 614 00:39:26,020 --> 00:39:31,460 on another, sit down and almost write a mini grant for yourself. 615 00:39:31,460 --> 00:39:33,220 What do you want to do? 616 00:39:33,220 --> 00:39:35,300 What did you want to get out of this? 617 00:39:35,300 --> 00:39:37,780 What were your aims coming to the lab? 618 00:39:37,780 --> 00:39:42,140 And is there a way that you can now address those questions? 619 00:39:42,140 --> 00:39:48,260 How can I help my patient who has sickle cell disease, who has alloreactive antibodies, 620 00:39:48,260 --> 00:39:51,260 and we don't have good transfusion options for them? 621 00:39:51,260 --> 00:39:55,400 If that's what's keeping you up at night and you've gotten away from that questionnaire, 622 00:39:55,400 --> 00:40:00,220 you're not moving forward towards that question, sit back down and say, how can I get back 623 00:40:00,220 --> 00:40:01,220 to that? 624 00:40:01,220 --> 00:40:05,300 I've built almost certainly, if you've been in the lab for one or two years already, you 625 00:40:05,300 --> 00:40:06,860 have built skills. 626 00:40:06,860 --> 00:40:12,420 And if you feel like those skills aren't taking you where you want to be, I really wish young 627 00:40:12,420 --> 00:40:16,920 people could hear that the people training you want to know. 628 00:40:16,920 --> 00:40:21,360 They want to hear from you that you're having these doubts. 629 00:40:21,360 --> 00:40:26,620 They don't want you to go to apply for your K, for example, and put together something 630 00:40:26,620 --> 00:40:32,860 that you don't even feel proud of, or you felt like it was fighting tooth and nail just 631 00:40:32,860 --> 00:40:37,300 to get it written because you're not passionate about what you're working on right now. 632 00:40:37,300 --> 00:40:41,220 People training you want to hear from you if you're having these struggles and be able 633 00:40:41,220 --> 00:40:46,140 to say, okay, let me move you to a different project, or okay, let's, you feel like you 634 00:40:46,140 --> 00:40:48,860 haven't had a success yet. 635 00:40:48,860 --> 00:40:51,540 What is this one thing that just needs to be completed? 636 00:40:51,540 --> 00:40:54,820 Let's get it done because this is up and running and working in the lab. 637 00:40:54,820 --> 00:40:57,940 And let's just have you put your hands on this to get some rejuvenation for a month 638 00:40:57,940 --> 00:41:00,380 or two, and then we'll come back to this. 639 00:41:00,380 --> 00:41:05,300 And I think a lot of people don't advocate for themselves in that way because they think 640 00:41:05,300 --> 00:41:11,380 they might come off as, I don't know what, as weak or uninterested or somebody it's not 641 00:41:11,380 --> 00:41:12,820 worth investing time in. 642 00:41:12,820 --> 00:41:18,340 And if somebody's accepted you into their lab, put you maybe on a T training grant and 643 00:41:18,340 --> 00:41:22,660 supporting your career development, sat through scholarly oversight committee meetings with 644 00:41:22,660 --> 00:41:24,380 you, like they're invested. 645 00:41:24,380 --> 00:41:26,660 They want you to succeed. 646 00:41:26,660 --> 00:41:32,060 So speak up if that's where the mode you're at, not, I just wish I was in the clinic, 647 00:41:32,060 --> 00:41:36,060 but if your mode is more, I'm feeling stuck, I'm feeling I'm spinning my wheels. 648 00:41:36,060 --> 00:41:38,540 I feel like I haven't gotten the experience I want to get. 649 00:41:38,540 --> 00:41:43,660 Say something and I think say it as early as you can because you really don't want to 650 00:41:43,660 --> 00:41:49,060 be in a three year fellowship at the end of year two in the lab, you know, at the end 651 00:41:49,060 --> 00:41:55,020 of your fellowship asking for instructor time when you're not even sure if you want it. 652 00:41:55,020 --> 00:41:57,540 Wow. 653 00:41:57,540 --> 00:41:59,420 That's a lot to unpack in that answer. 654 00:41:59,420 --> 00:42:04,300 I don't even know where to start, but I love what you talk about. 655 00:42:04,300 --> 00:42:07,420 I think what you're saying is you got to do what you love. 656 00:42:07,420 --> 00:42:10,100 And I know people say that it's almost like a cliche. 657 00:42:10,100 --> 00:42:11,840 This is hard work. 658 00:42:11,840 --> 00:42:15,780 And if you're going to work so hard, please do something you actually care about. 659 00:42:15,780 --> 00:42:20,940 Don't do something that drains you because it's too hard to invest time and energy in 660 00:42:20,940 --> 00:42:23,280 something you don't even care about. 661 00:42:23,280 --> 00:42:27,700 And I appreciate what you talk about the importance of self advocacy because sometimes there's 662 00:42:27,700 --> 00:42:30,700 this sense of like, well, I don't want my mentor to be upset with me, but it's like, 663 00:42:30,700 --> 00:42:32,480 look, this is not your mentor's journey. 664 00:42:32,480 --> 00:42:33,480 This is your journey. 665 00:42:33,480 --> 00:42:36,740 And years from now, your mentor is going to be out of your picture. 666 00:42:36,740 --> 00:42:37,980 And what are you going to be doing? 667 00:42:37,980 --> 00:42:41,340 Are you going to be that person who's so successfully miserable? 668 00:42:41,340 --> 00:42:43,100 And that's not worth that struggle. 669 00:42:43,100 --> 00:42:46,500 And actually you may not even end up being successfully miserable because you just might 670 00:42:46,500 --> 00:42:48,860 not even get that you're so miserable. 671 00:42:48,860 --> 00:42:51,020 But I do appreciate that. 672 00:42:51,020 --> 00:42:52,020 It's almost cliche. 673 00:42:52,020 --> 00:42:53,900 It's like, do what you love, but it's real. 674 00:42:53,900 --> 00:42:58,940 It's like, don't do things you hate because it's just too hard to sustain a career that 675 00:42:58,940 --> 00:42:59,940 way. 676 00:42:59,940 --> 00:43:00,940 It's impossible actually. 677 00:43:00,940 --> 00:43:07,780 Well, and having an Eliza that you can't troubleshoot is very different than I don't like research. 678 00:43:07,780 --> 00:43:13,340 But when you're been on call because you also have a clinical job and you haven't slept 679 00:43:13,340 --> 00:43:18,900 for some period of time, and maybe you also have family obligations and you're going into 680 00:43:18,900 --> 00:43:22,820 the lab and you're just thinking one more day that I have to get this thing to work 681 00:43:22,820 --> 00:43:23,820 that isn't working. 682 00:43:23,820 --> 00:43:26,620 And I don't even know what I'm doing with my life. 683 00:43:26,620 --> 00:43:31,980 And my colleague is doing a chart review in their pajamas at home and having a great time, 684 00:43:31,980 --> 00:43:37,740 but really, I mean, and that's important work too, but it's, yeah, I think it's very 685 00:43:37,740 --> 00:43:41,580 easy to get discouraged and to stay discouraged for two years. 686 00:43:41,580 --> 00:43:42,820 And then your fellowship's up. 687 00:43:42,820 --> 00:43:48,220 And then all of a sudden it's, well, you told us you wanted to do lab. 688 00:43:48,220 --> 00:43:52,940 You never told us that you were struggling. 689 00:43:52,940 --> 00:43:57,340 And we didn't sort of move things around or come to an understanding of maybe we need 690 00:43:57,340 --> 00:43:58,720 to shift your focus. 691 00:43:58,720 --> 00:44:00,820 Maybe you do want to do more clinical activity. 692 00:44:00,820 --> 00:44:05,860 And now you're not marketable from a lab standpoint and you're not marketable at an academic 693 00:44:05,860 --> 00:44:09,820 institution that's going to expect hardcore clinical work to have come out of a fellow. 694 00:44:09,820 --> 00:44:13,700 And so nobody has been coming into a clinical position. 695 00:44:13,700 --> 00:44:16,420 They're going to expect that you've done hardcore clinical work during your fellowship. 696 00:44:16,420 --> 00:44:20,300 So nobody's helped by not speaking up. 697 00:44:20,300 --> 00:44:25,060 And yeah, I think really, I almost wish that in fellowship you got a chance to rotate in 698 00:44:25,060 --> 00:44:29,420 a lab that you almost got like graduate students do. 699 00:44:29,420 --> 00:44:33,920 The expectation that you're going to spend six weeks somewhere, six weeks somewhere else 700 00:44:33,920 --> 00:44:38,320 and six weeks in a third place, and you're going to see what's the right fit for you. 701 00:44:38,320 --> 00:44:41,220 Because we, you know, we ask people to commit to mentors. 702 00:44:41,220 --> 00:44:42,220 They don't know them at all. 703 00:44:42,220 --> 00:44:44,180 They don't know the lab environment. 704 00:44:44,180 --> 00:44:46,260 And this is the beginning of the rest of their career. 705 00:44:46,260 --> 00:44:51,420 Now you're in a field that you're going to be in that field for at least, you know, for 706 00:44:51,420 --> 00:44:53,860 the foreseeable future. 707 00:44:53,860 --> 00:44:57,500 And I think that's an interesting that we just ask people to sort of jump in. 708 00:44:57,500 --> 00:45:06,380 Yes, so to our audience, if you are feeling miserable on your trajectory, you need an 709 00:45:06,380 --> 00:45:10,020 intervention and you can't give it to yourself. 710 00:45:10,020 --> 00:45:15,620 You can engage your mentor or find someone outside of your mentorship circle, but please 711 00:45:15,620 --> 00:45:17,900 don't try to do it alone. 712 00:45:17,900 --> 00:45:18,900 And build that. 713 00:45:18,900 --> 00:45:20,140 I wish I could come up. 714 00:45:20,140 --> 00:45:23,860 Maybe you know the name of this kind of map that you make. 715 00:45:23,860 --> 00:45:27,820 It's not a mentorship map because mentor is one word, but who are the people you're going 716 00:45:27,820 --> 00:45:30,980 to need different things from to support you on this? 717 00:45:30,980 --> 00:45:33,620 You know, you need a research mentor. 718 00:45:33,620 --> 00:45:35,820 You need a clinical mentor. 719 00:45:35,820 --> 00:45:41,140 You need a mentor to help you with the life part of doing this job. 720 00:45:41,140 --> 00:45:43,700 You need peers for peer support. 721 00:45:43,700 --> 00:45:50,180 You need a sponsor that is often, if it's also your research mentor, isn't that so great? 722 00:45:50,180 --> 00:45:53,780 It probably ought not to just be your research mentor. 723 00:45:53,780 --> 00:45:54,780 You need a sponsor. 724 00:45:54,780 --> 00:45:56,820 You need someone who's going to open doors for you. 725 00:45:56,820 --> 00:45:58,340 And you need role models. 726 00:45:58,340 --> 00:46:02,300 You know, these are different people who are going to give you these different things and 727 00:46:02,300 --> 00:46:05,000 you have to build that team for yourself. 728 00:46:05,000 --> 00:46:09,580 And there are these diagrams you can download online if you're a visual person where you 729 00:46:09,580 --> 00:46:11,860 then just fill the names in. 730 00:46:11,860 --> 00:46:17,100 Really sit with it and ask, who is in each of these buckets is my person? 731 00:46:17,100 --> 00:46:21,060 And in this moment, I'm having these feelings of doubt, you know, disconcertment. 732 00:46:21,060 --> 00:46:24,020 I'm not sure if I'm doing the right thing with my life. 733 00:46:24,020 --> 00:46:26,740 Which of these people can I go talk to about this? 734 00:46:26,740 --> 00:46:30,340 And maybe I start with one person and move to a different one. 735 00:46:30,340 --> 00:46:34,940 Maybe I, you know, meet with a peer first who's a few years ahead of me who might have 736 00:46:34,940 --> 00:46:36,420 had these same moments. 737 00:46:36,420 --> 00:46:40,240 Maybe I just bounce ideas off of them and then I go to my research mentor. 738 00:46:40,240 --> 00:46:44,340 Or I, you know, I go to my sponsor and I say, do you think I have what it takes? 739 00:46:44,340 --> 00:46:45,900 You're someone who's been my champion. 740 00:46:45,900 --> 00:46:50,940 You know, do you think I'm a person you see continue to be able to champion in the future? 741 00:46:50,940 --> 00:46:52,700 What do I need to accomplish now? 742 00:46:52,700 --> 00:46:54,620 And how do I get to accomplishing that? 743 00:46:54,620 --> 00:46:59,180 So yeah, sit down and make a map for yourself and then reach out to those people. 744 00:46:59,180 --> 00:47:00,180 Absolutely. 745 00:47:00,180 --> 00:47:02,060 You speak to the importance of mentoring networks. 746 00:47:02,060 --> 00:47:04,900 I mean, it's like one person cannot be all of it for you. 747 00:47:04,900 --> 00:47:05,900 It's not even possible. 748 00:47:05,900 --> 00:47:06,900 Don't do it. 749 00:47:06,900 --> 00:47:08,620 Don't, don't try to make it fit. 750 00:47:08,620 --> 00:47:11,500 But yeah, no, that's, this has been so awesome, Julia. 751 00:47:11,500 --> 00:47:13,380 I mean, just so much wisdom. 752 00:47:13,380 --> 00:47:17,180 I feel like we need to do like a part two because there's so much that could still be 753 00:47:17,180 --> 00:47:18,180 said. 754 00:47:18,180 --> 00:47:21,300 And I just just shared so much wisdom and I just want to thank you. 755 00:47:21,300 --> 00:47:22,660 Thank you for being on the show. 756 00:47:22,660 --> 00:47:23,660 Of course. 757 00:47:23,660 --> 00:47:24,660 Thank you so much for inviting me. 758 00:47:24,660 --> 00:47:25,660 All right, everyone. 759 00:47:25,660 --> 00:47:26,660 You've heard Julia. 760 00:47:26,660 --> 00:47:29,500 You've got to share this episode with someone else. 761 00:47:29,500 --> 00:47:33,060 Someone is struggling and they need advice and they need to think a little bit more broadly 762 00:47:33,060 --> 00:47:35,020 about that mentoring networks. 763 00:47:35,020 --> 00:47:37,700 Think about that one person and forward this episode to them. 764 00:47:37,700 --> 00:47:38,860 All right, everyone. 765 00:47:38,860 --> 00:47:48,820 It's been a pleasure to talk to you again the next time. 766 00:47:48,820 --> 00:47:54,180 Thanks for listening to this episode of the Clinician Researcher podcast, where academic 767 00:47:54,180 --> 00:47:59,620 clinicians learn the skills to build their own research program, whether or not they 768 00:47:59,620 --> 00:48:00,980 have a mentor. 769 00:48:00,980 --> 00:48:07,060 If you found the information in this episode to be helpful, don't keep it all to yourself. 770 00:48:07,060 --> 00:48:08,820 Someone else needs to hear it. 771 00:48:08,820 --> 00:48:12,860 So take a minute right now and share it. 772 00:48:12,860 --> 00:48:18,340 As you share this episode, you become part of our mission to help launch a new generation 773 00:48:18,340 --> 00:48:24,100 of clinician researchers who make transformative discoveries that change the way we do health 774 00:48:24,100 --> 00:48:25,100 care. 775 00:48:25,100 --> 00:48:51,340 All right, thanks for tuning in.