Ahmet Hoke MD Ph D Johns Hopkins School

Ahmet Hoke MD, Ph. D Johns Hopkins School of Medicine Recruiting Young Neurologists into the Basic Laboratory

A career in basic science in neurology Age 22 Age 37 -42 MD or MD/Ph. D 4 -8 years Residency 4 years Fellowship K 08 2 -3 years 5 years R 01 After college 15 -20 years to an independent career!

A career in basic science in neurology Pros Satisfaction of pursuing a challenging area of inquiry You get to choose what you want to study Potential for identification of new therapeutic targets Clinical practice informs your research Cons Competition with full time basic researchers Pressure to see more patients Lower compensation (salary differential is high, but this is not a critical issue for most clinician-scientists)

Requirements for a successful career in basic science Drive to want to make a change Mentor Adequate training Formal (e. g. Ph. D) or informal (postdoctoral fellowship in a lab, NIH medical student rotations) Institutional support Family support

Barriers for a successful career in basic science Medical school debt NIH loan repayment program Lack of departmental support Protected time Space Access to resources Pressure to increase clinical practice Revenue generation (including downstream revenue for the hospital and other departments) Long wait periods

Paths to a successful career in basic science Identify a mentor early in residency Choose someone who is willing to spend time with you and campaign for you Choose an area of research that you like Enjoy what you are doing, you’ll be doing it for a long time! Start planning for your independent research program early on At some point you need to differentiate yourself from your mentor

Paths to a successful career in basic science No need to despair, even in these current economic conditions Success rate for K-awards is relatively unchanged! (30 -40% at NINDS) First time R 01 awards pay at almost at twice the pay-line of senior investigators Yet the greatest attrition of physician- scientists occur during transition from K to R awards or when renewing first R 01 grant.

NIH-wide career awards in 2008 Activity Number Reviewed Number Awarded Success Rate* 2007 K 01 443 172 K 02 72 27 39% 38% K 07 84 29 35% K 08 509 222 44% K 12 36 19 53% K 23 574 216 38% K 24 97 49 51% K 25 50 24 48% K 99 795 180 23% 31% 44% 26% 37% 46% 33% 47% 35% 21% These are for applications, applicant success rate is higher due to resubmissions

NINDS K 08 career awards Year FY 06 Success Rate 33% FY 07 26% FY 08 39% FY 09 35% These are for applications, applicant success rate is higher due to resubmissions

K 08 pathway – suggestions for the applicants For most people in basic sciences this is the most straightforward path Pick a lab and mentor early on during training (preferably during residency) If available take advantage of R 25 grants Use your fellowship time to generate preliminary data for your K 08 Take your time for your first grant ▪ It is better to delay than submit a sub-optimal grant (dept and mentor support is critical here)

K 08 awards – kisses of death Proposals that do not appear to have been read by mentor Proposals that are not good training vehicles and pathways to independence, e. g. : Methods not yet established Specific aims 2 and 3 dependent upon success of specific aim 1 Methods that are limited in future applicability Vague career development plan Generic chair letter that does not spell out institutional commitment

K 08 awards – suggestions for the department Remove pressure for rapid submission and resubmission With only two cycles this will not impact departmental budgets as much as before Develop an internal review (something that is stressed by NINDS) and make it meaningful. Allow mentor time for appropriate review Have candidate reply to reviewers comments Department or mentor should be able to tell applicant to wait or skip a cycle

First R 01 grants – suggestions for the applicant Transition to R 01 requires adequate productivity from K 08 years Start to differentiate research from that of mentor Senior authorship Make sure you have adequate time to prepare the grant and get it vetted by mentor and departmental committee Pitfalls in the K 08 applies to R 01 Take advantage of grant writing courses offered

First R 01 grants – suggestions for the department Develop a departmental committee to oversee first R 01 applications Adequate review and feedback Consider establishing a fund to support junior faculty who is promising but has a funding gap between K 08 and R 01 Be rigorous in evaluating the potential of the faculty (say no early on – productivity during K years may be a good predictor of future success)

Other tips for a successful career Always on the look for grant opportunities relevant to your area of interest Non-federal grants (foundations, industry etc) Cultivate relationships with leaders in your field (they are the ones reading your papers/grants) Posters at national meetings is better than platform talks Strike a good balance between quality and quantity of manuscripts