A career in academic research: adapting in real time

I still remember the moment I fell in love with rheumatology. I was in my internal medicine rotation at Georgetown and was assigned to work with these two rheumatologists on Friday afternoons at the Washington Hospital Center in DC. Because it was literally the first week of internal medicine for me, I just shadowed the rheumatologist and fellow (rheumatologist in training) as they met a woman who had this crazy array of symptoms occurring. I couldn’t imagine what could tie all of those together. The fellow asked question after question, digging into the story like a detective. Then we went back to talk with the lead rheumatologist and together they quickly put together the diagnosis and set the patient on a new course with a new diagnosis, some more testing to round everything out, and a treatment plan. Right after that, we walked into another patient’s room, a young man who had just received his diagnosis at the his last visit. He had just started this medication that was only recently approved by the FDA at the time, etanercept (or Enbrel), and was feeling like a totally new person, back to his young 30-year-old self. The combination of detective work, the art of managing uncertainty, the need to listen closely and create flexible plans, and the chance to use new medicines was incredibly thrilling to me. I knew from that moment I would be a rheumatologist.

I later went on to train as a rheumatologist, obtained a Masters in Clinical Epidemiology, and completed a post-doctoral fellowship in epidemiology. In my job, I see patients one day per week with inflammatory arthritis (diseases that cause joint swelling like rheumatoid arthritis, psoriatic arthritis, and axial spondyloarthritis - I happen to be an international expert in the latter two), I have a research program focused in those areas, and I direct a center for clinical epidemiology and biostatistics. I … absolutely … love … my job - every day (not every hour, but on the whole, every day). My favorite part of my job is that I can see patients, understand their struggles, and then develop and test solutions for those pain points. I then get to enroll patients in studies that they helped me design and I get to form teams and work with teams across the country and across the world to make life just a little better for those living with these conditions. So not only do I get to see meaningful output but I also get to be creative and, commensurate with my type A personality, I get to see productivity and accomplishments.

I tell you all of this because I am not unique. To have a career in academic research, you have to be passionate about what you do. In the US, researchers essentially pay for their salary. We are entrepreneurs - the University may give us a certain proportion of our salary, 20-30% in most cases, and then we need to go get grants to cover the rest of our salary, the salaries of our teams, and the funds to actually do the work. Those grants are associated with indirect funds that cover all of the services at the Universities needed to allow us to run our research shops. We are writing grants all …the… time. The funding pay line is somewhere around 10% on average - so you write a grant and so do 99 other people, 10 of those grants will get funded. A LOT of the time, that’s NOT yours. Not only that, when you get the grant, sometimes the studies you wrote out don’t work. A lot of times though, at the very least, you learn something new and now you have to get it published - you can spend a year or more trying to get it out there. This is a hard road. Rejection is common but so too is resilience…

A now, more than any other time, resilience is needed. In the United States, academic research is on the precipice of changing in a way that couldn’t even have been imaginable last year at this time. Critics of research have been out there since COVID but it’s a whole new level now. And now, funding is disappearing, one grant a time, but now adding up into the billions (range from $1.8B to $9.5B depending on the source). One of my colleagues used the term “moral injury” to describe the feeling among academic researchers. We have been pouring our lives into our work; work that we do to make the world a better place. We’re used to rejection or occasionally being told that our work isn’t important by a cranky colleague or grant reviewer, but this is now at a societal level.

But, my approach to this is to treat it as we do any other form of rejection: let’s take the feedback and retool. This is an opportunity to innovate, to reconsider the ways in which we do research and the ways in which we communicate what we are doing (we are particularly terrible that!) and to re-examine our individual priorities. We may not be able to move everything forward, but move forward we shall move. I hope to use this blog to explore this retooling of academic medicine. Bring on the resilience!