Practical Advice From a Basic and Translational Researcher at a Major Medical School.

This issue includes a Paths and Places contribution from Mark Donowitz, MD. Mark received the American Gastroenterological Association Distinguished Achievement Award in Basic Science at Digestive Disease Week 2016. He has had, and continues to have, an exceptional career as a physician scientist. In the past, many referred to Mark as the uncommon triple-threat: investigator, physician, and teacher. He is all of that and more. How does one succeed in this endeavor and manage the demands of both research and academic medicine? Although there is certainly no single answer, Mark shares his experiences, with attention to the influences and behaviors that have been essential to his success, in this month’s column. We hope Mark’s insights will help those embarking on and in the midst of similarly structured careers.

JERROLD R. TURNER, MD, PhD, AGAF

Editor in Chief

Cellular and Molecular Gastroenterology and Hepatology

When I was President of the American Gastroenterological Association, one of the great privileges I had was to visit medical schools in this and other countries to speak to young as well as seasoned gastroenterologists. One of the questions that I was asked most frequently was, “When did you feel you had it made in your academic career?” I believed this question was being asked out of the frustration that young scientists especially were experiencing in funding their laboratories and I felt obliged to answer “Never, because as an investigator you are only as secure as your last grant.” I have chosen a career as a gastrointestinal (GI) basic and translational researcher and clinical gastroenterologist with a significant scientific administrative commitment and limited classroom teaching. I have followed this career path for 40 years. In this column, I describe the personal strategy that has allowed me continued participation in this wonderful career. Although I am not suggesting that this is the only path to success, some of the lessons I have learned might prove transferable to the careers of others. The areas I will emphasize are planning, persistence, and collaboration, along with the good luck of having wonderful mentors.

Mark Donowitz, MD

Planning

Based on my experience, I advise young faculty to understand the job being offered and how the person doing the hiring defines success. Only take a job if the description matches what you want to do and if you are willing to do what it takes to meet the criteria for success. Work with the person hiring you to ensure that you have the time and resources (including space and support) you need to get your career off the ground.

I have had only 2 academic jobs, the first as an assistant professor in the Department of Medicine at the New England Medical Center (NEMC)/Tufts University School of Medicine (SOM), and then at the Johns Hopkins University School of Medicine where I was recruited to be Chief of the GI Division. Three important factors related to planning allowed me to succeed in these 2 jobs: (1) the job I was hired for was the one I wanted to perform, (2) I received enough protected time and start-up support as part of my recruitment to begin my laboratory activities, and (3) I was exceptionally fortunate to be exposed to wonderful role models including the Chairman of the Department of Medicine at NEMC/Tufts University SOM, Sheldon Wolff, MD; a mentor from my fellowship, Henry J. Binder, MD, who has remained invested in my career; and a mentor who I identified early in my first academic job and who has influenced my activities for 40 years, Geoffrey W. G. Sharp, DSci.

Being hired for the job you want to do may seem obvious, but not having such a match has been one of the most common reasons for career dissatisfaction that I have observed. At NEMC/Tufts University SOM, I was hired to develop an investigative career and to contribute to delivery of clinical GI care. I was given my own laboratory and start-up funds. An important factor in my success was that I had limited clinical activities and teaching responsibilities. Dr Geoffrey W. G. Sharp was hired as Chairman of the Physiology Department shortly after I came to NEMC/Tufts University SOM and we began a collaborative relationship in which Geoff served as my mentor, taught me the love of science, introduced me to increasingly sophisticated experimental methodology, instilled in me the belief and confidence that we could move into new areas of science that required adopting techniques that were new to us, and the belief that if the science was rigorous and could be defended to critical investigators, it eventually would be accepted by all forms of peer review. I cannot overemphasize how having Henry Binder and Geoff Sharp as my mentors and friends energized my career, with their advice and support pointing the way for many career decisions. It was a separate stroke of luck that I was hired by Sheldon Wolff and accepted as one of his people. Shelly’s values were inspirational, and all of us who came under his tutelage still have his rules for an academic career prominently displayed on our walls and proudly refer to them frequently. I list them here because many have been important at almost every stage of my career.

At the Johns Hopkins University School of Medicine, I was hired to bring modern science to the GI Division, and to modernize the clinical entity by adding therapeutic endoscopy and liver transplantation to a division with strong, renowned senior clinical gastroenterologists. Here again, I stuck to the job description that I had accepted as my primary responsibility. Although I developed a clinical area that allowed me to attract patients from around the world as well as from the local Baltimore population, I did not expand my clinical activities beyond 20% of my effort. Although I taught medical students and graduate students in my areas of interest, I did not run courses or take part in extensive teaching activities. I was allowed to limit my committee activities to areas in which I believed I was making contributions based on my skills. Taking part in these activities allowed me to feel that I was a good citizen of the Johns Hopkins University School of Medicine community without compromising my major activities. This approach allowed me the time to develop my laboratory and generate the preliminary data needed to be competitive for National Institutes of Health (NIH) funding.

Persistence

My advice to young faculty developing an investigative career is to generate relationships with several colleagues whose scientific acumen you respect, who will spend the time to carefully hear and think about your ideas and preliminary data, and who will honestly and rigorously critique your work. Allow them the time to think about and provide input into your applications. Apply frequently for extramural funding. Do not give up or become angry or defensive when your ideas are not accepted, but use critiques to improve and resubmit your applications.

At the Johns Hopkins University School of Medicine, as at most major research-based medical schools, the expectation is that extramural support will pay for faculty time spent in nonclinical activities, although some support for administrative activities is provided. Thus, to pursue the investigative career that I wished to follow, I had to achieve extramural funding, in my case NIH support. Unfortunately, having good ideas and compelling preliminary data is not sufficient to guarantee getting funded, a fact that has been a constant during my almost 40 years as a principle investigator. My attitude has always been that if my ideas held up during presentations to my most critical peers, they likely were substantial enough to merit funding and the peer-review system would support the work if I was persistent. That is, if I accepted that my grant might be rejected the first time, took the criticisms of the Study Section as a guide on how to improve the application, avoided taking the rejection personally or reacting with anger or vindictiveness, and used the criticism to improve my application for resubmission, most of my grants eventually would be funded. Here I am after almost 40 years of continual NIH funding, still believing in the system. Persistence, having a thick skin, and constantly trying to improve my applications has been the rock-bed of my approach. Of course, while I pursued this approach, I continued other applications to societies and associations and sought philanthropic support, the latter based on the belief of some of my patients that our desire to ask questions with potential relevance to disease was worth supporting.

Collaboration

Finally, I advise new faculty members to follow Shelly Wolff’s rules that we should pay back our institutions for their investment in our careers and that we should all take part in some activities that we really enjoy.

For me, both rules fell under my desire to help develop working groups of scientists taking part in collaborative research to advance the science of gastroenterology and develop new therapeutics. In my case, the area of my interest was the pathophysiology and treatment of diarrheal diseases. One of the reasons the Johns Hopkins University School of Medicine is a wonderful place to take part in scientific exploration is because it has a highly collaborative environment. I often joke that because the Johns Hopkins University School of Medicine administration does not provide a large number of outstanding core services, it is up to the faculty to develop the facilities they need for their research. I learned the satisfaction of organizing groups of scientists to accomplish common scientific goals during my time at NEMC/Tufts University SOM where I served as the founding director of an NIH/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) GI Core Center. This was the first large center at NEMC and brought together approximately 30 investigators. At Johns Hopkins University School of Medicine, I recruited GI faculty who wanted to develop serious investigative careers with an eye to those who seemed intent on taking part in collaborative studies as part of their activities. Fortunately, the basic research component of the GI Division shared a large floor with the basic research component of the Renal Division, headed by Joe Handler, MD, a giant of renal physiology and dear friend, who was developing the same type of basic research division as I was. Together, we obtained funding for an epithelial biology–based Program Project Grant that included many members of the Johns Hopkins University School of Medicine basic science departments, especially the Physiology and Cell Biology Departments. This model tied basic science performed in our clinical divisions with that in the Johns Hopkins University School of Medicine basic science departments, and served as a model for the basic science-translational research that I have helped to develop and administer ever since. This has included a total of 3 NIH Program Project Grants (2 NIDDK, 1 National Institute of Allergy and Infectious Diseases), an NIH/NIDDK R24 grant (a grant to solve a single problem, often involving multiple institutions), an NIH/NIDDK Mini-GI Core Center, an NIH/NIDDK Core Center at the Johns Hopkins University School of Medicine, an NIH/National Center for Advancing Translational Science U grant for organ-on-a-chip development, and an NIH/NIDDK U01 Intestinal Stem Cell Consortium grant. These collaborative grants not only have provided us the facilities needed to accomplish our scientific aims, but the linked conferences have provided the intellectual interchange and training environment for the basic and translational research of the Johns Hopkins University School of Medicine GI Division. Helping organize these interactive groups of scientists has been one of the areas that has given me the most satisfaction during my time at Johns Hopkins. In addition to contributing hugely to our scientific accomplishments, it led, as a wonderful additional bonus, to some of my dearest friendships. I believe that the willingness of Johns Hopkins University School of Medicine investigators and investigators from other institutions to take part in these collaborative grants has come from our ability to provide an environment in which we show respect for the many contributions of others, fairly share the resources that come with these interactive grants, and are willing to use these joint grants for training of young scientists, not only from the GI Division but also from other participating divisions from the Department of Medicine and basic science departments.

Therefore, although the answer to the question of “When did I feel I had it made?” is the nonreassuring “never,” I do have an upbeat message for young GI faculty who are considering investigative careers, including physician-scientists. Mine has been an invigorating, satisfying, and exciting career that continues, and I expect the best science is yet to come. I have outlined the principles that have guided my career and that I suggest young faculty consider in developing their careers.

As a final point, I would like to return to how important a mentor can be in developing a career. Identify a mentor early on and do not be satisfied until you are convinced that the person selected has time to think about you and your career and that their advice is thought out and always in your best interest. Identify one or more mentors who will be honest in critiquing your work and work with them on your applications. Helpful criticism presented in a way you can hear it is hard to find, but invaluable. Accept that to have an investigative career you have to seek and succeed in getting extramural support, usually from the NIH. Be willing to apply, ask scientists locally to read and critique your proposals, and be persistent, accepting that multiple applications are pretty much the rule. Finally, keep your eye on your career goals—there are many opportunities in academic medicine to change directions and to commit large amounts of time to interesting, important, even income-generating activities that will take you away from your investigative pathway. Be sure to ask yourself frequently whether your time allotment provides you the best chance to succeed in your chosen career pathway. The advice I have provided has come from the perspective of someone who has greatly enjoyed an investigative career and hence is most applicable to a faculty member who wishes to pursue a research-heavy career. However, the concepts of planning, persistence, collaboration, and the importance of seeking an appropriate mentor are worth considering, no matter what type of academic career one wishes to pursue.