Ahmet Hoke MD, PhDJohns Hopkins School of Medicine

MD or MD/PhDMD or MD/PhD ResidencyResidency Fellowship

Fellowship K08K08

Age 22

4-8 years 4 years 2-3 years 5 years

Age 37-42

R01R01

After college 15-20 years to an independent career!

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)

Drive to want to make a changeMentorAdequate training

Formal (e.g. PhD) or informal (postdoctoral fellowship in a lab, NIH medical student rotations)

Institutional supportFamily support

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

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

No need to despair, even in these current economic conditions Success rate for K-awards is relatively

unchanged! (30-40% at NINDS) First time R01 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 R01 grant.

ActivityNumber

ReviewedNumber Awarded

Success Rate*

K01 443 172 39%

K02 72 27 38%

K07 84 29 35%

K08 509 222 44%

K12 36 19 53%

K23 574 216 38%

K24 97 49 51%

K25 50 24 48%

K99 795 180 23%These are for applications, applicant success rate is higher due to resubmissions

2007

31%

44%

26%

37%

46%

33%

47%

35%

21%

These are for applications, applicant success rate is higher due to resubmissions

Year Success Rate

FY06 33%

FY07 26%

FY08 39%

FY09 35%

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 R25 grants Use your fellowship time to generate

preliminary data for your K08 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)

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

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

Transition to R01 requires adequate productivity from K08 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 K08 applies to R01 Take advantage of grant writing courses

offered

Develop a departmental committee to oversee first R01 applications Adequate review and feedback

Consider establishing a fund to support junior faculty who is promising but has a funding gap between K08 and R01 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)

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