From Fellowship to FacultyFrom Fellowship to Faculty

William J. Bremner, M.D., Ph.D. William J. Bremner, M.D., Ph.D. Professor and ChairmanProfessor and Chairman Department of Medicine Department of Medicine

July 9, 2008July 9, 2008

Why do a fellowship/What to get out of it?

Our fellowship programs

Numbers, degrees, divisions

Balance of activities/sources of funding

Duration

Criteria for faculty appointments

Establishing positions

Searches

Pathways/tracks

Promotions

Questions/discussion

Why do a fellowship/what to get Why do a fellowship/what to get out of it?out of it?

Area is interesting Patients Research questions Teaching opportunities Practice opportunities Life style

Hours Geography

$

PatientsPatients

Types Numbers Level of responsibility Learning to do research and teaching Mentors

ResearchResearch

Mentorship—primary, secondary

“Lab” facilities/environment Space, equip, staff

Other trainees

Rarely if ever—a specific research questions first

TeachingTeaching

Mentorship Seek out excellent clinicians/teachers

Not so well supported financially

Very gratifying

Practice opportunitiesPractice opportunities

Developing local/regional/national contacts

Active demand for our graduates Shortages in most specialties throughout the

region Excellent reputation for quality of UW training

Biotech opportunitiesBiotech opportunities

Both Ph.D.s & M.D.s

Increasing locally

Tech Transfer/Intellectual Property (IP) issues

AcademicsAcademics

Clinical/Research/Teaching/Leadership Can determine individual balance Can vary over one’s career Varied life/challenges/opportunities Travel Generally lower incomes than practice or

biotech/pharma

Department of Medicine—Fellowship ProgramsDepartment of Medicine—Fellowship Programs

ACGME Fellows 123

M.D. Fellows not in ACGME 68

Ph.D. Fellows 58

Other 1

Total 250

Department of Medicine—Fellowship ProgramsDepartment of Medicine—Fellowship Programs

ACGME Fellowship Programs in:

Allergy and Infectious Diseases 16 Cardiology 21 Dermatology 1 Endocrinology 8 Gastroenterology 13 Gerontology 0 General Internal Medicine 0 Hematology/Oncology 25 Medical Genetics 1 Nephrology 8 Pulmonary and Critical Care 25 Rheumatology 5

Total 123

Fellowship Salaries: SourcesFellowship Salaries: Sources

ACGME Fellows: Medical Center Stipends Training Grants Division Funds

Non ACGME Fellows: Research

Institutional Research Training Institutional Research Training GrantsGrants

T 32 Institutional National Research Service Award

Individual FellowshipsIndividual Fellowships

F 32 Postdoctoral Individual National Research Service Award

F 33 National Research Service Awards for Senior Fellows

Department of Medicine—Fellowship ProgramsDepartment of Medicine—Fellowship Programs

MD 151

MD, MPH 8

MD, PhD 32

PhD 58

Other 1

Total number of fellows 250

Agencies fund DOM Fellowships, Career Agencies fund DOM Fellowships, Career Development & Training Awards (I)Development & Training Awards (I)

American Heart Association American Diabetes Association American Society of Hematology Arthritis Foundation American College of Cardiology American Federation of Aging Research American Lung Association American Assoc for the Study of Liver Diseases Association of Teachers of Preventive Medicine

Agencies funds DOM Fellowships, Career Agencies funds DOM Fellowships, Career Development & Training Award (II)Development & Training Award (II)

American Association for Cancer Research Cystic Fibrosis Foundation Doris Duke Charitable Foundation European Association for the Study of Diabetes The Firlands Foundation Juvenile Diabetes Foundation (and several of its branches) National Kidney Foundation Novartis Pharmaceuticals Pfizer, Inc. The Pfizer/AGS Foundation for Health in Aging

08-09 R-Level08-09 R-Level

RANK ANNUAL

R-4 $52,994

R-5 $55,032

R-6 $57,012

R-7 $59.676

R-8 $62,268

How to support fellow to How to support fellow to Academic PositionAcademic Position

Apply for K awards Foundations Request support on mentors’ grants

Collaboration with other faculty

K AwardsK Awards

K 08—Clinical Investigator Award

K 12—Physician Scientist Award (Program)

K 23—Mentored Patient-oriented Research Career Development Award

K 30—Clinical Research Curriculum Award

Years between Fellowship & Years between Fellowship & Academic TitlesAcademic Titles

Avg

Count Years Min Max

Fellow to Acting Instructor 118 3.1 0 8.5

Fellow to Acting Asst Prof. 41 4.6 0.9 7.7

Fellows to Asst Prof. 80 5.4 2.2 9.0

Acting Faculty (I)Acting Faculty (I) Annually renewable appointment No more that 4 yrs as Acting Instructor No more that 4 yrs as Acting Assistant Prof Combined Acting cannot exceed 6 yrs No independent lab space PI on grant proposals by permission

Whose space?

Tenure clock has not started

Acting Faculty (II)Acting Faculty (II)

Need same accomplishments as “non-acting” at same level, except

Often lack solid salary support Do not require a full search process

Acting Instructor Acting Instructor

Board eligible/certified in specialty Can bill in the specialty Usually have at one least one first-author

paper in a refereed journal

Acting Faculty Appointment Acting Faculty Appointment ProcessProcess

DH requests title to Chair Defines:

Salary Grants Scholarship to date Whose lab space

No other search process Begin appointment process

faculty appointment (no committees/votes) medical staff appointment (6-10 wks)

2-3 months

Assistant Professor Assistant Professor appointment (I) appointment (I)

Requires a search Requires three years minimum of solid

salary support “Several” first-authored original research

papers in strong peer-reviewed journals

Assistant Professor (II)Assistant Professor (II)

DH goes to Chair to request a faculty position Job description Salary—3 Years Minimum Space Candidates for position

Search committee Convenes (1-2 months) Advertises (2-3 months) Interviews candidates (2-10 months) Recommends the appointment

Assistant Professor (III)Assistant Professor (III)

Offer letter – negotiation

Begin appointment process faculty appointment

A&P committees, faculty vote, etc.

medical staff appointment (6-10 wks)

6 to 18 months, sometimes more

Tracks/PathwaysTracks/Pathways

Physician Scientist

Clinician Teacher

Full-Time Clinical

Physician ScientistPhysician Scientist Research accomplishments

Value of contributions First and last authored publications in strong,

peer-reviewed journals Independent grant support Eventual independence from mentor Eventual national reputation

Teaching, Clinical, Leadership, Mentorship

Clinician TeacherClinician Teacher “Predominance” of time in clinical and teaching

activities Clinical – judged by peers Teaching – as rated by peers, student, trainees Scholarship – some publications, teaching

materials Mentorship – Research – original research not required but

valued if present

Full-time ClinicalFull-time Clinical

Clinical excellence, both in quality and quantity

Clinical administration Teaching

Should I “go or stay”?Should I “go or stay”?

Switching institutions

Positive: established independence–acquired new perspectives and methodologies

Negative: dead time for move, start-up, and establishing new collaborators

Total Department of Medicine ExpensesTotal Department of Medicine Expenses Annual AAMC Financial Summary-FY07 Annual AAMC Financial Summary-FY07

$354,080,224

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

$350,000,000

$400,000,000

FY 95 FY 96 FY 97 FY 98 FY 99 FY 00 FY01 FY02 FY03 FY04 FY05 FY06 FY07

Total Department of Medicine ExpensesTotal Department of Medicine ExpensesFY2007FY2007

FHCRC 14.3%

Gifts and Endowments

1.8%

UWP 10.6%

VAMC 15.1%

Grants and Contracts (UW)

46.4%

Other Affiliated Institutions

1.3%

State/WWAMI1.6%RCR

1.7%

UWMC/HMC 7.1%

UW ADMINISTERED—TOTAL DIRECT UW ADMINISTERED—TOTAL DIRECT EXPENDITURES FROMEXPENDITURES FROM

GRANTS AND CONTRACTSGRANTS AND CONTRACTS

$155,011,860

$0

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

$160,000,000

FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02 FY03 FY 04 FY 05 FY 06 FY 07

Grants and Contracts-FY07

$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

AID CRD DRM GAS GER GIM HEM MGN MTE NPH ONC PCC RHU

$62,989,792

Clinical Revenue-FY07

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

AID CRD DRM GAS GER GIM HEM MGN MTE NPH ONC PCC RHU

Conclusions:Conclusions: Research Fellowships are a gateway to great

career opportunities Especially academics But also practice, biotech, and others Pick successful mentors and pick important questions Enjoy the time

Be challenged and be challenging

K award Kiosk….http://grants.nih.gov/training/

careerdevelopmentawards.htm