Alumni Profile: Joshua Fessel, M.D., Ph.D. (’06)
by Abin Abraham (M1)
Dr. Joshua Fessel graduated from the Vanderbilt MSTP in 2006 as the Founder’s Medal winner for the School of Medicine. He is currently an Assistant Professor within theDivision of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt University with appointments in Medicine, Pharmacology, and Cancer Biology. As a physician-scientist, Dr. Fessel splits his time between 20-25% clinical and 75-80% research. To date, he equally weights the discovery of isofurans and his work to help build the mitochondrial science community at Vanderbilt as his most important scientific endeavors thus far. His laboratory investigates redox biology and molecular metabolism with a focus on a variety of different disease models, most notably pulmonary arterial hypertension. Closing the gap between the bench and bedside, Dr. Fessel attends in the medical intensive care unit and on the pulmonary consultation service eight weeks per year and serves in a general pulmonary outpatient clinic.
A short biography of Dr. Joshua Fessel’s professional experiences
Dr. Joshua Fessel began the MSTP at Vanderbilt in 1999. During his first year of medical school, Dr. Fessel rotated with Dr. Jack Roberts, the Williams Stokes Professor of Experimental Therapeutics and an internationally renowned investigator in the field of redox biology. Following an unconventional path, Dr. Fessel decided to start graduate school at the end of his first lab rotation. He studied free radical lipid biochemistry and discovered isofurans, a class of oxidation products formed from free radical induced peroxidation of arachidonic acid. After his graduate training, he finished the remaining three years of medical school and matched into anesthesiology at Massachusetts General Hospital. He was named one of two Beecher Scholars which provided two years of protected time to do research after residency. Dr. Fessel’s plan was to complete the anesthesiology residency followed by a critical care fellowship, and then to join the faculty at MGH and Harvard Medical School on the physician-scientist track. Unexpectedly, during his first year of anesthesiology residency, Dr. Fessel realized that anesthesiology was not a good fit for him. He reached out to his Ph.D. mentor, who advised him that life was too short to be unhappy and, as a result, fail to do your best work. Reflecting on his experiences as an intern with the pulmonary and critical care services, Dr. Fessel returned to internal medicine with an interest in specializing in pulmonary and critical care medicine. The approach to diagnostic dilemmas encountered in the routines of internal medicine were reminiscent of hypothesis testing in the research lab. In addition, Dr. Fessel realized that he enjoyed getting to know patients and their families more than he had expected. With the help of his mentors, Dr. Fessel returned to Vanderbilt University and joined the Tinsley Harrison Society midway through his second year of residency. For his postdoctoral research during fellowship, Dr. Fessel joined the pulmonary vascular group at Vanderbilt, a world-famous multidisciplinary team of basic, translational, and clinical investigators focusing on the study of pulmonary hypertension.
What are your thoughts on the relationship between clinical and scientific interests?
“I think it is always cool when your clinical life interdigitates beautifully with your research life. But I don’t think it is a requirement, I really don’t. It helps – to say colloquially – to prevent some professional schizophrenia, but I like to study fundamental processes. So in graduate school I did free radical lipid biochemistry. So any cell with a membrane is fair game. That’s a fundamental thing that can apply to any specialty. Every cell has to solve the energy and biosynthesis problem. Now, I touch on neuroscience, pharmacology, and inflammatory immunology as a few examples. Studying a fundamental process will allow you to cross many boundaries.”
What are your thoughts on figuring out what clinical specialty is right for you, especially as a dual degree-trained physician-scientist?
“For medicine and medicine subspecialties, there are pretty natural pathways that fall out. In practical terms, you are going to be looking for a residency and fellowship as a package deal. Make sure the people you are talking to know what you mean when you say, ‘This is what I intend to do with my life.’; Ask them, ‘How do you support people like me?’ And the answer should require no thought on their part, because it should be something they do routinely. The other thing I will say in picking a medical specialty, pay attention to the intangible factors. There is a draw to the ‘lifestyle specialties’ and you might have it in your head that some specialties will mesh better with a life in research (and this may have been true for me in thinking about anesthesiology). That is not enough to make it worthwhile. Pick a specialty where you feel like you really fit personally. It doesn’t take long to notice that there are distinct personalities that gravitate to certain specialties – see where you gravitate to. Pay attention to the intangibles because they won’t show up on any survey or anything like that.”
How do you make the most of your Ph.D. training?
“During my Ph.D. training, I started out trying to answer a very simple question about chemistry and free radical oxidation. It was at first a very focused question that yielded an odd result. I was lucky enough to have a mentor that had the same reaction I did: that looks interesting, let’s figure that out. A key lesson that came out of that is to follow your data. If you did the experiment correctly, believe your data and go where it takes you. I think it is always wise to ask yourself, ‘What can I do with this to better understand a disease in human beings?'”
What are your thoughts on publications in high impact journals?
“I think there is a weak and maybe nonexistent correlation between what is published in high impact journals and what is important science. What I will say to that is that I have seen many examples of people who have had very successful scientific careers and they don’t have a single Science, Nature, or Cell paper on their CV. Dr. James West, my postdoctoral mentor, is a bit like this. He has published great work that has truly changed the field, but more importantly, he is very consistent. He does the work, has over 100 papers to his name, and has an incredible success rate with funding. That lack of a Science, Nature, or Cell paper has not slowed him down. It is more important to do consistently solid work that answers and raises interesting questions. Your work should be reproducible, relied upon and believed by your field and colleagues. Do you have to work hard? Yes, without a doubt. You have to consistently publish. And you need to try and answer questions that are actually important questions to answer. Always bethinking about going after them – things that will truly advance the field and things that will lead to something that you can actually deploy in a human being.”
Thoughts on personal challenges and lessons learned from training
“The biggest challenges in my training were personal ones that didn’t have a whole lot to do with the training itself. This training takes a big chunk of someone’s life, and it is not just any window, it is this very dynamic, formative decade. There are going to be personal challenges and crises. Those were the biggest challenges for me. In fact, it sounds cliché, but the stuff outside of work is the really important stuff. We throw the phrase ‘work-life balance’ around as if that addresses the issue, but you have to learn to value the outside stuff. You can’t ignore or compartmentalize the crises that you face. From my training, I learned that it is OK to put value on things that don’t have anything to do with a p value < 0.05 or the heart and lung exam. And you have to be a good,healthy person before you can be anything else. You will not do your best work if you are not seeing to those issues that we refer to as ‘wellness’ or ‘work-life balance.'”