Meet the new Stahlman-Thomas faculty advisor: Mary Philip, MD, PhD
by Ayesha Muhammad (G2)
Mary Philip MD, PhD, during her undergraduate studies in Molecular Biophysics and Biochemistry at Yale, thought she could not reconcile her passion for research with her desire to care for cancer patients. After discovering the MD/PhD pathway at the University of Chicago, she followed her interest in tumor immunology and hematology/oncology through University of Washington and Sloan Kettering, to Vanderbilt where she runs a lab focused on T-cell dysfunction in cancer. In her spare time, she also mentors budding physician-scientists as the new faculty adviser to Stahlman-Thomas. Ayesha sat down with her for a conversation about her career path, advice for new trainees and the leaky pipeline. Click here to read more.
AM: What prompted you to go down the physician-scientist pathway?
MP: I grew up in Chicago and then went to Yale for undergrad, [where] I really enjoyed an intensive science major. Over the summer, I did some research at Northwestern University and also worked a little bit in a lab at Yale. I was definitely interested in research, science and medicine, [but] at that point I wasn’t quite sure what direction I wanted to go in. To be honest, no one had talked to me about an MD/PhD pathway, so I thought I had to choose between the two. The combined pathway was not really on my radar, so at that time I definitely knew I wanted to see patients so I thought if I have to pick one, I should do medicine because with medicine I could still do research.
I decided to take a year between undergraduate and applying to medical school. I went back to Chicago and worked as a research tech at Northwestern while I did applications and tried to figure things out. I ended up at the University of Chicago for medical school, and became aware of the MSTP pathway. One of the nice things at the University of Chicago was that they have a pathway for people to get into the MD/PhD program even after they are already in medical school. I was really missing the science side of medicine, so right off the bat, I decided to do the combined degree.
I did my PhD in Cancer Biology – my father is an oncologist and he got me interested in cancer research at a pretty early age. When I was in 6th grade, we had to pick a topic to work on for the whole year and at the end, we had to put together a presentation. He suggested that I do it on cancer and that’s how it all started. When I started my PhD, they had just started a Cancer Biology PhD program, so I got to be in that program’s first cohort. When it came time to picking labs, I think the reason I worked in Hans Schreiber’s lab – a tumor immunologist who showed that cancers have mutations that lead to specific antigens that can be targeted by immune cells – was because of my cancer biology class. We would read papers every week and one week, our instructor, Craig Thompson (now at Sloan Kettering), picked one of Hans’ papers. I thought it was such a beautiful paper, so I went to talk to him, and asked if I could work in his lab.
Clinically, my interest in cancer biology [attracted me] to do heme-onc. As part of medical school, we actually spent a lot of time on the heme-onc services at UChicago because [the division] was a big [focus] of the hospital. I really enjoyed seeing that patient population and taking care of them. When I was applying to residency, I knew I wanted to do the fast track program. At that time, there weren’t really very many, if any, of the kind of physician scientist programs that are better defined now. The deal was, when you go to residency, you have declare from the start that you planned to follow the physician-scientist pathway, and then plan to apply for fellowship. After a debate between staying and leaving [institutions], I decided that I wanted to stay at the University of Chicago for my residency. Initially, I thought I would stay on for fellowship. Because of the timing of things, we actually had to apply for fellowships in our intern year.
AM: Oh wow! That really sounds stressful.
MP: Yeah it was pretty crazy. I actually remember that I was on a Q3 cardiac, intensive care unit call schedule. So I was on call, post-call I flew out to somewhere, got there at midnight, and the next day, which was day three, when you’re supposed to be off, I started interviews at 7 in the morning, got back to Chicago at 10 p.m that night, and was on call the next day. Through the process, I had heard from different people that it was good to get a different perspective of what different places are like, so I thought that it was time to go to a different institution and left Chicago for Seattle for my fellowship. It was a pretty big geographic shift and I had never lived on the West Coast, so it checked the “some place new where I wanted to live” box. Plus the Fred Hutch Cancer Research Center has a pretty great history of cancer research and transplant excellence and it was all around a great program.
The first year and a half was the clinical part. But when it came time to pick labs, I struggled a bit. I really liked the tumor immunology that I did as a PhD student in Hans’ lab, but thought I wanted to do something a little bit different, so I ended up joining Dr. Jen Abkowitz’s lab. She was at the time my division chief (Hematology) and her lab did a lot of work on hematopoiesis and stem cell biology. Interestingly, I ended up on a project that had more to do with T-cell biology, which wasn’t my original intention. That maybe shows you where my natural inclination lay.
Because, I was in a erythropoiesis lab working on T cell development, I developed a mentorship team from the immunology and T cell biology program. The University of Washington and the Hutch have a great tumor immunology program so I got to work with some great people there. During the course of my post-doc, I was thinking of where I wanted to go with my research as a potentially independent faculty. Even though I got a K08 and American Society of Hematology award, I didn’t think my project had legs to carry me through my career and that I could launch my lab on. I decided that I wanted to go back to tumor immunology, where I had started in the first place as a student.
I started a collaboration with Andrea Schietinger at the University of Washington, who I actually knew from my University of Chicago days. The project I was working on with her was really interesting and going well. So when she started her lab at Sloan Kettering, I decided to take a chance, move to New York and help her finish the project as she started her lab and use that as something to launch my own faculty career. I was at Sloan Kettering for 2 years, where I had a really intensive, but productive and fun time. I got out a lot of nice publications and that allowed me to go on the job market and look for a faculty position, which is how I ended up here.
AM: You have actually had quite a few geographical adventures. One thing that caught my attention was the idea of changing institutions. In your opinion, what are the pros of you moving to a different place, versus the way the programs are set now?
I think for me it was definitely the right decision to move to a different place. You realize once you are at different places, even with the little things, that institutions have a culture, not only in the way medicine in practiced, but even in the kind of science and people’s approach to it. A lot of that [culture] is driven by who really started the program, because they are going to put their stamp on the program. That culture perpetuates, and institutions tend to recruit people who think similarly. This is something that happens at every institution, and the only way you realize that is by going to different places.
The other part of it, to some extent is that let’s say you are a student, and people know you for a long time as an MD/PhD student. As you transition to higher and higher roles, sometimes people forget that you are now in that new role. When you come in new, people get to know you for the first time as a fellow or as faculty. The way you can be perceived can be different.
But even more than that, on a personal level, I think every time you go to a new place, it is a challenge. And adjusting to that new challenge can make you really believe in yourself. If you can do your science and practice medicine in totally different settings – so for example the patient population I took care of at University of Chicago was very different than the patients I had seen in Seattle – while in the beginning it might be a little bit nerve-wracking, you gain confidence and some strength from doing that.
AM: I hadn’t really thought about the perception problem.
MP: I saw it a lot with students – so sometimes we had students in my lab who had started as undergrads, and then they transitioned to graduate school but stayed in the same lab. My PI actually said that he didn’t think that was a good idea in retrospect, because once someone is an undergrad, people keep expecting you to do those kind of tasks for example. It doesn’t allow you to step outside your comfort zone.
AM: I think at the PhD level, there is more space to make mistakes and be okay, but at the post-doc level things are a little higher risk. You mentioned that you had trouble finding a lab at the post-doc level. Could you elaborate on that?
MP: It wasn’t really that there weren’t good mentors. I was just trying to figure out what I wanted to do. I think that as a PhD student, you can take more risks and learn from mistakes because you have a little bit more time and forgiveness on the back end, in terms of determining your career. As a post-doc, I wasn’t quite sure of the area of research I was interested in. I was interested in heme malignancy, and the immunology part I knew was important – but I wasn’t sure what the lab would look like. The lab that I wanted to join wasn’t taking post docs at the time, so I couldn’t join. So the question became what next. I ended up picking the lab (Jen Abkowitz) because they had done some strong science but also because I felt she was going to be a really good mentor.
AM: You took a big risk moving to Sloan Kettering at a later stage in the pipeline. Could you talk about your drive to take that risk. Did you think “what if it doesn’t work out?”
MP: Yeah absolutely! It was a really difficult decision. I was an acting instructor at the University of Washington, but I didn’t see a really clear path to the position I wanted – which was to be a research scientist. In order to be successful you need to have the commitment from the institution, and I wasn’t sure if that was going to happen. Also to be honest, a lot of students I knew from my MD/PhD, and even a lot of co-fellows, hit a difficult time in post-fellowship in an instructor position. I saw a lot of my colleagues struggling at that point and leaving academia and going into industry or private practice. At that point, I was thinking, this may potentially happen to me, because I was partway through a K. I was thinking if I don’t get a position and if a grant doesn’t come through, I might have to either decide to do more clinical work at the same institution to make up the salary, or go into industry or private practice.
To me, private practice was not really appealing, so I thought “if I end up not making it and leaving academia, which is really what I want to do, I could either do that right off the bat, wait for my funding to run out, or take my funding elsewhere and take a chance, and if it didn’t work out, I would still be in the same boat. I felt like I wanted to try everything – I’d rather say I really tried and then failed than to just self-select myself into not being in academia. Fortunately, I was also personally in a position where I could move across the country. Sometimes people don’t have that freedom.
AM: You mentioned that a lot of people struggle post fellowship, and there has been quite a lot of chatter on academic twitter recently about the leaky pipeline. How do you fix it? What could the institutions do to support people more?
MP: I think the physician-scientist pathway is becoming more established, which will help. On the back end – some programs have this and some don’t – when you are wrapping up fellowship and in the process of applying for grants, the institutions need to take a risk and say if this person has met enough benchmarks and shown progress, they have to be willing to give some money and some lab space and see if you can make it. Obviously, it is really hard to predict who will be successful and who’s not. The institution has to be willing to say we don’t know what’s going to happen, but let’s try to fund as many people as we can and it will hopefully work out in x% of cases. Sometimes, institutions insist that people show them they can get funding and papers before they make a commitment to you. But you can’t get papers and funding unless you have an institutional support. We have a great pipeline to train MD/PhDs; there are so many great programs. From all the people I have talked to, I have seen that these are really bright, motivated and hard working people who want to be successful. We have invested into them as a country through MSTPs and even residency training. So why would we, at the last step, not give them a little bit of the boost?
The other part of it also is that there is a proportion of people, who through this pipeline are getting lab space, but that might not be the right path for everybody. I think some of what has to happen is exploration of other career pathways post-fellowship. Is it our goal to train every single person to be academic physician-scientists or do we think there is value to have these bright people in industry, in leadership positions? The sooner people are able to figure out what path is best for them, the better. Post-doc and fellowship can drag a long time before you pull the plug.
AM: Given that this is primer interview season, what is your advice for people applying for residencies and PSTPs?
MP: If you are applying to PSTPs, your intention is to stay at the same institution for residency and fellowship. For the short track (2 years), I think I would put a lot of weight on thinking about the fellowship program and what kind of mentorship you could have in terms of research. I am of course speaking to people who want to follow a path like mine, an academic physician-scientist pathway. But the most important factor in going from being a fellow to an independent faculty position is who your mentor is during that time – they will hopefully open the doors for you. They need to let you grow as a scientist and develop your project in the lab, but then have the ability to let you take that project with you and promote you actively. They need to be a great mentor, but also have the pull to be able to promote you. And they hopefully do science that you are interested in. Look for institutions where that’s going to be the case. I think it’s hard to say go to institute X to work with person Y, because that person might not be there by the time you are ready. Instead see if that division has several really great mentors available where you could see yourself being able to make that transition. You want it to be a quality institution but there is a large number of academic institutions where you will get excellent clinical training – the flavor might be different but you will learn the basic skills, and that won’t change much from place to place. So what will really matter in terms of the next stage of your career is the research part of it, and that’s where the program and their approach to mentorship will be valuable and important.
AM: Any advice for the rest of us?
MP: I think this sounds silly, but try to enjoy this process as much as you can. Looking back, as a student, it is a more fun and enjoyable part of the pathway. Throughout your career, you will always be learning. It will not get boring, which is why most of us choose this path. But there is learning and doing the fun stuff, and then there is the stress and burden of finding funding, getting papers out, etc. When you are a student, the balance of learning to other things is most tipped in favor of learning. You have the most opportunity to learn a lot. Yes, you want to be successful, and you have standards to maintain and things to achieve, but the stakes are not quite as high. You can’t fail as much during your post-doc before you run out of time. So try not to think too far into the future and be in the moment.
One of the hard things about the dual pathway is that it feels like there are two things fighting each other for your time and mental energy. When you are on the clinical side, try to be mentally completely immersed. Later, when you are in the lab, you will not have as much time to keep learning the clinical stuff. So what you learn clinically as a student, resident and fellow will carry forward. There is a temptation when you are on the wards to think about the exciting science, but try to avoid that. And then in the lab, try to do the same thing as much as you can. Later, once you have a good foundation, it becomes easier to juggle, but early on, try to focus on what you are doing in the moment.