Meet Avery-Cohen Advising College Faculty Leader Patrick Hu, MD, PhD
PHYSICIAN-SCIENTIST, PIANIST, AND FATHER
by Eric KF Donahue (G3)
Introduction
Dr. Patrick J Hu is an Associate Professor of Internal Medicine and Cell & Developmental Biology at Vanderbilt University Medical Center (VUMC). Hu and his wife, a rheumatologist, live in Nashville, TN, with their three high-school-aged daughters. In addition to caring for patients in hematology/oncology and leading his research team, he directs the Physician-Scientist Training Program (PSTP) in internal medicine, which facilitates combined clinical and research training to support research-based careers in academic medicine. Hu is affiliated with Vanderbilt’s Diabetes Research and Training Center (DRTC), the Vanderbilt-Ingram Cancer Center (VICC), and the Program in Cancer Biology.
Hu’s research group uses the nematode C. elegans to investigate the role of insulin-like growth factor signaling in development, metabolism, and aging. The IGF/PTEN/PI3K/AKT pathway is one of the most commonly dysregulated pathways in both human cancer and age-related disease, and by developing a mechanistic understanding of its normal and pathogenic functions, the Hu lab supports new approaches to prevent, diagnose, and manage a wide variety of human cancers. He further promotes these goals extramurally though his work with on the Advisory Board to the Caenorhabditis Genetics Center and service with the National Scientific Advisory Council for the American Federation for Aging Research.
The early years
Hu’s family emigrated to the United States from Taiwan to further their education, and Hu was born in Royal Oak, MI, in the 1960s. Shortly thereafter, his sister was born, and the Hu family moved to Baton Rouge, LA, where they grew up. Supported by their father, a chemical engineer, and their mother, a research librarian, Hu and his sister excelled academically, and both are now practicing physicians.
At the age of 16 (1981), Hu enrolled at Harvard University, where he began his studies in biology and continued pursuing his love of music, practicing the piano whenever he could. His first research experience was with Dr. Victor Shashoua’s laboratory at McLean Hospital, where he worked on a project with memory consolidation in goldfish, and this experience left him wanting more.
During his junior year, he hit a wall. It was the first time he had truly struggled academically, and he was unsure where he wanted to direct his future career: music or medicine. With this uncertainty, he applied to both medical school and a Rotary Foundation Fellowship, which supported cultural exchange in the arts and sciences. He wanted to leave his known environment and “start from scratch in a new world,” where he could find himself and his motivation again.
In 1985, Hu graduated from Harvard with an A.B. in biology, and he deferred his matriculation to medical school. He accepted the Rotary Fellowship and moved to Düsseldorf, Germany, where he spent a year training in classical piano at the Robert-Schumann-Hochschule Düsseldorf. This formative year abroad helped him “understand [his] values in life and see the world in a new light.” Additionally, though he loved the piano, Hu realized he was unlikely to succeed as a concert pianist, and he returned to the US to attend medical school at the New York University School of Medicine.
The benefits of providence
During his first-year medical school courses, Hu’s interest in biomedical research grew, and he enrolled in a summer research program to study transcriptional regulation in E. coli in Dr. Nigel Godson’s laboratory. This research experience led to his decision to join the MD/PhD joint training program and begin his training as a physician scientist. Hu’s graduate work started in the Godson lab, where he had conducted his summer research, and after two years, he realized a different scientific environment would help him succeed. NYU’s MSTP was supportive of his decision, and he began to train in Dr. Joseph Schlessinger’s lab, a larger group that was making key breakthroughs in receptor tyrosine kinase signaling.
With the benefit of a larger research team and close training with a postdoctoral mentor, Hu became more productive and felt his desire for independence grow. He earned his PhD in biochemistry for his work on growth factor receptor signaling pathways. This portended his current research, as these pathways ultimately turned out to include PI3K/AKT, though the major roles of this pathway in oncogenesis were unknown at that time. As Hu returned to medical school, he was elected to the Alpha Omega Alpha Honor Medical Society, and he began his internship year in internal medicine at the Johns Hopkins Hospital, where Hu met the woman who became his wife.
Hu completed his medicine residency as a member of the Longcope Firm at Johns Hopkins from 1995-1998. Despite the strenuous nature of this training, Hu remains thankful for the “trial by fire,” citing its role in forming the physician he is today. He says he learns best by “trying, failing, and learning from [his] mistakes,” and the trials of his residency furthered his ability to succeed as a physician scientist. His wife began her fellowship training in rheumatology, and as there were no PSTPs at the time, Hu applied for fellowship and postdoctoral positions concurrently. Hu was accepted for and completed his fellowship training in Adult Oncology at Dana-Farber/Partners Cancer Care and Massachusetts General Hospital (1998-2001).
When asked how he found the right postdoctoral position, Hu laughed and described a slow shift on night float, when he went to the medical library to read. The newest edition of Nature caught his eye, with a featured publication from Dr. Gary Ruvkun’s laboratory on the role of PI3K in lifespan and growth regulation in C. elegans. Emphasizing the value of personal networks in the research world, Hu mentioned that while in the Schlessinger lab, he had helped train and collaborated with another student. This student was now working as a postdoctoral scholar in the Ruvkun lab. Hu emailed his colleague, who in turn facilitated an introduction with Ruvkun, and thus, Hu secured a postdoctoral position in the Ruvkun lab (1999-2005).
Building a research team—and a family
Though the main findings from his postdoctoral work weren’t published yet, Hu and his wife began an early but small job search in 2004, looking for a place where they could practice medicine and raise a family. In 2005, they accepted positions at the University of Michigan, and Hu received funding to launch his cancer research program as an independent primary investigator. The generous startup funds, salary, and location were key factors in their decision, allowing him to dive into his research and support his family with the quality of life they had hoped for.
He started his first laboratory with the goal of using unbiased forward genetics to understand the complex factors that promote oncogenesis. When establishing his research program, he decided to continue with C. elegans, whose genetic tractability makes it a powerful eukaryotic model for cell signaling, metabolism, and cancer biology. His lab significantly advanced our understanding of the PI3K/AKT pathway, which coordinates insulin-like signaling to promote growth and development, as well as the role of EAK proteins in PI3K/AKT signaling, which control lifespan and stress resistance by regulating FoxO transcription factors.
In 2011, he was appointed to the National Scientific Advisory Council for the American Federation for Aging Research, which recognized his progress and future potential in the aging field. These milestones and his position in the field supported his promotion to Associate Professor in Internal Medicine and Cell & Developmental Biology in 2014, and he additionally became the Associate Director of the Hematology/Oncology Fellowship Program at the University of Michigan Medical School in 2015.
Vanderbilt: a new beginning
As his research career grew, so did his family. The Hus welcomed their twins and another daughter two and a half years later, and they began looking for a new home for the next phase of their careers. His wife, who grew up in Louisiana, provided the primary impetus for moving to someplace warmer, and they performed another job search for opportunities in the South.
Once again citing the power of personal networks, Hu credits his relationship with Kimryn Rathmell, MD/PhD, who had recently been appointed Director of VUMC’s Division of Hematology and Oncology, for helping bring him to Vanderbilt, knowing that the division would flourish under her leadership.
During his visits to VUMC, Hu met with Nancy Brown, MD, who was then serving as Chair of Medicine. They discussed job offers and whether he would be willing to help direct Vanderbilt’s PSTP, which was then under the leadership of Christopher Williams, MD/PhD. Brown scheduled a back-to-back meeting with Williams, allowing her to introduce him to Hu, and since then, the two have become close colleagues and friends.
In 2016, Hu was hired by VUMC to serve as an Associate Professor of Medicine and Cell & Developmental Biology, as well as Associate Director of the PSTP. Williams later transitioned to direct the Medical Scientist Training Program (MSTP), and in 2017, Hu became the primary Director of the PSTP. Their close relationship has helped the two collaborate and build a relationship between Vanderbilt’s MSTP and VUMC’s PSTP, a connection that will be a key element in strengthening the physician-scientist training pipeline. Since then, Hu and Williams have worked together to train new generations of physician scientists, building a more cohesive and supportive network of leaders to come.
Final words of advice
Donahue: What advice do you have as we graduate and look for postdoctoral/fellowship positions?
Hu: In general, I think we (people looking for new faculty positions) are quite naïve about what one needs to do to sustain a research-based career. This is largely due to shortcomings in the practical education of physician-scientists. I see it as part of my obligation as the PSTP Director to educate our trainees about the practical aspects of a physician-scientist’s career.
Funding and salary protection are incredibly important. I was able to do a six-year postdoc because I had salary support from a foundation fellowship followed by a K award. If you work hard and bring in your own money, you keep your boss happy. If you have the funding, nobody cares how long you stay in their lab because they don’t have to pay you. This means you get to work on the projects you want to, which you can take with you to start your own lab. If your funding runs out, that means someone has to pay you, and you have less freedom.
I’d encourage trainees to start applying for funding early and often. To get a faculty position, you need papers and a career development award, and the best way to do this is by beginning to apply for them. Yes, you’ll be rejected, but you miss 100% of the shots you don’t take. I took risks; they didn’t all pay off, but I was rewarded with some applications I thought were premature at the time.
Donahue: What are your thoughts on dual residency training programs for physician scientists?
Hu: Many people worry that two years of residency is not enough, which is what it works out to if you apply for a fast-track combined program. These programs are relatively new, but I think people forget doctors used to short track residency training all the time. People worry that their clinical training will suffer, but the reality is that the vast majority of trainees who are applying to internal medicine and intend to do mostly research do not need three years of residency training. If you’re going to do research, you will probably do a fellowship. You’ll get all the clinical training you need, and combined programs will accelerate your research career. We never stop learning, even as attendings, and by reducing the time in residency so you can focus on your research career, you’re one step closer to achieving your goals.
Donahue: You frequently mentioned the power of relationships in helping you get where you are today.
Hu: The older I get, the less credit I give myself for anything good that has happened to me. At every key transition in my career, my relationships with others helped me find the path forward. It’s funny really, I never considered how connected my training was, but in hindsight, relationships with other scientists and doctors I built years before helped me take the next steps.
Donahue: What’s your advice for building these networks and relationships during a pandemic? I feel like it’s harder to meet people without meetings and conferences, and I feel anxious making virtual introductions.
Hu: One benefit of virtual networks is that it’s now easier than ever to disseminate your work and preach your own gospel. People expect it now.
Don’t underestimate the benefits of sending a cold email. Introduce yourself and a bit about your project and say you would love some feedback from them. More often than not, they’ll take you up on it. Send some emails, ask to talk on the phone or video call, or even ask if they could meet with your lab.
I’m as busy as I’ve ever been, but my travel time has been “returned” to me. People are more flexible with how they arrange meetings, and rather than spending time on airplanes or driving, working from home means that meetings can be scheduled with greater ease and flexibility. For example, one of our PSTP alumni reached out to an esteemed scientist in the field, and within two weeks, they’d scheduled a joint lab meeting that advanced the science, and that relationship will only continue to grow.
Finally, I think all trainees should join Twitter to expand their networks. It’s easy to meet people, and through a few comments or retweets, you can start to build a relationship with people all over the world. You want to shrink your world as much as possible, and never underestimate the benefits of these connections. From there, you can message people to have a conversation, and the worst they can say is no.
Whenever scientists are reviewing papers, reading grant applications, examining tenure packets, or rifling through job applications, if they have a face that they can put with the name, it can only benefit you. I don’t agree with it, but if somebody knows and likes you, when you apply for jobs, you’re going to get a better close look than others. That’s the nature of the game. When I applied for my first faculty position, I didn’t think I’d get very far since my publications were still in the works. I anticipated applying again the next year with twice as many publications, but I had successful interviews at four universities, all of which I had a personal connection with.
Donahue: How do you find time to lead a lab, direct the PSTP, see patients, and be with your family? It seems like a lot to manage.
Hu: Being aware of your priorities and knowing their importance to you is critical. Early on, I made the decision that my family would always be my first priority. From there, it was easy. Academic medicine is demanding, but one benefit of running a lab that most people underestimate is the flexibility that a research career gives you. We won’t earn as much as our colleagues who are invested in a medical only practice, but having a research career lets us pursue our passions and have more control over our time. When you look for jobs, think about your priorities and your ideal quality of life. Look at the offers and the cost of living, and compare your startup packages. Pick the one that is most in line with your priorities—not the most glamorous one.
Donahue: That’s great advice. Any other reflections on your career path that will help future physician scientists follow?
Hu: To be particularly frank, this path has been harder than I thought. And as you know, I’m still struggling. I think a mistake I made in Michigan was keeping a low profile. I tried to focus as much as I could on my research, but this may have backfired. I kept my network small, and this meant I was off the radar for collaborations. So, it all comes back to working with others. At each stage, you may feel like you need to buckle down and focus on yourself, but that’ll hurt you. Build a network. Find friends and collaborators. As I said earlier, good things in life come from your relationships with others, and investing in that early will help you be successful and happy later on.
Donahue: Thank you for sharing that. Two last questions before we go: who is your favorite composer? Do you still have time to play piano?
Hu: You know, music is one of the only things helping me maintain my faith in humanity during these troubling times. I’m sure it’s the same with you—I find a certain solace in it. I’ve always been torn between Bach and Beethoven, but with the pandemic, my love for Beethoven is growing. I relate more to the spirit of his music, and it’s been comforting. The pandemic has brought me back to the piano.
Though I rarely play for myself in recent years, my daughters are growing musicians, and with the pandemic, we’re hesitant to hire an accompanist for them. I used to be able to sightread their parts just fine, but they’re getting too good for that now. Now they’re applying for college, and we need to record audition tapes. This weekend is going to be kind of crazy—after I submit my grants, I need to practice so I don’t make them look bad!