Endangered Species
Two thousand fifty years ago, the Roman poet Horace spun a phrase that never seems to lose its power: Carpe diem. Seize the day.
The line continues: Put very little trust in tomorrow. By that Horace meant, don’t leave the future to chance. Act now. Make tomorrow better.
Carpe diem is a worthy mantra for the physician-scientist, the researcher with an MD or MD/PhD who applies his or her unique combination of scientific knowledge and clinical expertise to solving some of the most intractable challenges of human health.
In the past three years alone, physician-scientists at Vanderbilt University Medical Center contributed to the ultrafast development of COVID-19 antibodies, antivirals and vaccines, identified new targets for the treatment and prevention of cancer, diabetes and heart disease, and advanced the fields of precision health care and genetic medicine.
This did not happen by accident. More than six decades of commitment and creative problem-solving by VUMC leaders, coupled with significant support from the National Institutes of Health (NIH) and the private sector, has transformed Vanderbilt into the powerhouse of physician-scientist training it is today.
“Vanderbilt has played an oversized role in cultivating, training and developing physician-scientists,” said Kimryn Rathmell, MD, PhD, the Hugh Jackson Morgan Professor of Medicine and chair of the department. “Our engagement of physicians in active research is higher than almost any other academic medical center.”
Physician-scientists trained at Vanderbilt University School of Medicine and VUMC exceed the national average when it comes to obtaining training and independent research grants from the NIH. Vanderbilt also is an influential advocate for increasing the supply of MD/PhDs nationally and internationally.
In 2020 and 2021, for example, Rathmell and Lorraine Ware, MD, the Ralph and Lulu Owen Professor of Medicine, served back-to-back terms as president of the American Society of Clinical Investigation.
According to the first truly global consensus document addressing issues facing physician-scientists and the continued need to develop individuals who work in this arena, “Physician-scientists are major research engines that drive discovery across academia, government and industry.”
The work, published this fall in the journal eLife, was led by Christopher Williams, MD, PhD, professor of Medicine and associate dean for Physician-Scientist Education and Training at Vanderbilt, with contributions from Rathmell and an international panel of experts, including thought leaders from Europe and Asia.
Maintaining Vanderbilt’s carpe diem attitude is crucial, for despite sustained efforts by the government, academic medical centers and private foundations, physician- scientists remain, according to some observers, “an endangered species.” Since the 1980s, the percentage of U.S. physicians involved in biomedical research dwindled from 4.75% to approximately 1.5% in 2014.
There are many explanations for this. Efforts to reduce the onerous cost of medical school and streamline the curriculum in some places has limited exposure to the basic sciences. Lack of mentors, inadequate financial support and little protected time to do research discourage many from embarking on the physician-scientist track.
Even when aspiring physician-scientists attain “K”-series research development grants from the NIH, a traditional stepping stone to their careers, nationwide fewer than half of them are able to make the transition to “R01” independent investigator awards that can provide sustained and reliable support for their laboratories.
In comparison, about 70% of Vanderbilt-trained MD/PhDs make the K-to-R grant leap, a rate that is “one of the best in the country,” said Roy Zent, MBBCh, PhD, the Thomas F. Frist Sr. Professor of Medicine and vice chair for Research in the Department of Medicine.
“The secret sauce behind it is we protect their time,” Zent said. “That’s really important, so they have lots and lots of protected time to do their research.”
On the following pages are some of the initiatives Vanderbilt has implemented to bolster and protect the physician-scientist population.
Medical Scientist Training Program (MSTP)
Initially supported by local donations and foundation grants, the MSTP at VUSM received its first significant endowment of $1 million from the New York-based Vivian B. Allen Foundation in 1968. NIH support followed in 1977 and has continued ever since.
Of the program’s nearly 330 graduates, most have pursued or are pursuing discovery-based careers in academic medicine, the private sector or government. Alumni in leadership positions at VUMC include Jeff Balser, MD, PhD, VUMC President and CEO and Dean of the School of Medicine, and Williams, who directs the MSTP.
“Consistent institutional investment, capitalizing on Vanderbilt’s talented clinical and research faculty, has allowed for sustained growth in the program, especially in the past 10 years, to help meet the national demands for physician-scientists,” said Christopher Williams, MD, PhD, associate dean for Physician-Scientist Education and Training at Vanderbilt.
“Our program benefits tremendously from the rich collaborative nature of the many institutional programs that foster physician-scientist careers at numerous stages,” he said. “Because of this, we have recruited terrifically talented trainees who care about each other’s success as much as their own.”
Currently, 111 MSTP students are in various stages of their training. Among them are Margaret Axelrod, who recently earned her PhD in cancer biology and is in her final year of medical school, and Xavier Bledsoe, in his third year in the PhD program in human genetics.
As an undergraduate at Georgetown University, “I was struck by how different the research and medicine worlds seemed,” Axelrod said. “I was really interested in the idea of being someone who could stand at the intersection of those two worlds.”
At Vanderbilt, Axelrod said she has received excellent medical and research training as well as leadership and mentoring opportunities through the MSTP.
“Most importantly,” she said, “I am surrounded by an incredibly supportive community. I feel well prepared for the next phase of training in residency and beyond. My career goal is to be a pathologist who runs a translational tumor immunology laboratory.”
Bledsoe, who earned his bachelor’s degree from Princeton University, became intrigued with the idea of combining research and medicine while participating in a summer research program at Washington University in St. Louis. But it was at Vanderbilt that he learned how to turn his dream into reality.
“Through the weekly MSTP seminar I have learned the importance of being able to give a well-structured, lucid talk,” he said. “I have learned that the first important test of a research finding is not how flashy and impactful it is, but how well it stands up to rigorous testing and external scrutiny.
“Being part of the MSTP here has meant learning key goals to pursue and finding myself equipped to achieve these goals through coursework, mentorship, vertical and horizontal collaborations, and a seemingly endless suite of resources.”
Master of Science in Clinical Investigation (MSCI)
The MSCI program trains investigators in the techniques and processes utilized in clinical and translational research. It is open to medical students, residents, clinical fellows and faculty physicians, as well as PhD candidates in the Vanderbilt University School of Nursing, postdoctoral PhDs and others.
Established in 2000 by the former chair of Medicine, Nancy J. Brown, MD, currently the Jean and David W. Wallace Dean of Medicine at Yale, and the late Thomas Hazinski, MD, the MSCI program was one of the first such formal programs in the country.
“At the time, it was quite a novel program,” said program director Eric Austin, MD, MSCI. An associate professor of Pediatrics, Austin directs the Pediatric Pulmonary Hypertension Program at Monroe Carell Jr. Children’s Hospital at Vanderbilt. He earned his MSCI at Vanderbilt in 2008.
As of July 2022, nearly 250 trainees had earned the MSCI degree at Vanderbilt. They have produced more than 7,000 original research publications, and they have garnered millions of dollars in research funding to support their research at academic medical centers, in industry and the government.
“The vision since its inception has been to serve as a global leader in cultivating and training biomedical scientists whose efforts will improve human health,” Austin said.
Maame Yaa “Maya” A.B. Yiadom, MD, MPH, earned her MSCI from Vanderbilt in 2018. Today she is vice chair of Research in the Department of Emergency Medicine at Stanford University. Her career trajectory exemplifies the power and potential of physician-scientist training.
Yiadom earned her MD from the Robert Wood Johnson Medical School in Camden, New Jersey, and her Master of Public Health from Harvard before enrolling in VUMC’s Emergency Medicine Research Training Program as a K12 Emergency Care Scholar in 2014.
Coupled with her K research development grant, “having strong scientific faculty leaders teach in the (MSCI) program, develop our early-career projects, and often become part of our study teams provided a scientific career-elevating experience,” Yiadom said.
“It is a very unique master’s program … that encourages rigorous scientific discovery toward producing impactful science,” she said. “I’m not sure there are many like it in the country … My lab started at Vanderbilt and has evolved into a national network of emergency care research at Stanford.”
Physician Scientist Training Program (PSTP)
Another route to clinical research at VUMC is the Physician Scientist Training Program, which currently is offered to residents in the departments of Anesthesiology, Medicine, Pathology, Pediatrics, Psychiatry and Behavioral Sciences, and Surgery.
VUMC’s first PSTP, established by the Department of Medicine in 1999, is one of the oldest in the country.
Residents in internal medicine receive combined clinical and research training via the American Board of Internal Medicine Research Pathway. They are eligible for membership in the Harrison Society, a peer group that facilitates mentoring by VUMC faculty and distinguished visiting professors.
Named for Tinsley Harrison, MD, Vanderbilt’s first chief resident in Medicine, the Harrison Society is dedicated to the preservation of science in clinical medicine and to the scientific literacy of physicians who use this knowledge at the bedside.
Celestine Wanjalla had completed her MD/PhD at Thomas Jefferson University in Philadelphia in the spring of 2013 when she heard about VUMC’s PSTP for internal medicine residents.
A native of Nairobi, Kenya, she has lost several family members to complications of HIV/AIDS, including two uncles who died on the same day in 2001. Since her college days at Cornell, she has been determined to try to help find a way to stop the virus.
Wanjalla wanted to become a physician and a scientist because doctors bring a different level of understanding to scientific inquiry. “We see the patients. We also ask the questions,” she said. Because doctors know what their patients are struggling with, “we ask the questions differently.”
At VUMC, Wanjalla discovered a clear path to achieving her goal: two years of residency and five years of guaranteed fellowship and postdoctoral training. The PSTP, in her experience, “was the only program of its kind at the time that was well structured.”
Patrick Hu, MD, PhD, associate professor of Medicine in the Division of Hematology and Oncology and current director of the department’s PSTP agrees: “The commitment here to train and develop physician-scientists is stronger than any other place I’ve ever been.”
Another plus for Wanjalla is BioVU, VUMC’s DNA repository that enables sophisticated genetic studies of disease, and the Medical Center’s well-managed research cores. This panoply of resources for investigators seemed a natural fit for the next stage of her training.
Today Wanjalla is an assistant professor of Medicine in the Division of Infectious Diseases at VUMC, with nearly 40 publications to her credit. Her well-established lab is studying immune responses that drive noncommunicable diseases such as atherosclerosis in people living with HIV and other pathogenic viruses.
In 2021, Wanjalla won major career development awards from the Burroughs Wellcome Fund and Doris Duke Charitable Foundation to support her research. She attributes much of her success to VUMC’s culture of caring for its trainees.
“Everyone was very supportive,” said Wanjalla, a former co-chief fellow in Infectious Diseases who joined the faculty as an instructor in 2018. Through her contact with other physician-scientists in the Harrison Society, and by asking questions and bouncing ideas off colleagues and mentors, “I felt I truly could do it.”
Edge for Scholars
Vanderbilt’s support of physician-scientists spans the gamut, from the Vanderbilt Faculty Research Scholars (VFRS) program, which provides funding and mentorship to junior faculty and fellowship-level trainees, to Edge for Scholars, an office and online platform that fosters academic career development.
“We aim to be a one-stop shop to help early-career faculty to do great science, write grants that get funded, and succeed in academic life,” said Rebecca Helton, senior program manager for Edge for Scholars.
“As an example of our wraparound strategy, a researcher can view examples of funded grants from our library, take an online grant writing course funded by our office, and have their grant reviewed in an internal study section before it goes to a funding agency,” Helton said. The office also provides award-tracking databases, seminars and training sessions.
These programs are overseen by Katherine Hartmann, MD, PhD, VUMC Vice President for Research Integration and associate dean for Clinical and Translational Scientist Development in the School of Medicine.
Hartmann, who holds the Lucius E. Burch Chair of Reproductive Physiology and Family Planning, is an epidemiologist known for her leadership of Right from the Start, a community-based study of early pregnancy. For the past decade, she has been heavily involved in efforts to increase the nation’s supply of physician-scientists.
Established in 2015 from a merger of two preexisting programs, VFRS provides a stepping stone to NIH “K” career development grants and, later, to R01 independent investigator awards.
At any given time, the program provides internal funding for up to 18 early-career faculty members, both MD and PhD investigators, for up to three years as they prepare and submit their applications for NIH or foundation support.
Edgeforscholars.org was the first platform of its kind focused on the needs of trainees and early-career investigators. It offers a space for candid discussions about life in academia. Since it was launched in 2017, “we’ve had more than 500,000 visitors from every state in the U.S. and every country in the world,” Helton said.
Other mentoring and networking opportunities are available through the Elliott Newman Society, while the Vanderbilt Institute for Clinical and Translational Research offers internal grants and grant review “studios.”
Among those who have used internal grant review services, 60% to 70% are successful in attaining external funding, more than twice the national average, she said.
Physician-Scientist Doctoral Program
Another avenue at Vanderbilt for physicians contemplating a research career is the Physician-Scientist Doctoral Program.
Established in 2014 by Roy Zent, MBBCh, PhD, vice chair for
Research in the Department of Medicine, the program is a joint effort of the School of Medicine and the Graduate School to help resident physicians or fellows near the end of their clinical training earn a doctorate.
“People often assume that we have a really good understanding of how and why normal tissues develop into tumors,” said Scott Haake, MD, PhD, who completed his training after his hematology/medical oncology fellowship in 2015. “The more you dig into this area, the more you realize how little we know. It’s hard to treat a disease whose biology you don’t really understand.”
Haake visited several cancer centers in his quest to fulfill his dream. “Most of them did not want to invest in developing physician-scientists. They didn’t think it was the best use of their resources,” he said.
Vanderbilt, on the other hand, “was very open and encouraging.”
Mentored by Zent, Haake joined the faculty as an assistant professor of Medicine in 2015, contributed to a dozen papers published in high-profile scientific journals during the next six years, and in the spring of 2022 successfully defended his dissertation for his PhD in cancer biology.
In 10 years, he said, “I hope to be a clinically active physician who has an independently funded lab and who is successfully training a new generation of physician-scientists and making discoveries that will improve the lives of patients.”
“This guy had 55 reasons why he shouldn’t have done what he did,” Zent said of his mentee. “He has two kids. He had medical school debt. Yet, he was prepared to take a chance on himself, and a chance on a system that promised him the opportunity to be successful.
“It wasn’t that hard to do,” he added. “Put him in the right environment. Give him the right tools. And just do it.”