Why do a fellowship/What to get out of it? Our fellowship programs Numbers, degrees, divisions

1. From Fellowship to Faculty William J. Bremner, M.D., Ph.D. Professor and Chairman Department of Medicine September 27, 2006

2. 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

3. Why do a fellowship/what to get out of it? Area is interesting Patients Research questions Teaching opportunities Practice opportunities Life style Hours Geography $

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

5. Research Mentorship—primary, secondary “Lab” facilities/environment Space, equip, staff Other trainees Rarely if ever—a specific research questions first

6. Teaching Mentorship Seek out excellent clinicians/teachers Not so well supported financially Very gratifying

7. Practice 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

8. Biotech opportunities Both Ph.D.s & M.D.s Increasing locally Tech Transfer/Intellectual Property (IP) issues

9. Academics 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

10. Department of Medicine—Fellowship Programs ACGME Fellows 136 M.D. Fellows not in ACGME 63 D.V.M. 1 Ph.D. Fellows 75 Total 275

11. Department of Medicine—Fellowship Programs ACGME Fellowship Programs in: Allergy and Infectious Diseases 20 Cardiology 22 Dermatology 0 Endocrinology 9 Gastroenterology 13 Gerontology 3 General Internal Medicine 0 Hematology/Oncology 23 Medical Genetics 6 Nephrology 11 Pulmonary and Critical Care 24 Rheumatology 5 Total 136

12. Fellowship Salaries: Sources ACGME Fellows: Medical Center Stipends Training Grants Division Funds Non ACGME Fellows: Research

13. Institutional Research Training Grants T 32 Institutional National Research Service Award

14. Individual Fellowships F 32 Postdoctoral Individual National Research Service Award F 33 National Research Service Awards for Senior Fellows

15. Department of Medicine—Fellowship Programs MD 165 MD, MPH 8 MD, PhD 26 PhD 75 DVM 1 Total number of fellows 275

16. Agencies fund DOM Fellowships, Career 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

17. Agencies funds DOM Fellowships, Career 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

18. 06-05R-Level RANKANNUAL R-4 $49,284 R-5 $51,780 R-6 $54,264 R-7 $56,796 R-8 $59,688

19. 06-07 PGY-Level RANKANNUAL PGY-3 $43,428 PGY-4 $45,048 PGY-5 $46,992 PGY-6 $48,852 PGY-7 $51,036

20. How to support fellow to Academic Position Apply for K awards Foundations Request support on mentors’ grants Collaboration with other faculty

21. K 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

22. Years between Fellowship & Academic Titles Avg Count Years Min Max Fellow to Acting Instructor 87 2.8 0 6.0 Fellow to Acting Asst Prof. 25 4.5 1.0 7.3 Fellows to Asst Prof. 35 4.9 2.2 8.3

23. Acting Faculty (I) Annually renewable appointment No more that 4 yrs as Acting Instructor No more that 4 yrs as Acting Assistant Prof CombinedActing cannot exceed 6 yrs No independent lab space PI on grant proposals by permission Whose space? Tenure clock has not started

24. 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

25. 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

26. Acting Faculty Appointment Process 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

27. Assistant Professor appointment (I) Requires a search Requires three years minimum of solid salary support “Several” first-authored original research papers in strong peer-reviewed journals

28. 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

29. 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

30. Tracks/Pathways Physician Scientist Clinician Teacher Full-Time Clinical

31. Physician 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

32. Clinician 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

33. Full-time Clinical Clinical excellence, both in quality and quantity Clinical administration Teaching

34. 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

35. Total Department of Medicine Expenses Annual AAMC Financial Summary-FY05 Increase 01 to 03 reporting: FHCRC 34 million, VA 9 million True increases: Grants/Gifts 33 million, Medical Centers 6 million

36. Total Department of Medicine ExpensesFY2005

37. UW ADMINISTERED—TOTAL DIRECT EXPENDITURES FROMGRANTS AND CONTRACTS

39. 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