1. From Fellowship to Faculty William J. Bremner, M.D., Ph.D. Professor and Chairman Department of Medicine July 9, 2008

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 Fellows123 M.D. Fellows not in ACGME 68 Ph.D. Fellows 58 Other 1 Total250

11. Department of Medicine—Fellowship Programs  ACGME Fellowship Programs in:  Allergy and Infectious Diseases16  Cardiology21  Dermatology 1  Endocrinology 8  Gastroenterology13  Gerontology 0  General Internal Medicine 0  Hematology/Oncology25  Medical Genetics 1  Nephrology 8  Pulmonary and Critical Care25  Rheumatology 5 Total 123

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 MD151 MD, MPH 8 MD, PhD 32 PhD 58 Other 1 Total number of fellows250

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. 08-09 R-Level RANKANNUAL R-4$52,994 R-5$55,032 R-6$57,012 R-7$59.676 R-8$62,268

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

20. 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

21. Years between Fellowship & Academic Titles Avg Count YearsMinMax Fellow to Acting Instructor1183.108.5 Fellow to Acting Asst Prof.414.60.97.7 Fellows to Asst Prof.805.42.29.0

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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

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

30. 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

31. 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

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

33. 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

34. Total Department of Medicine Expenses Annual AAMC Financial Summary-FY07

35. Total Department of Medicine Expenses FY2007

36. UW ADMINISTERED—TOTAL DIRECT EXPENDITURES FROM GRANTS AND CONTRACTS

38. 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