Building Career Paths for Ph.D., Basic and Translational Scientists in Clinical Departments in the United States: An Official American Thoracic Society Workshop Report.

"Subcommittee Disclosures: B.B.M. served on advisory committee for Galapogos; served as consultant for Boehringer Ingelheim, Pulmonary Fibrosis Foundation, Scleroderma Foundation. M.N.B. received research support from NIH. T.S.B. served on advisory board for Novartis; served as consultant for Boehringer Ingelheim, Janssen, Orinove, Pliant; received research support from Boehringer Ingelheim, Bristol Meyers Squibb, Department of Defense, Department of Veterans Affairs, Morphic, NIH. G.R.S.B. received research support from Department of Veterans Affairs and NIH. S.C.E. served on advisory board for NIH; served as chair of ABIM Pulmonary Disease Board; served in leadership role for Cleveland Clinic; received research support from Cleveland Clinic and NIH. B.E.H. received research support from NIH. R.K.M. served as consultant for Koutif; received royalties from Generian. F.J.M. served as consultant for Abbvie, AstraZeneca, Bayer, Biogen, Boehringer Ingelheim, Bristol Meyers Squibb, Csl Behring, DevPro, GlaxoSmithKline, IQVIA, Novartis, Polarean, ProTerrix Bio, Pulmatrix, Pulmonx, Raziel, Regeneron, Sanofi, Shionogi, Teva, Theravance/Viatris, twoXAR, Veracyte, Verona; served on data safety and monitoring board for Biogen and Medtronic; served as speaker for Academy for Continuing Healthcare Learning, Brooklyn Methodist Hospital, France Foundation, GlaxoSmithKline, Integritas, Integrity Communication, Medscape, NACE/Haymarket, National Association of Managed Care Physicians, Paradigm, PeerView, Physician Education Resource, Projects in Knowledge, United Therapeutics, UpToDate, Vindico, WedMD/MedScape; received research support from Chiesi, DevPro, Gilead, Nitto, Patara/Respivant, ProMedior/Roche, Sanofi/Regeneron. J.E.M. has financial stake in Affinivax. D.C.N served as consultant for University of Indiana; served as speaker for Oklahoma State University; received research support and served as reviewer for NIH; received travel support from ICAN Network and FOCIS. P.J.S. served as consultant for Boehringer Ingelheim, UCB, Three Lakes Partners; served on scientific board for Parker B. Francis; received honorarium from Grand Rounds McGill University, Ground Rounds University of Kentucky, Grand Rounds University of Nebraska, Grand Rounds University of Virginia; received research support from NIH, UCB, PFF, Ford Foundation; received travel support from Boehringer Ingelheim; issued US Patent 10,765,376; patent application 60/567,397; 60/5653,657; 60/513,372; 63/264276; holds stock for Galecto. A.I.S. received research support from NIH. S.V. employee of Q32 Bio; served on advisory committee for Apie, Cytimmune, Kymera, Mediar, Morphic Therapeutics, Scholar Rock; served as consultant for Biogen, Mediar, Morphic Therapeutics, Scholar Rock; holds intellectual property with Biogen and Q32 Bio; holds stock in Apie, Kymera, Mediar, Morphic Therapeutics, Q32 Bio, Scholar Rock. D.S.W. served as consultant for Cartesian Therapeutics and DevPro; served as national director of Harold Amos Medical Faculty Development Program for the Robert Wood Johnson Foundation; holds intellectual property with ImmuneWorks. N.N.B., Z.B., B.C.M., V.G.K., H.S.K., T.J.M., R.A.J., M.A.O., Y.S.P., K.M.R., M.K. reported no commercial or relevant non-commercial interests from ineligible companies."

"This section is devoted to potential barriers or disadvantages of hiring basic scientists in clinical divisions. From the perspective of basic scientists, although access to and synergy with clinical colleagues may be advantageous for their work, there are downsides to consider. These include lack of familiarity with career development and promotion metrics or knowledge of strong external evaluators for promotion packages by clinical unit leadership, a sense of isolation if there are few basic scientists in the unit, and potential for administrative staff in clinical units to be less familiar with research grant submission processes. As clinical departments are rarely degree-granting entities, Ph.D. faculty in clinical departments may not have access to graduate students to train in their laboratories. Finding opportunities for leadership may be more challenging for basic scientists in clinical units, necessitating Ph.D. faculty to look to medical school or university-wide opportunities for leadership or within their professional scientific societies. Finally, norms for start-up costs and space allocation may be different between basic science and clinical departments, which may disadvantage Ph.D. faculty in clinical units. Given these cultural and financial differences, clinical departments that want to embed basic scientists may have difficulty attracting the most competitive candidates. It can be dispiriting for clinical departments to repeatedly lose top basic and translational talent to basic science units, where indefinite hard money for salary is a strong lure. Given time and political capital invested in failed recruitments, such disappointments may negatively impact future willingness to recruit tenure-track Ph.D. scientists to clinical departments. To alleviate this perceived financial risk, many AMCs have recently instituted a non–tenure-seeking research track. On this track, Ph.D. scientists who are still primarily affiliated with a PI with the resources to pay their salary can enter a faculty track that requires nearly 100% salary coverage using grants, contracts, or philanthropic sources. This track offers a faculty title for Ph.D. scientists who may age out of the usual 5-year postdoctoral fellowship category but may not be ready to leave the laboratory where they conducted their postdoctoral training. The advantages for those research-track faculty can be the opportunity to remain in the PI’s lab long enough to finish critical studies or to have faculty status needed to submit grant applications in hopes of becoming more competitive in the job market elsewhere. Most research-track faculty positions are not long term, given the criteria for promotion often match the tenure-track faculty expectations, yet research-track faculty are rarely given any start-up funds or technical support staff to advance their independent work. As such, they generally do not offer the long-term benefits truly embedded tenure-eligible basic scientists can bring to clinical units. It can also be more challenging for research-track faculty to compete for NIH funding if study sections do not perceive institutional commitment to these faculty. identifies disadvantages to the clinical unit and the basic scientist regarding work in a clinical department. Fear of financial pressures and space resources were the most commonly noted barriers to hiring basic scientists in clinical units (). Paradoxically, funding fears are partially at odds with the success of funding at the NIH by degree. For a roughly 25-year period (1986–2009), ∼70% of PIs on NIH grants held a Ph.D. degree, whereas about 10% held an M.D., Ph.D. degree. The M.D.-only percentage of PIs was around 20% (). Recently released analyses by the NIH show in 2020 the number of NIH grants awarded to M.D. degree holders dropped to 15%, whereas the numbers awarded to M.D., Ph.D. degree holders held steady at 10%, and awards to Ph.D. holders rose slightly to 71% () (, left). Interestingly, if you look at investigator characteristics of the top 1% of NIH-funded investigators, M.D., Ph.D. scientists make up 17.2%, M.D. scientists make up 33.2%, and Ph.D. scientists make up 47.6% (, right). Adding the M.D. and M.D., Ph.D. statistics together, there is a slight edge for a clinical degree in the top 1% of funded investigators (50.4% hold an M.D. degree vs. 47.6% who hold a Ph.D. degree alone), but this difference is quickly lost when you consider the bottom 99% of grant holders where >71% are Ph.D.-only degree holders. There is no doubt the top 1% of NIH awardees are an impressive group of researchers, averaging a median of $4.8 million in funding each, with >80% of these investigators holding two or more research grants (). In contrast, the bottom 99% of investigators averaged $400,000 median funding, with only 32.7% of these investigators holding more than one research grant (). Thus, these statistics raise an important question: can AMCs reasonably expect any of their faculty in either clinical or basic science units to regularly hold more than one research award from the NIH? The data suggest this is unlikely and make the case for new algorithms for support of the research missions in AMCs. Moreover, data also show <8% of these awards went to faculty underrepresented in sciences, again highlighting the need to increase the diversity of faculty who are applying for these awards in AMCs overall. Similar data can be found for career development awards/funding. If looking at outcomes of Parker B. Francis fellows (), 42% of awards have gone to Ph.D. recipients, and 82% of those awardees remained engaged in research after the fellowship. This is compared with 49% of M.D.s who were funded, only 55% of whom remain in research. When looking at later R01 funding, 38% of M.D. awardees went on to obtain an R01, whereas 50% of Ph.D. awardees did so. Thus, if a clinical division wanted to maximize chances of funding success to drive research and training missions, leadership should be aware of these measures and consider hiring at least some faculty who are basic and translational scientists. The NIH data book, updated in 2022, also indicates funding success for basic and translational scientists who have been supported by a Kirschstein–National Research Service Award fellowship is 16.2% for obtaining an NIH grant within 15 years of the degree. This is compared with only 8.3% for trainees from those same fields and institutions that were not funded by National Research Service Award grants (). Thus, striving to hire the most qualified applicants with a focus on those who have obtained previous career development fellowship support, whether from within or outside the NIH, should further increase chances of successful independent funding when clinical units are considering which basic scientists to hire."