As a psychiatric resident, when I was considering a research career in academic psychiatry, a senior colleague gave me a cartoon to read. It depicted two white-coated scientists peering into a laboratory where another similarly attired figure was hunched over a microscope at the bench. The first doctor at the door pointed toward the figure at the bench and said to his colleague, "He's trying to find the gene that makes people do this kind of thing (medical research) for a living." Indeed, it takes a special set of qualities and circumstances to enable a person to successfully and enjoyably pursue a career in biomedical research. I often say to young aspirants that, when it comes to research, "Many are called, but few are chosen." This is not meant to be elitist or to romanticize research, but simply to say that not everyone is cut out for it and that specific attributes in the individual and circumstances in their professional environments are important in facilitating the realization of this goal and ultimate satisfaction with this career path.
At the same time, it has become painfully apparent that the proportion of medical school graduates going into research is declining and is near all-time lows (1,2). Although the explosive growth in the neurosciences has spawned burgeoning numbers of Ph.D.s going into basic and clinical neuroscience research, the number of M.D.s has not kept pace (3). The reasons for this are numerous and complex and are the focus of many analyses and reports by graduate medical training organizations, along with the NIH, APA, and the AAMC (1—4). Therefore, this article will not explore these matters. Rather, the remainder of this piece will describe what I consider to be the important elements to success in pursuing a research career in academic psychiatry for physicians in the early stages of their professional development.
Individual Factors for Research Careers
A major reason that, when it comes to research, many are called, but few are chosen, is that most medical students and residents have a fundamental misconception about what research involves and what it is like to do it. They have the notion that it is intellectually exciting and professionally glamorous. In large part, this is because the exciting discoveries and breakthroughs that move modern medicine forward emanate from research laboratories and scientific journals and because researchers are the "stars" of academic medicine. However, the idea that research is an exciting, "thrill-a-minute" pastime could not be further from the truth. A former mentor of mine compared research to flying. "Flying is hours and hours of tedium occasionally and unpredictably interrupted by a few seconds of stark terror." Similarly, research involves long periods of repetition and tedium infrequently punctuated by moments of intellectual ecstasy or disappointment. Thus, it is enormously helpful, if not essential, that someone be so stimulated by the intellectual challenge of scientific research that he or she will be sustained through the arduous process of carrying out laboratory experiments and clinical studies. These persons must be able to tolerate delays in gratification and derive sufficient rewards from the intellectual process in which they are engaged to be happy in this line of work. Indeed, it is best if they crave this form of intellectual exercise and would prefer it to all other forms of gratification that can be derived from medical careers (e.g., helping people, humanitarianism, being respected, financial remuneration, wielding power and authority)—which brings me to the second misconception. Most aspirants think that what ultimately determines success is how smart they are. Thus, early on, a great deal of effort is spent by trainees in trying to show their teachers and peers how clever and well-read they are. However, although intelligence and knowledge are important, to be sure (particularly in distinguishing the truly gifted scientists at the world-class level), to achieve success at the academic-institutional level, the more important qualities are perseverance and willingness to work hard. When it comes to medical research, Edison's adage that "genius is 99% perspiration and 1% inspiration" applies. I repeatedly hear residents saying that they would like to pursue research but worry that they aren't "smart enough" or "might not have what it takes,"—to which I respond with three comments: 1) You'll never know if you don't try. 2) If you don't do it now, then when will you again have the opportunity? and 3) If you don't try, you may regret it for the rest of your life. In general, the earlier one is exposed to research, the better. The ideal time is during or at the completion of residency training (5). Often, this opportunity comes in the form of a research fellowship, which is time that is protected and dedicated to learning research methodology and acquiring experience doing research. Even if you find, a year into the fellowship or upon its completion, that you don't like the experience or aren't willing to work that hard and be competitive, you will have still learned a great deal and will be more qualified to seek a non—research-oriented position. For a neophyte to learn in the context of a job or junior faculty position is not impossible, but it is much harder.
I firmly believe that the most important quality for aspiring medical researchers early in their career is willingness to work hard. If they have this quality, and particularly if they are in a good setting, the rest will take care of itself, and ultimately they will succeed. Of course, there are a few other things that can also be useful to aspiring researchers. It helps not to be "rejection-sensitive" because they will repeatedly get critiques of their papers and grant proposals. It also helps to be organized and efficient. But this is clearly not essential, as is evidenced by the high proportion of scientists with messy offices and disorganized schedules. It also helps if they like to read and are good writers, or at least like to write, since they will need to report their findings in scientific articles and grant submissions. However, as helpful as these attributes can be, they pale in comparison to the importance of a good work ethic and perseverance.
External Factors for Research Careers
Clearly, the elements most critical to successful research careers are the individual qualities described above. Highly motivated persons—particularly if they are bright and talented—will ultimately succeed, even if they start out in an unconducive setting, as long as they persevere. However, external factors are important in facilitating the process and influencing the rate of scientific development and the trajectory of an individual's scientific career. Thus, it helps to be in a good institutional setting that provides a clinical research infrastructure. This includes the presence of experienced investigators who can serve as mentors, an active and ongoing research program of studies in which the aspirant can participate, and adequate facilities in terms of clinical settings and populations and laboratory facilities. If the place where one has trained does not have these, the person should move to a place that does. Many trainees succumb to the familiarity of their home institution, which, if eager to keep them, often says that they will provide them with what they need to develop as a researcher or build a research program around them. However, this is unrealistic and unlikely. If it doesn't exist already at their home institution, it is unlikely to be developed in time for their career-development needs. The best way to get the first-hand experience and training that is required to successfully pursue a research career is through a research fellowship. There are many of these programs in the United States at top institutions, and finding a place is not difficult. Moreover, funding for research trainees and young researchers in general is relatively abundant. The leadership of the NIMH and the research community are acutely aware of the importance of developing the next generation of psychiatric researchers and therefore are doing many things to facilitate this process (2,6).
At the same time, American medicine and the United States health care system have been battered by managed care and other mechanisms of cost-containment (7). These have had an impact on the research training process as well. However, in a curious way, this impact may have prompted young physicians to give more consideration to academic careers, given that the clinical and private-practice career paths are not as attractive as they might have been previously (8,9).
If all of my experience were distilled into some simple recommendations, these are what they would be.
There has never been a better time to go into biomedical research. The science is burgeoning and better than ever. The current funding levels are generous. There are numerous training opportunities. And, finally, the field is eagerly seeking the next generation of psychiatric researchers. What have you got to lose?
This work was supported by the Foundation of Hope (Raleigh, NC) and by the University of North Carolina (UNC-MHCRC MH-33127).