M.D.-Ph.D. Program Harvard Medical School Fall 1996 Newsletter

Articles in this issue:

Life is Short, the Art Long, Survey Confirms

by Linda Burnley

The most frequently asked question about the Harvard M.D.-Ph.D. Program is: where are the graduates and what are they doing? This inquiry comes not only from students and faculty interested in where the M.D.- Ph.D. career might lead but also from the National Institutes of Health (NIH) which must renew the Program's future funding. With the rising costs of tuition, and uncertainties in funding commitments, this question is even more crucial to answer. A recent alumni survey confirms that the graduates of the Harvard M.D.-Ph.D. Program are following the career paths and expectations defined by the NIH when the nation's first Medical Scientist Training Program (MSTP) was begun over thirty years ago.

In 1964 the MSTP was established by NIH to support the education and training of outstanding students interested in pursuing academic careers in the biomedical sciences. These physician-scientists were expected to become a national resource of teachers, investigators and scholarly physicians. There are now 33 MSTPs nationally with Harvard representing one of the largest programs in the country (current class size, including non-MSTP funded students, is 150). The training program begins typically with two years of medical school, followed by 3-5 years of graduate school to obtain the Ph.D., and then 2 more years of clinical studies. Once M.D.-Ph.D. students complete both the M.D. and Ph.D. degrees, they leave the Harvard Medical School for several more years of clinical and research training before the first anticipated faculty appointment. There are now over 200 graduates since the first Harvard MSTP student completed the program in 1975.

The recent alumni survey reflects overwhelmingly that the graduates are fulfilling the expectations of the training program. Of the 107 graduates who have completed their post-doctoral training, there are currently 9 professors, 2 NIH Chiefs, 24 associate professors, 50 assistant professors and 9 instructors. Nine individuals are holding positions in industry as CEO's (2), Vice Presidents (2), Directors of Divisions (2), and senior research scientists (3). There are 87 men and women still completing the residency and fellowship training and only two individuals known to be in private practice. To answer the question of which departments are attracting the most graduates, one can find the largest concentration in medicine (64), followed by surgery (16), pathology (14), pediatrics (14), neurology (12) and neurosurgery (12).

In our survey we asked the graduates some questions to gauge their opinions on how valuable their training has been to them. Of those who responded, an overwhelming majority (96%) felt that dual degree training has been valuable to their careers. Only a fourth of the respondents felt that M.D.-Ph.D. training was too long in proportion to the value it continues to bring to their careers. A small number of respondents (15%) felt it would have been sufficient for their careers to have obtained either the M.D. or the Ph.D. degree alone. Forty per cent of the graduates who returned a survey felt the M.D.-Ph.D. Program would be enhanced by a curriculum unique from that of the medical school. Finally, and not unexpectedly, only 40% of respondents stated that their career is similar to what they expected when they first began the M.D.-Ph.D. Program.

Linda Burnley is the Deputy Director of the M.D.-Ph.D. Program.

Meet the Investigators

by Nancy Andrews, M.D., Ph.D.

The M.D.-Ph.D. Program is hosting a series of Meet-the-Investigator breakfasts for small groups of students to meet informally with M.D.-Ph.D. faculty members. These events will focus on career opportunities and pathways for professional development, and will provide a forum for asking questions about life after graduation.

The first breakfast was hosted by David Golan, M.D., Ph.D. and myself, Nancy Andrews, M.D., Ph.D., both of us hematologists who combine part time clinical work with active research efforts. Responding to student questions, we discussed residency and fellowship options in medical and pediatric subspecialties, and outlined post graduate training routes often taken by M.D.-Ph.D.s. We described our current commitments to clinical medicine, research and teaching, and how to make decisions in partitioning career obligations. Dr. Golan and I talked about strategies for securing fellowship and junior faculty research funding, and gave our views on current and future economic constraints.

The next Meet-the-Investigator breakfast will be hosted by Clifford Saper, M.D., Ph.D., Chief of Neurology at Beth Israel Hospital, on December 17. Dr. Saper will assemble a group of M.D.-Ph.D. faculty members from his department to meet with students particularly interested in careers in Neurology and Neurosciences. Students interested in this event should put it on their calendars, and watch for further information from the M.D.-Ph.D. Program office. For more information, or to suggest topics/faculty for future breakfasts, call the office at 432-0991.

Dr. Nancy C. Andrews is Associate Faculty Director of the M.D. Ph.D. Program

A Conversation with Hugh R. Byers, M.D., Ph.D.

by Ryan Putzer

Hugh R. Byers, M.D., Ph.D., graduated from Harvard Medical School in 1983, completing his Ph.D. thesis under Keigi Fujiwara in the Department of Anatomy. Dr. Byers' thesis, which was partially researched at the Marine Biological Laboratory at Woods Hole, focused on the immunofluorescence of cytoskeletal proteins in fish pigment cells. He subsequently completed residencies in Anatomic Pathology (Brigham and Women's) and Dermato-pathology (MGH). Dr. Byers was appointed Instructor, then Assistant Professor of Pathology at Harvard before assuming his current position as an Associate Professor of Dermatology at Boston University Medical School.

My discussion with Dr. Byers centered on the range of possibilities that confront the M.D.-Ph.D. upon graduation. Historically, it often has been presumed that M.D.-Ph.D. students would immediately pursue research careers following graduation. Dr. Byers deferred this option, choosing instead to complete residencies in Anatomic Pathology and Dermatopathology. His experience was an excellent example of the sort of fusion that often is referred to in M.D.-Ph.D. circles, as the immunolocalization techniques that he researched in graduate school were first pioneered clinically in the years he was a resident. Nonetheless, Dr. Byers observed that for the M.D.-Ph.D. graduate, who has emerged recently from an intense research environment, residency may present a certain "frustrating tension" inasmuch as it often precludes the ability to stay meaningfully connected to basic research efforts.

Concluding his residency, Dr. Byers also noted the difficulty of reentering the research field. For example, one is awarded fellowships largely for one's thesis work, despite the passage of several years and much advance in the field. He emphasized that there are strong economic and other pressures that discourage postdoctoral work, not least the absence of departments with well-defined places and programs for clinician-researchers. Dr. Byers commented on the importance of selecting an academic department strongly committed to basic research, one that offers both the intellectual and material resources needed to inspire and sustain a budding scientific career. Optimistically, he also notes the distinct advantages of reentering basic research enriched with a clinical perspective, citing a "maturity of clinical thinking" that results from residency training.

Following his residencies, Dr. Byers was awarded an NIH FIRST award, a fellowship that is a pretrack for starting an independent lab. He observed that many of the awardees were M.D.-Ph.D.s and suggests that the combined degree offers a considerable advantage in securing competitive grants providing that the work bears directly on human disease. During this time, Dr. Byers spent about 80% of this time in research and devoted 20% to clinical practice. The two, however, were conceptually and practically linked: for example, his experience in pathology permitted him access to human tissue and appropriate sampling without compromising patient care, a situation which proved to be critical to his research on melanomas. Conversely, his diagnostic work with melanomas provided a perspective on his research efforts. Dr. Byers suggested that this continuum of research and practice surely will increase in prominence as medicine advances. As we move from genetic studies to the patient population, the logistics, he notes, is complicated but inevitable, and the M.D.-Ph.D. is distinctly suited to profitably bridge these two worlds by combining perspectives from both sides and by asking questions that emerge uniquely from such a synopsis. He notes from his research, for example, the fallacy of expecting the results from "idiosyncratic" cell lines to apply uniformly to clinical disease; his view, he argues, is more nuanced as a result of his clinical experience.

I also spoke with Dr. Byers at length concerning the current funding crisis. Sadly, he notes, funding is narrowing, if not disappearing, for entire research areas. Where it remains, it is carried out by laboratories that maintain a certain momentum. This can become a cycle wherein labs with momentum secure future grants, which in turn promises the possibility of sustaining that momentum. The cycle creates a dilemma: how to resolve the tension between past success as the best predictor of future success versus the as yet unproven efforts of young investigators struggling to enter a field. Following his FIRST award, Dr. Byers has been unable to secure NIH funding, and describes the situation of pursuing research areas that are "below the fundability of NIH." Researchers in such areas thus turn to private funding or smaller grants, as well as relying on departmental support to do what Dr. Byers calls "cottage research." This begets its own tension in a university climate suffering from intense economic pressure to produce research in well-funded areas. This is lamentable, Dr. Byers maintains, as much basic science work is both practically and intellectually important, but not "cutting-edge." However, in order to sustain such cutting-edge research in the current climate, it is difficult to pursue clinical work to a significant degree.

Dr. Byers' advice to current M.D.-Ph.D. students, then, is to remain flexible about the future, and to maintain a balance between one's idealism and the presentation of opportunities. He notes the very real possibility that M.D.-Ph.D.s' research interests may end up in areas that are outside the range of NIH fundability and "one must be capable of switching one's area of research focus, which may be difficult if one is in a clinical subspecialty." On the other hand, Dr. Byers points out that to contribute clinically to an academic department, one must also focus on a subspecialty.

M.D.-Ph.D.s are pulled in several directions, encouraged by multiple and, to some extent, exclusive communities to following certain paths. Two choices, for example, are to remain largely below the horizon of NIH in clinical subspecialties, or to pursue very competitive basic research with less emphasis on the development of clinical skills and sophistication. The rare individual, doubtless, can excel in both realms, but the dynamics of research and clinical specialization encourage a more tempered view for most of us.

Ryan Putzer (Cannon Society) is an M.D.-Ph.D. candidate in his second year of medical school.

Ausiello Announces Faculty Changes

by Dennis A. Ausiello

I am happy to announce the appointment of Nancy Andrews as the Associate Faculty Director of the M.D.-Ph.D. Program. Dr. Andrews graduated from the Program in 1987 and is now an Assistant Professor of Pediatrics and a Howard Hughes Medical Institute Assistant Investigator at Children's Hospital. She is an internationally recognized leader in the field of transcriptional control of erythropoiesis and in the disorders of red blood cell iron metabolism. Dr. Andrews has made numerous contributions to the medical school and to Children's Hospital and has been the organizer of the annual dinner for women in the M.D.-Ph.D. Program. For many years she has lent her expertise and energy to the M.D.-Ph.D. Subcommittee on Admissions, which she now chairs, and we are enthusiastic about her taking a larger role in the Program.

Leaving the position of Chair of the Subcommittee on Admissions is Dr. Stephen Beverley. Dr. Beverley has accepted a new position at Washington University, and we thank him for the many years he participated on the Subcommittee on Admissions and the two years he served as chair, as well as his many other contributions. Steve has been one of our most effective teachers and outstanding scientists at Harvard Medical School. He will be sorely missed, but we wish him well in his new position as Chair of Molecular Microbiology and Director of a new center on Host-Pathogen Interactions.

We would also like to thank Dr. Mark Goldberg for teaching the Longitudinal Course in Clinical Medicine for M.D.-Ph.D. students. Dr. Goldberg taught this course since 1990 and eased the transition of many recent Ph.D.s returning to medical school. Mark taught this course with an enthusiasm which will be difficult to replace. He has the enormous gratitude of many current and past M.D.-Ph.D. students who feel that this course made a significant contribution to their ability to deal with the eclectic environment necessary to obtain an M.D.-Ph.D. degree. We extend our best wishes to Mark as he heads to an exciting new opportunity at the Genzyme Corporation.

Dennis A. Ausiello, Jackson Professor of Medicine, is the Director of the M.D.-Ph.D. Program and Chief of Medicine at Massachusetts General Hospital.

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