Interview with Lynne Richardson

Lynne D. Richardson, MD, is Professor of Emergency Medicine, Professor of Health Evidence and Policy, and Vice Chair for Academic, Research and Community Programs of the Department of Emergency Medicine at The Icahn School of Medicine at Mount Sinai in New York City.  Dr. Richardson is a practicing emergency physician and a nationally-recognized expert in health services research.  Her areas of interest are access and barriers to care, improving effective utilization of health care resources, and healthcare disparities.

Dr. Richardson spoke with Dr. Nidhi Garg (RSI Section Chair) and Dr. James D'Etienne (RSI Section Chair-Elect) about her career and her advice for early stage investigators.

Dr. Garg: Thanks Dr. Richardson, thanks for doing this. The section is really thankful to you for taking time out to speak with us. You have a really impressive career and there is a lot we want to know from you about how you are able to be so successful and productive, and we are really humbled to have you here.

Dr. Richardson: My pleasure.

Dr. Garg: Thank you. So, the first question I am going to ask you is a very basic question: as a scientist, what excited you to do research? At what stage were you in your life or career, and how did it transition to healthcare disparities research?

Dr. Richardson: Well, I think I have always been interested in issues of health equity and health disparities, but as I sometimes tell my trainees, research has actually been my third career in emergency medicine. I did not start out in research. I also tell them that anyone who is interested in a research career today cannot take the kind of path that I took thirty years ago. But I actually started out on a clinical administrative track. After a couple of jobs out of residency, which was pretty common back then in the mid-1980s, I was running an emergency department and I was pretty good at that. But I had always been interested in academics and so, after starting out in clinical operations, I got an opportunity to move into graduate medical education.  I was recruited by someone who actually had been the Director of the Emergency Department when I was a medical student, and that was Shelly Jacobson.  He had just become the first Chair of Emergency Medicine at Mount Sinai. He was looking for someone to run the residency program at Mount Sinai. I had just finished submitting a residency application where I was as the operations chief, because the institution said they wanted an emergency medicine residency and there wasn’t anyone out to do it. I was actually the only emergency medicine residency-trained physician working there. I told them they couldn’t get a residency, there wasn’t enough support from the medical school and they didn’t have the proper faculty. I told them all the things they had to do to get a residency, and they said, “we don’t want to do that, we just want a residency.” So, I had put together the program information form for a new residency application, which of course was unsuccessful, due to the reasons I had told them it would not succeed. But at this point, Shelly Jacobson had heard that I had done that and so he came and said, “well, how would you like to come to Mount Sinai and run our residency?”

So, I made a lateral move from operations into graduate medical education, and first came to Mount Sinai as the founding program director of their Emergency Medicine Residency. Shortly before coming to Sinai, I had completed a health services research fellowship at a program that doesn’t exist anymore; it was designed for mid-career physicians, thinking that these were the people who had important questions about how health care works, and if you taught them some research tools, you might get some interesting results. So, I did this health services research fellowship, which was run by the AAMC and funded by what is now AHRQ (Agency for Healthcare Research & Quality. I was just finishing that when I made the transition from Columbia to Sinai to start the residency program.  I had fun creating a new residency; I liked deciding the best way to train emergency medicine residents and liked getting it up and running.

But after recruiting the first couple of classes of residents, I wanted to spend more time on research, and I felt I could not do that as Residency Director. I had already written a Robert Wood Johnson grant that had been funded, and I was getting involved in a multi-center study for public access defibrillation, and I needed to let go of the residency responsibility so that I could spend more time on research. So, I made a lateral move, this time at the same institution, from being the Residency Director to being the Research Director. At the time, I was the only trained researcher and the only funded researcher in the department.

I started on what I think was a long-term strategy of ‘growing our own’ within the department. We did not have money to go recruit a successful, funded researcher. But I did start identifying research-minded residents and helping them to get into research fellowships, and then, whenever I could, recruiting them back to Sinai as faculty. I did this several times, and so most of my first faculty recruits in the research division were actually former residents who had gone elsewhere to get fellowship training because at the time we did not have the infrastructure to train research fellows.  Over time, I was able to attract other talented young people as they finished residency or fellowship, and help them write career development awards to get them launched as researchers.

Slowly, over many years, we have built a first-class research division as more and more of the trainees grew up and became independent investigators on their own. It did not happen overnight; it happened because we made a big investment in training young researchers. It is something I really enjoy, it is still something I spend a lot of time doing. We did, after a number of years, establish our own research fellowship and when the original funding announcement for the K12 programs came out, I had already been training research fellows in an unfunded way for quite a few years.  This positioned me to write a successful application to get funding for a K12 program – that is an institutional Career Development Program. That allowed me to recruit more young research-minded faculty and give them salary support while they got their research careers jumpstarted.  And that is how we built the division that we have here at Sinai, where we have six faculty with “R-level” funding from NIH, all of whom started as my residents or research fellows or mentees. So, we ‘grew our own’ in terms of training researchers here.

Dr. Garg: That’s remarkable and you know astonishing how the program developed. I can’t believe it. Congratulations to you and Mount Sinai. It sounds like it was a long but a very good journey you had.

Dr. Richardson: It was exciting. I mean, the trick really is to find and hire talented people that make you look good. But you have to provide them with support and guidance and all of the resources they need to succeed. So, you create an environment where they are really set-up to succeed, rather than being set-up to fail.

One of the important steps that I think we took initially, and we took relatively early on in the research division, was to hire a full-time grant writer. Because up until that time, the ability to help junior faculty submit their research grants was really limited, because I was the only one in the department who knew how to do it.  So, I was trying to write at least one a year on my own and then maybe I could help one or two others write a grant. But, that’s not really a sufficient number of submissions if you’re trying to grow a research division. So, I hired a full-time grant writer, and we went from submitting 2-3 grants a year to submitting 6-8 grants a year because there was a staff member who was available to help with all of the parts of the grant other than the actual research strategy.

As you all probably know, grant submissions are large documents- they’re typically 100 pages or more- and a lot of it is what I call “boiler plate,” where there are descriptions of facility and resources, and there’s a bio sketch for every investigator, and there’s a budget and budget justification, and so on. There are all of these pieces of the grant application that are very time consuming, and if a young investigator has to write their research strategy with their specific aims and the description of the research, and they have to try to assemble all of these other pieces to submit a grant, it’s very difficult.  If they only have to write the research strategy, because you have an experienced staff person - and this was a masters level person who had been involved in grant submission when I hired her - to put together the rest of it, then you can readily multiply the number of grant submissions you can produce with the same number of faculty. So, building that infrastructure is very important.

Now we have a research fellowship training grant, this is a T32, so we have funded our practice of training researchers.  The T32 grant pays a stipend to the fellows and pays for their tuition to get a Master’s in Clinical Research. Now we have a lot to offer graduating residents who are interested in careers in research, and recruit them into our T32 program because again, we now have this infrastructure which is funded by NHLBI.

So again, none of it happened overnight, but I do think that finding people who are interested and working with them has been very rewarding for me, and that is how we have built this division. We never got a lot of money from the dean to go recruit experienced investigators and bring them here; we developed and trained them ourselves.

Dr. Garg: So, I think that is very innovative in every way in what you have just described, particularly hiring the full-time grant writer. To me that sounds so amazing. So, can you expand on it a little bit more: was this your unique idea, or anyone you heard from was doing this, or was it a position you created?

Dr. Richardson: Well, it was a position I created. I was aware that researchers in other departments had staff to help them with grants. At the time I had a funded grant from NIH and I had a project manager and research coordinators who were doing the research. But those people were really occupied with doing the research that had been funded; they weren’t paid to help me write another grant on another topic. So, we needed someone who was not paid for by grants, and that’s what I mean by infrastructure.

I observed what went on in other departments because the other theme to growing this was that I had a very collaborative approach to working with other departments. So, I went outside of emergency medicine to find experienced researchers who had interests that coincided with the young investigators I was training. This was a very successful model that I used for the K awards – I would co mentor the K awardee with an experienced researcher from another department. So, for example, for the very first K award where I was the primary mentor was for Ula Hwang, who is now a full professor here with funding of her own. She was interested in geriatric emergency medicine, and so for her K award to the National Institute for Aging, I wrote a co-mentoring model with a geriatrician who was the Vice Chair for Research of Geriatrics here at Sinai.  That was a model that I have used for almost all of my K grants – to get an experienced researcher from another discipline to be either a co-mentor or an advisor on the K award.  I think that is what made it possible for me to be very successful as a mentor with the K awards. This is a model that I think NIH likes.

I think that the traditional model, where there is a single mentor and you sort of attach yourself to them and work hard and study and come out after five or six or seven years as an independent investigator, is not the way science works. Creating interdisciplinary teams of mentors and advisors is how you train young researchers, and that’s a model we have been very successful with.

So, I did a lot of collaborating with other departments. At first, I went knocking on doors, introducing myself as Vice Chair of Research in Emergency Medicine. I would say that I had this very enthusiastic young physician who was interested in whatever it is: geriatrics, overdose, sickle cell disease, informatics (all of the people I’ve mentored), and you can find people in other departments who are kind of excited to have talented young people who are interested in what they’re interested in. We would give these investigators access to the patients who come in to the ED, and for many of them this was a population they had never considered and didn’t realize how rich that could be as a resource for studying various populations or conditions. A lot of the collaborations I formed were around training young investigators, and some of them were around my own work in disparities.

I had observed that in these established departments, with very robust research portfolios, (which is common here in Mount Sinai), they all had staff helping them write grants. Many of them had grant writers: pre-award people who knew how to do the budgets, knew how to enter data into the system (here it is called InfoEd) that we use to submit grants. Everything that I was doing by myself for my grants, they actually had staff to help them with it. And so, I realized that we needed staff just to help us submit more grants. So that’s how I got the idea of a grant writer.

Initially I had approached one department about maybe sharing a grant writer - paying a part of someone’s salary, so we could have access to them.  The problem with that was there are standard NIH deadlines three times a year, so everybody would be wanting the grant writer for the same deadline.  So, if we were only paying 25% of the salary, what were the chances that your grant would actually get submitted on time when they were also working with PIs from their own department?  Since it didn’t seem that sharing one would work, so I put together the money for us to hire our own. It was a one-year experiment to see how many grants we could produce. It was so successful that by the end of the year, no one could imagine not having a grant writer. It was a little over a year before she had helped us submit enough grants that got funded, that the indirects from the grants actually covered her salary. So, it’s like a business plan – you have to invest some money upfront but it is sustainable if you’re successful.

Dr. Garg: Thanks. So, Dr. Richardson, I’m going to circle back a little bit on your own interest, which is the healthcare disparities research. How did you get excited about that? What led you to choose that topic over other topics.

Dr. Richardson: My commitment to equity and ending disparities preceded my research career. It is the reason I went into medicine. I think my own lived experience as a Black woman in America informed the fact that there are huge differences in health outcomes that are not attributable to individual behaviors, but really are a consequence of structural racism and both implicit and explicit bias.  I think this was clear to me throughout all of my careers: when I was running an emergency department in a public hospital serving a predominantly African American community, I was very aware of disparities in the resources available to care for our patients compared to other hospitals. When I was residency director, I gave all of my residents formal sessions in cultural competence and we talked a lot about caring for people who were different from you.  So, it was natural that this became a focus for my research when I became a researcher. It is what I am passionate about and it is the change I would like to see in the healthcare system and in the world. Everyone should have an equal opportunity to optimize their health, and we currently have a system that does not do that.

Dr. Garg: Correct. So –

Dr. Richardson: And I think, if I can just say, this is true of most of the successful researchers I know.  They find their passion for something they really care about and then they build their research career around it. It’s not like you become a researcher and then you look for something to study. I think the passion really comes first, and you need to tap into that. Research is a lot of hard work and it can be a tedious process. You need that passion of being connected to the question you are trying to answer or the problem you are trying to solve to get you through the hard work to the end of the project where you actually get the answer. It is hard to sustain that interest if you’re not studying something you really care about.

Dr. Garg: I think that is very correct for 99% of people. So, my following question is along the same line, but it’s directed towards being a woman. Did you feel like being a woman you needed a different approach in your career than a man? What would your advice be?

Dr. Richardson: Well, of course I’ve only ever been a woman, so I don’t know what I would’ve been like if I had been a man, so it’s impossible to answer. But I do understand what you’re asking.

I think there are lots of barriers and problems that women face disproportionately. I also have the added element of being Black, so I have lots of personal experience with prejudice and discrimination and microaggression. I think that you have to learn to deal with those – I think that’s true whether you’re a clinician, or an educator, or a researcher. Like many women, I had substantial responsibilities at home – I was a single parent of two children while I was building my research career. I think that certainly required sacrifices on both sides. There were times where I had to sacrifice things that might’ve been good for my career, so that I could fulfill my obligations to my children, and there were times where I had to sacrifice things I might’ve liked to do with my children so I could fulfill my professional obligations to my career. Most men do not have the primary responsibility for childcare and child rearing that many women still have, and yes, I do think that makes it harder. (It also makes you more efficient and nothing teaches you to organize your time than an infant – it teaches you preparation!)  But women do face additional obstacles.

Your question about whether I do things differently is interesting.  I appreciate the fact that there are things that I may say or do, which would be acceptable if a man said or did them, which people find objectionable to because it’s a woman saying or doing them.  Being aware of that, I try to be very intentional about what I say and how I do things.

But I am goal-directed. I actually think using some of what might be considered a more feminine approach, which is to be collegial and collaborative, rather than competitive and aggressive, actually has helped me be more successful as a researcher because research is a team sport. Being more open to collaboration and cooperation has actually benefitted me. But I am a fairly direct person; I am very straightforward in my dealings. I certainly have been told I display some characteristics which are more commonly seen in men than in women, which was especially true when I was younger. I have accepted criticism for that, and I might be called names for that, but I was focused on trying to get what I needed.  I think I have mellowed a lot with age.  I have certainly learned a lot about how to handle different situations and different people, but I think I still run into situations where clearly people are making judgments about me because of my gender and race. Often that is to their detriment because they underestimate me or dismiss me, whatever the case may be.

You have to learn how to deal with these situations without letting the anger distract you or destroy you, but you cannot pretend it doesn’t exist. I mentored a lot of young investigators, both men and women, and I do see some differences in the kind of guidance I give them. Although there is a great deal of individual variation, I do find that some of the women do not seem to realize how good they are and many of the men are not as good as they think they are.  (I know this is stereotypical and I will probably get in trouble for saying that, and there are exceptions to that generalization.)  As a mentor, it is for me to identify what it is that the trainee needs from me, and whether they need guidance and support and reassurance or they really need someone to set limits and keep them from getting into trouble and getting over their heads. That’s an individual assessment you make with each trainee, but there do seem to be patterns based on gender; I think this is because women seem to be socialized more differently than men. I keep hoping this will change with each generation.  I think it’s getting better but it’s still there.

Dr. Garg: Awesome. I think you have nailed it in my opinion in many ways. You kind of answered my next question, which was about how to deal with it. A couple of things you said about being goal directed and not letting anger get over you with any type of discrimination, I think that’s great advice. I think that was my next question about balancing your career and everything.

Dr. Richardson: Yeah, I think what you discover is that you’re not as effective when you’re angry. And so if you respond emotionally, you usually don’t get as good of a result as you can when you learn to control the emotions and then make an intentional decision about what is the best response: what is the best way to handle this situation?  How do I choose what to do such that I get what I am looking to get out of this situation?

I give a lot of talks and there is a talk that I give very frequently on conflict management; it’s probably the talk I am asked most frequently to give internally. It basically is about controlling the emotional response and then making a choice about how you’re going to deal with  a conflict: whether you’re going to avoid it, whether you’re going to confront it head-on, whether you’re going to submit to it.  And weighing the issue, the conflict, the relationship with the other party, and again, making a decision about what is the best thing for me to do in this case.

The problem is that we all have a default reaction to conflict; some of us always stand up and fight back, some of us always give in and back down, and there is a time for each of those reactions. It’s about becoming intentional about when should I do one thing or the other, based on the situation.  The first thing you have to do is control your emotions or you’re not actually making a clear decision about what is the best way to handle the situation. The more you do that, the easier it is to control the emotion because you know for a fact you’re going to be able to handle the situation. So, you don’t have the same sort of emotional reaction that you might have the first few times something happens, when you’re really feeling helpless and hopeless about what was done to you. At this point, I never feel helpless or hopeless, so it is easier for me to manage these situations now. That just comes with lots of practice.

Dr. Garg: That’s a sign of strong women, and a strong clinician, I would say that.

Dr. Richardson: Yes, I think that’s right. Many of the attributes that we need to be good emergency physicians really serve you well outside of the clinical arena.

Dr. Garg: That’s true, I agree with you. So, my next questions are towards your nomination and appointment as a member of the National Academy of Medicine. That’s an honor, and what was your path towards it? What were events that led to that, because it’s a rare thing.

Dr. Richardson: It is a rare thing. So first I have to explain to you how it works. The only way to be elected to the National Academy of Medicine is to be nominated by people who are already in the academy and the academy is organized into sections by scientific discipline and so Section 8, which includes emergency medicine, family medicine, and rehabilitation medicine, these are all sort of small specialties so they’re grouped together in its own section. They have a process of identifying candidates and then nominating them. In the process, ideally the candidates aren’t told this is what is happening. That’s a little unrealistic, because they have to get a copy of your CV, and usually they want to be able to talk to you to write a persuasive case for your nomination.

So, I was actually approached a number of years before I was elected by people within the specialty who said they thought I would I be a good addition to the academy. They thought that I had the CV and body of work that would make me an attractive candidate. I was flattered and excited and I gave them the information they asked for and I didn’t hear anything for 2-3 years. And then, somebody came again and said listen, get me this information and so there actually was a process of being nominated and then perhaps not having that nomination be well enough received that you actually got elected.

I am grateful to my colleagues in emergency medicine who continued to put my nomination forward. I think, over time, as I did more things nationally, I became known to people who are members of the academy outside of emergency medicine.  So, my reputation outside of the specialty grew, and ultimately that’s why my nomination went on to be successful.  I had been involved in a couple of activities within the National Academy of Medicine (when it was known as the Institute of Medicine); I had served as a reviewer on one of their reports, and I had actually been on a committee that wrote one of the Institute of Medicine reports, and I think that kind of involvement and service to the academy helped the nomination.

One of the things that I have been doing since I was elected is that we do often get notices that they’re putting together a committee, or they have a report and they’re looking for people to be reviewers of the report, and we get asked if we would like to suggest anybody for those opportunities. And, so, I always make it a point to think, who do I know in emergency medicine who would be good for this?  This gives others within emergency the opportunity to serve these roles and I think over time, that will be helpful if you get to a point in your career where people feel like you would be a good addition to the National Academy of Medicine.  But it’s not something you can seek out.  You have to be elected by the people who already in there.

Dr. Garg: So, in your experience, since you have been the inside member now, are there a lot of women in the National Academy of Medicine?

Dr. Richardson: Well, I think there are a growing number of women. I did go to the annual meeting this year, and they presented the data on the new class that they elected. I think they are aware of the fact that there are demographic groups that are underrepresented within the National Academy. I think women still are underrepresented because there were so many years when there were very few women, but within the last decade there have been a proportional number of women being elected.

But it takes a long time for the overall composition of the Academy to change. It’s like the number of women graduating from medical school has been equalized, but there are still more male physicians than female in this country because for many decades before that, it wasn’t equal. But I think there are aware of this, and it is something that is talked about – increasing the diversity of who is within the Academy and sections are encouraged to identify candidates that would add to diversity. This is an active conversation within the Academy.

Dr. Garg: Awesome. In your experience, since you have trained an abundant number of researchers, do you feel like there was a difference – that you trained a male and there was a longevity of career vs. female? So, what do you think of the longevity of careers of people that you have trained?

Dr. Richardson: Well, for my small personally-trained cohort, men and women have been equally successful.  Most of my female trainees are married and almost all of them had children during the process of when I was mentoring them towards their research careers. They have continued to be resilient and committed towards research, and have not dropped on the wayside, if that’s what you’re asking.

Dr. Garg: Correct.

Dr. Richardson: And I think it is both making sure they get the training they need, so they have the skills they need to succeed, and providing that mentoring and support. And of course, in our department, there are peers that they see are succeeding.  I think doing it in isolation is difficult for both men and women. Both men and women fall off the research pathway along the way, including even after they’ve had a K award from NIH. There are a lot of people who never make that K to R transition. But, thus far, I have not experienced somebody throwing it in, saying it’s too hard and doing something else with their career. There are a lot of people who get discouraged when they’re in environments that aren’t supportive, and they don’t have both good mentorship and a peer group to help support them. I think that happens to both men and women but it happened to women more often. We do know that if we look at academic promotion of women, the proportion of women falls off as you go higher in academic rank.

But there’s tremendous variation across institutions and departments. I do think it’s important to find a place where you feel supported. I often get asked casually by somebody I meet at a conference, or somebody that’s referred to me by somebody, and people talk to me about their situation and what’s going on, and sometimes the only advice I can give them is you have to move. You have to go someplace where you will be supported; you can’t do what you’re trying to do where you are because there aren’t the resources or support for you to do it. Sometimes people aren’t in a position to move geographically.  But I think finding the right environment is key if you want to develop a research career, and I think that’s true for both men and women.

Dr. Garg: So that’s why I think when we see the grant application, there’s many pages on environment and resources. So, I think I concur with you absolutely. So, you gave us a lot of valuable advice today about the path, and we learned a lot. So, my final question to you is: what is your most burning advice to the young stage investigators? What is one thing you think is most important and they should do to be successful?

Dr. Richardson: Well, again, if I have to identify a single thing, no question it is mentorship. I think you have to find people who are senior to you who are willing to invest time in you, invest their resources in you. The origin of the term “mentor” actually comes from the Greek, and we now say “mentor” and “mentee,” but the other half of the mentor relationship is actually “protégé.” So, there’s a mentor and a protégé.  If you don’t feel like you’re somebody’s protégé, that’s not how you should feel when you have a mentor. This is somebody who actually invests time and energy in you, looks for opportunities to move your career forward – that’s what real mentorship feels like.

But there are many who will help you in other roles. You can have advisors, and guides, and coaches, and sponsors, but a real mentor invests their time, their energy, their resources; they make things happen for you. I never had that type of mentorship when I was developing my career, but that’s the kind of mentor I try to be to my trainees. So, finding that I think is really they key to building a successful career. And if you don’t have it where you are, you need to seek it out.

Dr. Garg: Dr. Richardson, that was invaluable advice. Jim, do you have any questions?

Dr. D'Etienne: Dr. Richardson, thank you for sharing with us. I really appreciate it. One of the things the section talks about a lot is helping newer programs that are starting a residency program, etc. develop residents, as well as infrastructure for good teaching of research. So, my question would be for those places that are new and working on building on support and using a model. So, what advice do you have for those to get the lot started?

Dr. Richardson: There are, and we talked a little bit about this at the research committee at ACEP, and I do think that some combination of matching the stronger programs with successful research faculty with newer programs in some kind of distance learning model. There are now enough places that actually have research fellowships and curricula to teach research. Probably we should do a better job of figuring out how to make these resources available remotely, since you may not have faculty who could teach a course in research methods to your residents. But, within the specialty there are certainly faculty who could do that and one of the things that happens here in New York, where there are a number of programs, is that New York ACEP every year sponsors a research education day where all of the programs in New York bring their residents and they take advantage of the experienced research faculty who are here to actually give some of that teaching to the programs who maybe don’t have their own research faculty. So consider doing more collaboration with stronger programs, or something regional, even if you have to import faculty.  It’s hard for somebody who doesn’t actually have expertise to teach research. It’s a little bit like a clinician who has never actually seen patients and worked in an emergency department trying to teach residents how to see patients. You can read about it and tell them what you read, but that’s very different than being taught by somebody who actually knows how to do it. I think we have to start figuring out how to leverage the expertise we do have and share it amongst the programs that are just getting started. Of course, each program does need to develop a few of its own faculty who are going to acquire research expertise.

Dr. D'Etienne: That actually gets into the second question if you have the time. You laid out your career as starting out as a resident, and then being on staff, and then administrative, and then into research. Earlier you said, “you can’t do that anymore if you want to be a successful researcher.”

Dr. Richardson: What I tell people now is that if you want a career in research, you must get formal research training. You must do a research fellowship. If you want to be able to compete successfully for federal funding, you must do that. You can’t sort of fall into it the way I did.

Dr. D'Etienne: One of my questions was because emergency medicine can be strenuous and stressful, and administrative as you said can be a day-to-day grind, if there are physicians out there who are interested in this career or to go into research for a myriad of reasons, how would they do that?

Dr. Richardson: I think at this point it is hard to learn it on the fly or in an apprenticeship model. The first thing it takes is time. So, you’re not going to be able to do this while you’re working a full clinical load, or if you’re already out in clinical practice.

For people young in their career, for residents, I tell them you really have to do a research fellowship. I actually have someone who I accepted into my research fellowship this year who has been out for five years, and had a very successful academic career, but had always wanted to do research. And he was willing to make the lifestyle sacrifice to come back and do a fellowship. I was really impressed with that level of commitment. I think there are other ways of acquiring some research skills, again, EMBERS or something at your institution.  That may be adequate to learn to do research that interests you, it may be enough to help you acquire enough expertise to guide your residents in their projects. But if you actually want to build a career as a funded researcher, I think you have to get formal training. So, if you can’t enter a research fellowship, you’re going to have to do a master’s of clinical research on your own. You’re going to need formal research training.

When I sit on a study section, where grant applications get reviewed, it is clear than you have to have research credentials to be successful in getting funding. This is why most people do K’s, because it gives you the time to get some projects off the ground and get publications and demonstrate that you can actually conceive of a project, and collect data and analyze it, and publish it. If you’re coming to this not having done a research fellowship and not working on a career development award, you’re competing with others who have done those things when you start submitting grants to NIH. So how are you going to compete with that?

Dr. D'Etienne: Yeah, it’s understandable why people work hard, and as discussed in sections before, how to promote a wider distribution of at least participation and development of research and scholarly activity across emergency departments that are not just academic centers.

Dr. Richardson: That’s right. There are all levels of expertise that can be acquired. I do think it’s possible to teach skills and for people to develop some research expertise. But again, if you’re talking about research as your primary professional focus and you want to be funded by NIH, you have to have formal research training at this point in time.

Dr. D'Etienne: Got it. Thank you for expanding on those extra questions.

Dr. Richardson: And that’s the advice I give to young people who I talk to. And they’re like, “well, can I just take an academic job and build my research career from there.”  But you really can’t. You really can’t do that.  It’s so difficult because you need to time to acquire the skills. It’s hard to do that when you’re working 25-30 clinical hours a week.

Dr. D'Etienne: Yeah, I know I really appreciate hearing your advice and thank you for the hour you spent with us.

Dr. Richardson: I think these would be important issues to take on for the section – how do you spread the expertise, how do you make it available? This is the 21^st century, you don’t actually have to be there to listen to a talk or even to be involved in a skills workshop.  Trying to figure that out is important to the specialty. And now, there is enough of a pool of expertise that I think some of us should take the time to actually share it in the ways that you’re talking about. Twenty years ago, it was hard – there weren’t enough of us to really even begin to share it across all residency programs. But today there probably are ways to do it much better than we’re doing.

Dr. D'Etienne: It seems true, based on what you’re saying, that if you develop relationships across distances. Because if you do that now for the program, it might actually benefit research in general, and then in the future you can have multi-site studies without an NIH funder in the back. You can get three hospitals working together, as we did on the lab, by extending out the capabilities to collect more data.

Dr. Richardson: I think that’s exactly right. We’ve actually talked about this, the kind of level of expertise that you need to be, for example, a site PI on a multi-center study. That’s a functionality that we really need in emergency medicine - people who are research interested and understand the rules and understand how to help collect data – there’s a real need for those people, and other specialties have networks of those people.  They’re not the ones writing the grant to NIH, but they are on grants that other people are writing so we can do these multi-center studies. So, I think varying levels of expertise are important in building those bridges so that one center that has a deep-bench and high levels of expertise feeds other departments, so they are ready to be written into a multi-center project. You’re right, that helps everybody grow and develop. That’s certainly a model that we could think about and maybe we could develop a course for that – how to be a site PI.

Dr. D'Etienne: Thank you. Thank you, Dr. Garg, for letting me ask those questions.

Dr. Richardson: My pleasure. We talked about doing it here, but nobody seemed to have the bandwidth to take it on. I think people would be interested in something relatively short where you actually learned everything you need to know to participate in a multi-center trial as a site PI.

Dr. Garg: That’s an excellent idea. Dr. Richardson, we can’t thank you enough for the rich advice you gave and all the time you have spent with us. The section and I are really thankful for you.

Dr. Richardson: Okay, my pleasure. Good luck.

Dr. Garg: Thank you.