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It's time! "How to Support & Retain Early Career Physician-Scientists / Insights on the Impact of COVID-19 on This Cohort" This thread will feature tweets + quotes from this session
Speakers include: @NIHDirector, Dr. Kay Lund (also NIH), @KBibbinsDomingo, Dr. Sindy Escobar Alvarez (Doris Duke Charitable Foundation), @DavidHaflerMD, and Dr. Nancy Brown (Dean, @YaleMed). Moderated by @jennkwanMDPhD and @EvanNoch
Great opening by @jennkwan laying out the issues leading to attrition in the physician scientist pipeline, including difficulty obtaining funding... Doing my best to get everyone on via audio!
A majority of respondents to a survey on these issues believe that if the NIH salary cap were raised, it would encourage trainees to remain in the pipeline (prelim data, waiting for increased response for conclusions)
"I've got to say how much admiration I have for the healthcare workers on the front lines" @NIHDirector as he practices #socialdistancing
Great opportunities for #doubledocs today as many of the things that used to be dreamed about are now possible... ex. genetic therapies for sickle cell dz
...discovery of the gene for #cysticfibrosis 
Even @NIHDirector was stressed about his career while in training. Take that, #impostersyndrome
"If there were ever a time to have physician scientists at the core of our workforce, it's now." @NIHDirector wants the NIH to be at the top of the list of staunch supporters of #DoubleDocs
We need training programs to be shorter & more integrated, funding mechanisms like K99-->R00 that facilitate the move to independence
NIH increased their loan repayment program. This is a huge barrier to pursuing research for those whose education is not covered by institutions, programs, or grants
NIH budget has gone up by 40% in recent years-->real purchasing power! 
Specific support for women: childcare, parental leave policies in development
All hands on deck... moving at rapid speed to develop a vaccine for #COVID19 and accelerate this into clinical trials. NIH are doing their best to work closely with private industry for the benefit of #allofus
This could be our "Sputnik" moment to wake our people up to the importance of our field and why we need to recruit the next generation
NIH will do their best to help trainees in this time of lost productivity, mentioning shifting deadlines specifically
Per Dr. Kwan: currently working on increasing the cap for this session!
Next is Dr. Kay Lund, Director of the Division of Biomedical Workforce at NIH
Data presented by Dr. Lund show decreasing # of MD-PhD appointees to T32s since 2000. Possibly due to application for other awards, yet still down from 10% to 8.7%
% of MDs & MD-PhDs applying for K awards is very low, but funding rate for those who do apply is encouragingly high!
Data from Akabas, Brass, et al, JCI Insight 2019 show low representation of women & URM appointees, women < men in faculty appointments, longer time to degree for URM, fewer independent NIH funds to women & URM
Check http://researchtraining.nih.gov/programs/career-development for detailed information on early career grants
One of the concerns with many early career grants is the % of time that must be dedicated to research-many at 75%; some talk about expanding the # that require only 50% to allow more specialties to participate
Next up is Dr. Nancy Brown from @YaleMed
On being an "endangered" #DoubleDocs species: "There's never been a more exciting time, where we've had a better understanding of molecular mechanisms or better ability to discover molecular mechanisms"
One issue is the increasing age at receipt of first independent grant due to the lengthening pipeline...
Solution: PhD programs to be offered during the residency/fellowship training period for "late bloomers"
One gap: transition from T32 funding to early career awards (K08/K23, etc.)
Institutional solutions to this funding gap are crucial. Example: Institutional Development Funding @VUMChealth Physician-Scientist Development providing salary support, lab funds, & requiring protected time
Work in mentor's space (easy access to advice, lab help, etc.) & selected on competitive basis. Monitored at 6-month intervals, must show progress + apply for career awards with potential to gain start up funding from the department as incentive
Second gap: if R01 is not funded first go-round, unfunded time results b/t end of K award and start of 1st R
Another @VUMChealth solution, the Newman Society: providing institutional support, mentorship, career development seminars, repository of successful grants, & internal grant review
3rd gap: if not enough protected time on a grant, there is lack of retention in 1st R01 recipients
"There is no one-size fits all" -->one of my favorite things about #DoubleDocs training. Many paths, many forms of success
Next up is @KBibbinsDomingo from @UCSFMedicine
Changing the line up and moving next to @DavidHaflerMD from @YaleMed
Love the title of this first slide "Physician Scientists: We Connect the Dots" 
#DoubleDocs
#DoubleDocs
Update: Access has been expanded!
Fascinating research by Dr. Hafler on T cell receptors in #COVID19, connecting clinical and scientific observations. This is the role of #DoubleDocs in the current pandemic
Hypothesis on how #COVID19 leads to ARDS: infected lung epithelium induces IFN-1-->T cells in lung express co-inhibitor receptors and less TIGIT-->cytokine secretion & cytokine storm damages lung
Research question: will TIGIT agonist decrease cytokine storm & release anti-inflammatory cytokines?
Next, info on the Yale Investigative Neurology Program & how it promotes success for #DoubleDocs in #neurology
Identify post-doc supervisor with clinical residency, cohesively integrate research training with clinical residency, separate slots through @TheNRMP, funding through NIH R25 or the dept, 3 months research time in PGY-1 and 24 months in years 4 & 5 with guaranteed R24 funding...
Technician included in PGY-4 year, attempts to combine science post-doc with clinical fellowship
Goals: competing successfully for NIH K series, provide a pipeline for #DoubleDocs in the dept, integrate clinical fellowship with basic science training
