Why Pursuing A Dual Neurology/Science
Career is FunNo really…
Elliott H. Sherr M.D. Ph.D.University of California, San Francisco
How to reach me� Phone: 415-514-9306 (office)� Email: [email protected]
Road Conditions Ahead» My experiences (it’s all about me)
» When the research bug bit» Neuroscience Research Beckons» The Switch to patient based research» Combining Science and Patient Care» Is there life outside work?
» What to do at the fork in the road» The $, ¢, and time of academia» Job satisfaction…?
Free Advice
» It’s a long haul, have fun along the way» It’s all about the “way” anyway» Pursue fun from all angles» Don’t forget, you’re in charge of you» The MD/PhD DOES give you the inside
angle on the bench/bedside interface» Research in Neurology is entering its
“sweet spot”» It IS hard work, but it’s worth it
Peripatetic
» “walking or traveling from place to place”
» Opposite of career with early and clear goals
When the research bug bites
Summer Research Options
Volume 305:1425-1431December 10, 1981Number 24
Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy
homosexual men: evidence of a new acquired cellular immunodeficiency
MS Gottlieb, R Schroff, HM Schanker, JD Weisman, PT Fan, RA Wolf, and A Saxon
First Research Experience
Roads not traveled
Research is fun
• The need for investigators who are well trained in both basic science and clinical research has long been recognized within the biomedical science community. To help meet this need, in 1964 NIGMS established the Medical Scientist Training Program (MSTP). This program encourages and supports the training of students with outstanding credentials and potential who are motivated to undertake careers in biomedical research and academic medicine. MSTP students participate in an integrated program of graduate training in the biomedical sciences and clinical training offered through medical schools. Graduates receive the combined M.D.-Ph.D. degree, and the majority of them pursue careers in basic biomedical or clinical research.
• The MSTP currently has 40 participating programs involving 45 degree-granting institutions with a total of 933 trainees. (There are approximately 75 medical schools that do not have NIGMS MSTP training grants but that also offer opportunities for M.D.-Ph.D. studies.)
• MSTP participants may choose from a wide range of research training programs in the biological, chemical, or physical sciences. Other disciplines in which MSTP participants can pursue graduate study include the computer sciences, social and behavioral sciences, economics, epidemiology, public health, bioengineering, biostatistics, and bioethics.
Medical Scientist Training Program
Medical School: P&S
Diversions: Theatre(How to succeed in business without really trying)
Neuroscience PhD at P&S
We are family…
What do myosin I’s do for a living?
Decision: Residency Training
Diversions: Sabbatical
Clinical Training at UCSF
When the basic and clinical don’t match
2002 The New Yorker Collection
Clinical/Research Interface
0 5 10 15
Time (ms)
Am
plit
ude
( µV
olt)
0
1
23
1901
F2 - No Seizure
65 dB
85 dB
45 dB
25 dB
15 dB
wt
jams1
It’s the questions you ask
And how you ask them
Callosal Agenesis
Genetics of Brain Development
Whole Genome AnalysisBAC-CGH
Patient & Control DNAisolated from blood
Patient DNARed
Control DNAGreen
+ Mixed together& Hybridized to
Array chipEach spot equals aspecific “address” in the genome
Chr X Array CGH
Female Patient B vs. Mother B
Female Patient B vs. Mother B
Female Patient Y vs. Mother Y
Female Patient Y vs. Father Y
Median probe spacing: 110 bp
Female Patient B vs. Father B
ACC & Probst Bundles
MRN34609586 MRN34609586
How is the brain hardwired in ACC?How is the brain hardwired in ACC?
3D rendered LCF
P
A
Red: LCF ↔ thalamus Green: LCF ↔ cortex
A P
Left lateral view
LCF ↔ thalamus
A P
Left lateral view
LCF ↔ cortex
A P
Left lateral view
LCF ↔ thalamus
A P
Left lateral view
LCF ↔ cortex
A P
Left lateral view
FA 0.0 0.5 1.0
Errors and compensation in brain wiringErrors and compensation in brain wiring
BA10
BA7
S1
BA10
S1
BA7
BA20Right Left
BA10
BA7S1
BA10
S1BA7
BA20
Right Left
LCF LCF
Function--Anatomy Correlates
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
MRI Features Predict Clinical Outcomes
Table IV: Presence of Cerebral Malformations and PCPC Scores
Malformation
Percent with malformation
(n)
PCPC score moderate or
severe1 (n)
p-value
O.R.
C.I.2
Callosal agenesis 42% (19) 84% (16) 1.00 0.97 0.19 - 4.95
Cysts 16% (7) 57% (4) .068 0.16 0.03 - 1.00
Cortical heterotopia 32% (14) 79% (11) .662 0.56 0.11 - 2.95
Ventricle abnormality 80% (36) 89% (32) .131 4.0 0.71 - 22.62
Cerebellar abnormality 27% (12) 75% (9) .362 0.41 0.08 - 2.21
Vermis abnormality 40% (18) 94% (17) .215 4.86 0.53 - 44.34
White matter volume abnormality (loss)
80% (35) 91% (32) .024 8.53 1.46 - 50.05
Brainstem abnormality 34% (15) 100% (15) .077 -- 1.90 - NA3
Probst bundles 82% (37) 84% (31) 1.00 0.74 0.08 - 7.15
Absent hippocampal commissure
85% (33) 88% (29) 1.00 1.45 0.13 - 15.79
Absent anterior commissure
56% (24) 100% (24) .004 -- 4.50 - NA3
Clinical Implications
Where are we going?
?
Life outside work
Life Outside Work
How long will it take?
� 8 years for MD PhD� 5 years for clinical training� 3-4 years for “retooling” post-
doc� Start faculty position at 38+
(Same age many people start a second career)
How much will you make?
Not enough to make it on one income in a big city
Enough as a dual income family (e.g. two academicians)
More than the basic scientists and less than the straight clinicians
Starting Assistant Professor range: 110-140K
Academic vs. HMO Practice
Cumulative Earnings in Today's Dollars
-
2,000.0
4,000.0
6,000.0
8,000.0
10,000.0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43
Working Year
Ear
nin
gs
(000
)
MD PhD
Academic MD
Health Care System MD
How to reach me� Phone: 415-514-9306 (office)� Email: [email protected]
The end…
Complete Callosal Agenesis
Diversions: Start Cafe
• Scanned in version of RRC
Diversions: Sabbatical (cont)