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Nephrology Fellows

Fellows: Career Profile

Dr. Linda Fried - Clinical Researcher

Dr. Linda Fried

My career track is as a clinical researcher. At the current time, I devote 75% time to research and 25% to clinical work. My research time also includes serving as IRB vice-chair, but otherwise I do little administrative work. I am extremely satisfied in my choice of career path. I enjoy clinical care and I would not want to give it up completely. Perhaps it is a little cliché, but I consider that clinical research has the potential to impact a larger number of individuals than I can in practice. I find clinical research intellectually stimulating and am rarely bored with my work. While I do not deny that I can work long hours, I have found that there is a flexibility in my schedule that fits well with having a family. Clinical research also lends itself to collaboration. I spent a year between residency and fellowship in a internal medicine/family medicine practice. While the patients changed daily, it did not have the opportunities for varied interactions that an academic center provides. The main negative of a clinical research track is the pressure for publications and funding.

For personal reasons, my initial interest in nephrology was diabetic nephropathy and in particular slowing the progression of nephropathy. While I pursued this interest in fellowship, my focus shifted. In truth, this shift was somewhat due to chance. My diabetic nephropathy project was slow in getting started and I was looking for a second project in the meantime. I began a project with Beth Piraino evaluating infection and mortality in peritoneal dialysis. I found the work interesting and developed a strong relationship with my mentor. This led to further collaborations and my early career focused on peritoneal dialysis outcomes. During this time, I also obtained a masters of public health. During my work in PD, I came to realize that in order to have an impact on outcomes in ESRD, one likely needed to focus on earlier stages of kidney disease. I began evaluating the epidemiology of kidney disease in the elderly. More recently, I have been able to return back to my initial interest of diabetic nephropathy.

My advice to fellows who are interested in a career in clinical research is to obtain a MPH or masters in clinical science (e.g. in a clinical science training program). It teaches many of the tools that are used in clinical research. To me, it is analogous to training in laboratory methods that a basic scientist needs. It is easiest to obtain a masters during fellowship, though this will often require an extra year of fellowship. Many fellows are reluctant to add this year, but it is time well spent for a clinical research track. With junior faculty commitments, it can be difficult to obtain the masters after fellowship is completed. In addition, it allows you time to produce research articles. While most early career grants do not require prior publications, your application is often judged against applications from individuals who have publications. Having the extra time in fellowship to complete research projects and publish them, strengthens later grant applications. There are also fellowship awards for your research years, which can provide salary support for extra years (if necessary) and for some awards help with tuition and research costs. These awards can give you practice in grant writing and also as a first award help establish an early track record.

Once you are a junior faculty member, a career award is also helpful. These are available from NIH, VA and some societies. To facilitate the transition from dialysis outcomes to epidemiology of CKD, I applied for a VA career development grant. The major advantage of a career award is adequate protected time to focus on research. Prior to the career award, my time was 40-50% research, 50-60% clinical time. The increase in protected time improved my publication productivity and I think that for junior investigators it is very helpful to have a career award. In truth, I wished I had pursued it sooner in my career. Your mentors do not need to be in your division; mine were in epidemiology and health services. It’s more important that you find mentors that you can comfortably work with and who have the time to guide you in your career. Becoming part of a collaborative group, either within your institution or across institutions can also help productivity.