Becoming a Psychiatrist-Researcher: What It Means and How to Do It

Down to Earth

Becoming a Psychiatrist-Researcher:What It Means and How to Do It

Art Walaszek, M.D.Ronald Rieder, M.D.

The title is not a non sequitur. It is possible to be botha psychiatrist and researcher. However, it is not easy.

This article provides some information and advice formedical students, residents, research fellows, and juniorfaculty who have such an ambition, or need to respond toan expectation to do research by, for example, a depart-mental chair or promotions committee. We describe thefinancial and other rewards for those doing research, theskills that are required to conduct research, the opportu-nities for obtaining research funding or training that areavailable at various stages of a psychiatrist’s career, theobstacles to success in this endeavor, and some strategiesfor overcoming those obstacles.

The Nature and Finance of Research Careers Toembark on any career path, one should know how successis obtained, including financial rewards. Being a re-searcher is an unusual job, in that few such positions areadvertised and paid, as opposed to jobs such as being astaff psychiatrist on an inpatient unit with clinical care andteaching responsibilities. Most researchers do have a sal-ary, via a University, but the funds for that salary areusually obtained by the researcher herself, from a sourcelike the National Institute of Mental Health (NIMH), or apharmaceutical company interested in doing research onits product. Such researcher-generated funding is espe-cially the case for full-time researchers; part-time work ona research project might be funded via someone else’sgrant, and thus resembles a regular job. For example,

someone might be hired to be the treating psychiatrist in aclinical trial, or to help diagnose patients entering a studyfocused on brain imaging or genetics.

Given that for many years full-time researchers gener-ated their own salaries by writing successful grant appli-cations, it can be stressful and precarious—reasons whymany choose not to pursue this career. However, there areimportant rewards. A researcher gets a chance to work inan independent, self-directed way, studying exactly his orher own interest, and there is the possibility of becomingwell known in the field. Also, the most successful re-searchers are sometimes granted “hard-money” support, auniversity or research institute salary with the job securitymost often called tenure.

This renown and financial security may be the outcomeof a fruitful career in research, but this is not what thebeginning researcher encounters. In the early stages, re-search is not usually supported by one’s own grants. Med-ical students might or might not be paid for assisting instudies, residents are paid by their hospital programs withsome elective time available for research, postresidencyresearch fellows usually receive a “stipend” that could bedefined as a skimpy salary with no or few benefits at-tached, and junior faculty usually have a salary for doingclinical duties with the possibility of part-time (paid orunpaid) research. All of these are excellent ways of learn-ing what it feels like to be doing research. However, theydo not fully convey both the excitement and perils of beinga full-time researcher. A student thinking of this pathshould talk to researchers who are further along on it. Heor she would probably report that a period of full-timeresearch training is necessary for a successful career as afull-time researcher. The goals of training (the researchskill set), and ways of doing both part-time and full-timeresearch training at various levels of one’s career, arediscussed below.

Received December 10, 2009; revised January 28, 2010; accepted Feb-ruary 2, 2010. Dr. Walaszek is affiliated with the Department of Psychi-atry at the University of Wisconsin School of Medicine & Public Healthin Madison, Wisconsin; Dr. Rieder is affiliated with the Department ofPsychiatry at Mount Sinai School of Medicine in New York. Addresscorrespondence to Art Walaszek, M.D., University of Wisconsin Schoolof Medicine & Public Health, Department of Psychiatry, 6001 ResearchPark Blvd., Madison, WI 53719; [email protected] (e-mail).

Copyright © 2011 Academic Psychiatry

58 http://ap.psychiatryonline.org Academic Psychiatry, 35:1, January-February 2011

Research Skills Putting aside the skills for basic sci-ence laboratory work, we focus on clinical researchskills—those involved in doing clinical trials or psycho-biological studies. First, there are diagnostic skills, usingrigorous diagnostic methodology such as structured inter-viewing. Residents and junior faculty who have had clin-ical training can easily develop these abilities and can alsoserve as reviewers of diagnoses that are developed bynonprofessional interviewers. Next, there are the skillsinvolved in recruiting and managing patients who are vol-unteering to be part of a study. Residents and junior fac-ulty can employ their psychotherapeutic training to as-suage fears in volunteers and help them stay committed tothe study. The number of patients who complete a studycan be the most important, rate-limiting step in the wholeprocess, and those who can help this happen are veryappreciated. Residents and junior faculty may be trained todeliver patient care in a clinical trial of a medication orspecific psychotherapy. Here, their clinical skills may beboth a help and a hindrance. Residents may feel discom-fort responding to the needs of a patient by increasing thedose of medication when it might actually be a placebo.Or, think of how, in a trial of CBT exposure therapy, youmight want to discuss a transference comment made by thepatient but feel you cannot do so because it will be caughton the videotape that is reviewed by the project’s therapymonitor.

In addition, other skills are necessary for a career inresearch:

• Identifying mentors and cultivating mentoring rela-tionships at one’s institution and nationally;• Having a knowledge base relevant to the specific re-search being conducted (e.g., identifying brain structuresin neuroimaging research);• Writing research protocols and obtaining grant fund-ing;• Seeking and obtaining institutional review board ap-proval, including an awareness of research ethics;• Writing a manuscript, including collaborating with co-authors;• Effectively presenting research findings at grandrounds, national meetings, and other venues.

Medical Students Many medical schools offer oppor-tunities to do research. The most substantial of these arethe combined M.D./Ph.D. programs, which may not onlypay for tuition, but offer a living stipend over 7 or so years.What is not well known is that many of these programs

can be entered as late as the second year of medicalschool; students who find that neuroscience, for example,is exciting should think of finding a research lab andmentor and applying.

Much of the research that is currently funded by NIMHis termed “translational research”—extending basic sci-ence findings to study psychiatric disorders, and there is notraining that qualifies a psychiatrist more for such studiesthan having a Ph.D. in a basic science area such as genet-ics or neuroscience. However, some students might notwant to do laboratory research for one or more years butare attracted to doing clinical research with patients. Thereare usually opportunities to do this as well. Many medicalschools support students doing such research in the sum-mer after the first year, and brief training experiences inaging research have been specifically designed (1). Balonet al. (2) review this and many other programs availablefor medical students.

External agencies offer substantial and desirable re-search training programs for medical students. The DorisDuke Clinical Research Fellowship supports 1 year ofclinical research, including coursework and a stipend of$27,000, at 12 different sites (3). The Howard HughesMedical Institute Medical Fellows Program also supports1 year of research (with stipend, personal allowance, andresearch funds) (4) and the Howard Hughes/NIH ResearchScholars program offers 9–12 months of research experi-ence on NIH campus, including salary and benefits (5).

Psychiatric Residents Medical students interested incareers in academic psychiatry should consider the re-search resources available in the psychiatric residency pro-grams at which they interview. It would be rare for anyresidency program director to say that she could not offersuch opportunities. However, the essential mentorship andresearch infrastructure that is actually necessary is in noway spread equally across different departments of psy-chiatry. Students may begin with the most recent list ofNIH funding for departments of psychiatry, available on-line via the Blue Ridge Institute for Medical Research (6).Those departments at the top of the list will have the mostresearch resources.

Then, students should discuss research training with theresidency program director and residents in the program.See if there is a research track that offers time for research.Determine if there are specific researchers who mightserve as a mentor and provide lab space or a clinicalpopulation to study. Ask if any funds for presenting at orattending research meetings might be available. Ask how

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residents with research interests can be funded as researchfellows after graduation. However, also ask carefullyabout the quality of the clinical experiences and education;the primary focus of the 4 years should be on your learningabout psychiatric illness and its treatments (including psy-chotherapy). There should be time to do research and learnsome new research skills, especially those used in clinicalresearch. However, students should not expect, or want, a4-year laboratory postdoctoral fellowship. Students shouldconsider, as they develop their NRMP rank lists, how wellresidency programs will be able to support their currentand potential research interests.

Those who did research during medical school andwanted to continue research in addition to obtaining clin-ical training in psychiatry will likely pick a residencyprogram that can provide both opportunities. However, itis not too late for those residents who have not doneresearch but find themselves dreaming of causes and cures.

Residents are usually told what to do—where to workeach month, when they must be on call, what forms theymust complete for each patient, and so on. Also, they arevery busy with their assigned duties, especially in the earlyyears of residency training. Thus, it is understandable thatthey often do not see how they can pursue their ownresearch interests if they are not in a research track. How-ever, all residents should know that in the department ofpsychiatry (or related clinical and basic science depart-ments such as neurology, psychology, and neuroscience),there are investigators who would be happy to meet andengage them. For example, this might come in the form ofa discussion surrounding a research article, or it might bedesigning a project that could be done on a part-time basis.Sometimes residency training directors will give time offfor research to residents who have a plan and a facultymember backing them. Residents usually have a substan-tial amount of elective time in the last year of training, butif they have not made these connections earlier, they tendto pick clinical rather than research electives and thusnever develop any research skills or find an area of aca-demic interest. Given the longitudinal nature of clinicalresearch, it is especially important that residents considertheir options early in the course of residency.

Residents should maintain an inquisitive and scholarlyapproach to their clinical experience. Any time a literaturesearch does not uncover a satisfactory answer to a clinicalquestion, the resident should ask, “How would I design astudy to answer that question?” Residencies should haveavailable in their curricula courses on research methodol-ogy and biostatistics that will help residents answer such

questions. If those resources are unavailable in the depart-ment, residents should ask program directors where elseon campus they could receive such training. There areexcellent articles on research training during psychiatricresidency (7–10). We recommend that residents interestedin research apply for the numerous national awards andfellowship programs available to provide funding for re-search or to support travel to research meetings to obtainassistance with research career development (see Table 1).

Residency can be a good time to gain experience withscholarly writing. Residents should watch vigilantly forclinical cases that they could write up and submit as casereports. For example they may wish to submit manuscriptsto the Residents’ Journal of The American Journal Psy-chiatry. Residents may partner with faculty supervisors onwriting a review paper or writing or updating a bookchapter. Residents involved in educational projects shouldconsider submitting posters or workshops for presentationat the annual meetings of the American Association ofDirectors of Psychiatric Residency Training (AADPRT),the Association for Academic Psychiatry (AAP), or theAssociation of Directors of Medical Student Education inPsychiatry (ADMSEP).

Finally, residents should get in the habit of keeping theirCurricula Vitae (CVs) updated. While the official format-ting of an academic CV varies from institution to institu-tion, residents may refer to a helpful Association of Amer-ican Medical Colleges (AAMC) website to learn how toprepare a CV (27).

Research Fellowships There are many postresidencyresearch fellowships, but few psychiatrists are in them.This may be due to the low compensation, at least relativeto the pay of a psychiatrist beginning practice. Some fel-lowship programs find ways to supplement a fellow’s in-come. Nevertheless, fellowships are the main route forbecoming a psychiatrist-researcher. Those residency grad-uates without prior substantial research training needabout 3 years of mentored research to become researchers,and even those with prior research training, such as M.D./Ph.D.s, graduating from residency, need time and trainingto reestablish their research skills and credentials.

The goal is to obtain independent funding after a fewyears of fellowship. The importance of this needs to beunderstood. The assumption is that “good research” willbe funded by grants from NIMH or other agencies, soanyone getting such a grant is assumed then to be a “goodresearcher.” The most common aim of a research fellow isthus to get a “K Award” (a Mentored Clinical Scientist

BECOMING A PSYCHIATRIST-RESEARCHER


TABLE 1. Research Awards and Fellowships for Psychiatric Residents, Fellows, and Junior Faculty

Name of Program Description Eligibility and Timeline

APA’s Research Colloquium forJunior Investigators (17)

The purpose of the colloquium is to provide guidance,mentorship, and encouragement to younginvestigators, who will have an opportunity toobtain feedback about their research interests fromresearch mentors. All-day workshop held during theAPA Annual Meeting.

Senior residents, fellows, or junior faculty.Should hold a medical degree and be amember (or be eligible to become amember) of APA. November deadlinefor May meeting.

APA/Lilly Resident ResearchAward (18)

This award provides $1,500 to five psychiatricresidents or fellows who submit the best, original,unpublished scientific paper (plus $1,000 to eachresidency program). The award is presented at theAPA Annual Meeting, and is supported by anunrestricted educational grant from Eli Lilly andCompany.

The work submitted must be primarilythat of the applicant, and must havebeen completed during residency.December deadline for May awardpresentation.

APIRE/Lilly Research Fellowship(31)

This fellowship offers one year of postgraduatefunding for residents who demonstrate significantresearch potential, have not had extensive researchtraining, and are not already establishedinvestigators. Less than 15% of the fellowship mustbe devoted to non-research activities. A stipend of$45,000 is provided.

Final year residents, who will be juniorfaculty immediately after completion ofresidency training in general psychiatryor child and adolescent psychiatry.October deadline.

APIRE/Janssen ResidentPsychiatric Research Scholars(19)

The purpose of the program is to identify promisingpsychiatric residents and encourage them to enterthe field of psychiatric research. Emphasis is placedon mentoring and career enrichment programs atthe APA Annual Meeting and throughout the year.An individual research mentor is assigned to overseeeach scholar’s fellowship.

PGY-1, PGY-2, or PGY-3 psychiatricresidents who are members of the APA,and are U.S. or Canadian citizens (orare Permanent Residents). Januarydeadline for May meeting.

Society of Biological PsychiatryTravel Scholarship (20)

The training of a new generation of psychiatricacademicians is a major objective of the Society.This award provides $1,500 towards travel expensesand free registration for the Annual Meeting.

PGY-3, PGY-4, or research fellows.January deadline for May meeting.

NIMH Outstanding ResidentAward Program (21)

This award is intended to honor psychiatric residentswith outstanding academic potential. It includes aninvitation to come to the NIMH, a two-day awardprogram to meet with NIMH Researchers, to beintroduced to the cutting-edge research conductedat the NIMH, and to present a talk about theirresearch.

PGY-2 at time of application. Maydeadline for October meeting.

ACNP Travel Award ForMinorities (22)

ACNP supports the attendance at the Annual Meetingof up to ten individuals from minority populations.Candidates must indicate an interest inneuropsychopharmacology and, if possible, provideevidence of continuing and future involvement andactivity in the field.

Residents, fellows, or junior faculty; mustbe members of an ethnic minoritygroup underrepresented in biomedicalscience areas. April deadline forDecember meeting.

Pittsburgh/Stanford ResearchCareer Development Institute(23)

Four-day intensive institute for junior investigatorsinterested in a research career, with continuingcommunication with mentors and peers.

PGY-4, fellow, or junior faculty. Januarydeadline for April meeting.

Summer Research Institute inGeriatric Psychiatry (24)

Week-long institute that covers career developmentstrategies for those interested in geriatric psychiatryresearch.

Fellows or junior faculty. March deadlinefor July meeting.

Career Development Institutefor Bipolar Disorder (25)

Three-day intensive institute for junior investigatorsinterested in a research career in bipolar disorder.

PGY-4, fellow, or junior faculty. Januarydeadline for May meeting.

ASCP/NIMH Workshop onClinical Trials (26)

A limited number of travel awards are available forresidents and fellows to attend this conferencesponsored by the American Society of ClinicalPsychopharmacology, NIMH and the ZuckerHillside Hospital in New York.

Residents, fellow, or junior faculty.February deadline for April meeting.

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Development Award) from NIH or something similarfrom the Department of Veterans Affairs (VA) or a foun-dation. There are a variety of different types of K Awardsoffered by the various institutes (11).

Junior Faculty Finally, what about junior faculty, whowant to be “academic psychiatrists” and have a facultytitle, but also have substantial clinical responsibilities ininpatient, outpatient, ER, or consultation-liaison settings?Publishing is necessary to advance in academic status.They often feel their only choices are to stay in their jobsor leave for independent practice. A number of papershave commented on this situation and have suggestedways that clinical faculty could develop research skills(12–16).

One alternative we recommend is to find research col-leagues in the department, or in a nearby institution, anddevelop a long-term collaboration. A junior faculty memberbrings all the skills mentioned above that residents bring, andthey also often bring something that may be extremely valu-able—access to a clinical population out of which mightcome some research subjects. Examples of this would becollaborating with those who have a biochemical measurethat they want to correlate with clinical symptomatology, orthose who would like to try a new medication combination ina specific clinical condition.

Junior faculty are often asked to participate in educationalactivities for residents and medical students. This may be anexcellent opportunity to develop an educational researchproject. Those interested in educational research are referredto two excellent reviews (29, 30).

Junior faculty may also be eligible for loan repaymentprograms through NIH, which offers a number of differentoptions for those conducting clinical research, pediatric

research, and health disparities research, as well as thosefrom disadvantaged backgrounds. Repayment is up to$35,000 per year in exchange for a commitment to conductqualified research for at least 2 years. In 2008, 35% of newapplications and 70% of renewal applications for loanrepayment programs for clinical research were funded(28).

Academic promotion requires establishing a regional, thennational, reputation. A typical promotion packet includes let-ters of recommendation from faculty outside one’s own in-stitution. Junior faculty can begin to identify extramural men-tors and collaborators by attending national meetings orconferences specifically designed to foster career develop-ment (Table 1). These may lead to invitations to present onpanels at national meetings, be a peer reviewer for a journal,or coauthor on articles or book chapters.

Conclusion

We have focused on the various ways to obtain researchtraining and become involved in research at various stages ina young psychiatrist’s career. We end by emphasizing thatjust participating in research is a way of training in research,especially if it’s followed by writing for publication. Onethereby reviews all aspects of research—hypothesis, ratio-nale, sample characteristics, intervention, outcome measure,results, statistical analysis, and discussion or interpretation.You will quickly learn that the discussion always concludesthat “More research needs to be done on this topic”—and noone is now more qualified to do it than YOU!

Dr. Walaszek is a consultant for Terra Nova Learning Sys-tems, Inc. At the time of submission, Dr. Rieder reported nocompeting interests.

TABLE 1. Research Awards and Fellowships for Psychiatric Residents, Fellows, and Junior Faculty (Continued)

Name of Program Description Eligibility and Timeline

AACAP Pilot Research Awards(32–35)

These awards offers $15,000 for child and adolescentpsychiatric residents and junior faculty who have aninterest in beginning a career in child andadolescent mental health research. Awardees willpresent their research at the AACAP annual meetingthe following year.

Child and adolescent psychiatry residentsor junior faculty. April deadline forAugust award.

AACAP Beatrix A. HamburgAward for Best New ResearchPoster (36)

This award recognizes the author of the new researchposter presented by a child and adolescentpsychiatry resident and provides a $1,000honorarium.

Child and adolescent psychiatricresidents. June poster submission forOctober meeting.

ACNP�American College of Neuropsychopharmacology; APIRE�American Psychiatric Institute for Research and Education; ASCP�AmericanSociety of Clinical Psychopharmacology; AACAP�American Academy of Child and Adolescent Psychiatry



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Becoming a Psychiatrist-Researcher: What It Means and How to Do It