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: sherre@neuropeds.ucsf.edu

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: sherre@neuropeds.ucsf.edu

The end…

Complete Callosal Agenesis

Diversions: Start Cafe

• Scanned in version of RRC

Diversions: Sabbatical (cont)