Wednesday, June 5, 2013

NIH Loan Repayment Program

When I was trying to decide what to do with my life after the Navy, it came down to two possibilities: medicine or physics.  One, medicine, was wholly new to me but seemed like a good fit for my personality and it was a pretty sure bet, career wise.  The other, physics, had been my passion since I was introduced to it in 1992 by Bob Shurtz, my high school AP Physics teacher (and the greatest physics teacher of all time).  I had a really hard time picking between the two and ended up choosing medicine for pragmatic reasons, but always hoped to be able to incorporate my scientific inclincations with my new career.  I found out pretty late in the game about the MD/PhD programs funded by the NIH through the Medical Scientist Training Program, but applied to a few anyways and was rejected.  So, I started medical school as Case Western and was happy.

I distinctly remember one day during MS-1 when I was shadowing a hand surgeon in the OR at the Louis Stoke VA (our teaching VA in Cleveland), and the surgery resident, a PGY-2 in general surgery, described the NIH Loan Repayment plan to me.  He was going to take a few years off after his PGY-3 year to pursue a PhD in tissue engineering.  The benefit of doing this, he said, was that he could pick his clinical interest first, then pursue a related research area, rather than the MSTP folks who have to pick a scientific discipline before they know what sort of doctor they'll be.  This has come into sharper focus for me as my best friend from medical school did his PhD in cardiac stem cells, assuming he would do cardiology, and fell in love with urologic surgery.  It isn't so much that his training was wasted, it certainly wasn't, but he lost the momentum that he could have had had his clinical interests been aligned with his doctoral studies.  So, in this sense, I'm glad that I wasn't accepted into the MSTP programs, as by going straight through medical school, I found my 'calling' as an oncologist, and then subsequently found how research fits into that - and this is an important distinction.

So, to continue the story, I chose radiation oncology, and now, between PGY-4 and 5, I have been taking time off to do dedicated translational research, and because of the NIH extramural loan repayment program, I am paying off a year of medical school for each year of qualified research!  (Considering the opportunity cost of not practicing radiation oncology, I am still a bit 'behind' each year I postpone taking a faculty job, but this dulls the pain significantly.)

While I was disappointed that I didn't get in to the MSTP programs, I truly feel that, at least for me, this path is one that will better suit me for a rewarding career.  Obviously, each person is different - had I had a burning passion about a certain kind of research early on, then following that path when I was younger might have been easier.  I certainly face a whole slew of personal difficulties as a 37 year old PhD student with 2 young kids that I wouldn't have had I pursued this earlier.  On the other side of the coin, with nearly ten years of medical experience, I bring a lot more to the table for my research than I would have after MS-2.  At the end of the day, I am happy that the NIH funds both pathways, and we are in dire need of more physicians doing science.  Like I said in my TEDMED talk, I truly feel that the physician-scientist plays a unique role in science. Indeed we are specifically trained to connect seemingly disparate pieces of data to build a theory, like a constellation of symptoms to build a diagnosis.  As science gets more and more specialised, and knowledge silos get deeper and deeper, I feel this role will grow in importance as well - highlighting the need to keep these programs going.

While I love science and research, I came out of medical school with ~$200,000 in debt.  I could not have afforded to take this time off if it weren't for this program.  So, thanks NIH.

OK - so some nuts and bolts.  You get a health related doctoral degree (specifics on eligibility here).  Graduate.  Get a job doing research at a non-profit, preferably NIH funded (post-doc sort of thing).  They pay off your loans!  Each quarter I get notified that they sent $8,750 off to Sallie Mae.  The only continuing work, besides the research, is that your supervisor has to fill out a form saying you are working hard (thanks +Alexander Anderson) and you have to verify that the money is going where it is supposed to.  Easy.

Here are some links that the folks at NIHLRP provided me to supply with data about who has gotten funded.

The application process was similar to any other grant writing endeavor.  There was a 6 page project description as well as a biosketch and some institution-specific paperwork.  Importantly, a major component is the training program that you and your mentor create, which must be described in detail in a letter.  For me, this included a PhD training program, but this is not necessary.  Here is my successful grant application:

You can then, competitively, renew this grant as well.  I don't know how that process goes since I missed the renewal application cycle (whoops!).  It turns out, they don't remind you...  But, I'll be submitting a renewal application this year, as long as there isn't a 5 year gap, you can renew.  This is important, as when I go back to finish my clinical training, I will not qualify, as I won't be able to dedicate at least 50% of my time to the research.  However, once I am faculty again, as long as I have educational debt and am spending 50% of my time doing qualifying research, I can continue to apply.

Long winded, sorry.  Short story: great program. Give it a shot!  We need more health professionals doing research, and this is a great way to defray some of the opportunity cost of not practicing.

At press time - I realize I've forgotten a few key points.  They are:

Application cycle runs September 1-Nov 15th.  Funding level is nearly 50%, so your odds are good, and the initial contract period is 2 years.  Go apply!

Also - here is a 'tip sheet' on best practices for applications:

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