Since 1979, the physician scientist with a medical degree has teetered on the edge of the “endangered species” list. This group of doctors not only sees patients, but conducts research and teaches or mentors students. Early career physician scientists, in particular, struggle with working long hours, finding time to write grants to fund their research, starting a family, and maintaining an even work-life balance. They are at-risk for burnout and many will leave the profession before becoming tenured.
Sylvia Becker-Dreps is one of these physician scientists. She practices at the site of UNC Family Medicine’s underserved track in Prospect Hill, North Carolina — but her research is a little more remote. Every few months, she travels to Leon, Nicaragua, where she and her team focus on the prevention and epidemiology of childhood pneumonia and diarrhea and, in recent months, Zika infection.
On top of being a physician and researcher, she juggles the schedules of three children — and her youngest daughter has a rare coordination disorder. “There are only four or five kids in the country that have what she has,” she shares. So in-between her travels to Nicaragua, her clinical work at the Prospect Hill Community Health Center, and days spent in her office at UNC writing research grants, Becker-Dreps traverses all over the Triangle, taking her daughter, now 8, to her physical and occupational therapy appointments and tutor.
“I’ve spent a lot of time in the waiting room during a therapy session trying to get a grant written,” Becker-Dreps shares. “But it’s not the best way to do things. It’s better to have a block of time to really focus on writing a great grant.
UNC psychiatrist Eliza (Leeza) Park lives a similar life. When she’s not seeing patients, she’s researching how parents with advanced cancer make decisions about their treatment and identifying ways to improve their quality of life. After beginning to delve deeply into this topic in 2015, though, she gave birth to her son 12 weeks early. He spent the next 10 weeks in the neonatal intensive care unit battling lung problems and other consequences of prematurity.
Park took leave for six months to focus on her son. Now 19 months old, he sees eight specialists and attends anywhere from one to four appointments each week. “I think to be a good scientist you really have to throw yourself into it, which most of us want to do,” Park says. “But at the same time, I’m devoted to being a good doctor to my patients and mother to my two small children. That’s the difficult part — the balancing act.”
Early career physician scientists like Becker-Dreps and Park are vulnerable to burnout from these high work demands, limited resources, and caregiving needs at home. The Doris Duke Charitable Foundation recognizes this problem and, at the beginning of 2016, awarded a total of $5.4 million to 10 schools over the course of five years to provide stronger institutional support and supplemental funds to early career physician scientists.
Carolina received $540,000 to develop a program that, today, is led by UNC psychiatry professor Susan Girdler and Amelia Drake, director of the UNC Craniofacial Center. “The risk that not only our institution faces, but the risk our nation faces at losing some of our brightest and best physician scientists is exceedingly high,” Girdler stresses.
An initial recipient of the grant, Becker-Dreps has funded one day of her week for writing grants and collaborating with colleagues. “With my collaborators here at UNC, we have written six grants in the past few months,” she says, “and four of those have been for the National Institutes of Health. Unless you have time to do that, you can’t stay in the research field.” So far, she and her collaborators expect to receive funding from four of those grants and have already started their research study on Zika infection in Nicaragua.
Park, the other recipient, used her funds to hire a research assistant to help her recruit patients for studies and conduct study activities. “That flexibility has allowed me to be present for more of my son’s healthcare needs and shift some work that normally might happen in the middle of the day to the evening,” Park says. “So far, it’s made a big difference.” As for her work life, hiring her research assistant has given her more time to work on grant proposals. So far, she and her colleagues have successfully completed and submitted three of them.
Above and beyond
Twenty-one physician scientists from across campus applied for this year’s caregivers grant. Both Girdler and Drake recognize the need to help each and every one, and have developed a cohort called Caregivers at Carolina: Support for Physician Scientists, which provides mentoring and networking opportunities for all involved.
Through partnering with the Center for Women’s Health Research, they are able to offer cost-free administrative support services for the 2017 fiscal year. This includes literature reviews, Institutional Review Board submissions, manuscript preparation, support of patient-related activities, and design support for presentations and manuscripts. They’ve also awarded the top-eight applicants with $1,000 each to put toward a scientific workshop.
“It’s not just the science we want to help them achieve,” Drake says. “It is also the human interest part of sharing, perhaps, a babysitter who could take care of a child with special needs or someone with CPR or nurse training that could help. A lot of meetings we’ve had to date have helped us help them share resources in the community.”
A grant for women and men
Matt Coward loves his job. The UNC urologist specializes in male reproductive medicine and surgery — only 2.4 percent of urologists in the United States do so. Most recently, Coward has been working with Paul Dayton from the Department of Biomedical Engineering on a prototype for a scrotal ultrasound machine.
When not collaborating with Dayton, Coward finds solutions for couples struggling with infertility. “I have the best job in the world,” he says. “One thing I always tell medical students trying to decide what they’re going to do is if you like your specialty, you don’t think about the hours at work.
“But, in truth,” he adds, “my real job is at home.” The UNC urologist has three children under the age of 5. His middle child, who is 4, has CHARGE syndrome — a spontaneous genetic mutation that occurs in one in 10,000 babies. Each person living with CHARGE syndrome has varying degrees of a series of anomalies affecting the heart, ears, eyes, esophagus, brain, and genitals.
Coward’s son spent four months in the ICU after he was born, struggling with heart, ear, and breathing problems. He’s undergone more than a dozen surgeries in the short four years of his life. Today, he breathes through a tracheostomy and feeds using a G-tube. He is legally deaf-blind, although he wears prescription glasses that do help him see. Mentally, he’s a typical 4-year-old. “He loves his bear and likes watching cartoons,” Coward laughs.
“I’m not his primary caregiver — my wife stays home with the kids, plus we have a nurse in the house 24 hours a day,” he explains. “But we do this as a team. I feel lucky I have the job I do, with healthcare to give him everything he needs.”
Although Coward didn’t receive the full award, he received a $1,000 travel award and continues to utilize the benefits of this caregiving community at Carolina — and stresses the need for more men to apply to the program. “There’s a cultural shift that needs to happen in our society,” he says. “We need to begin valuing males as caregivers and women as breadwinners — and the old tradition as well. It goes both ways. I think men applying for this grant could help with that.”
“We don’t want to lose these top-notch scientists simply because it is too hard to keep research going when they’re also a clinician and also facing substantial caregiving demands at home,” Girdler adds. “So we’re going to retain them in science — and that’s huge.”