The Neurophilia Podcast
Neurophobia is "the fear of neural sciences and clinical neurology" that is often experienced by medical students and young healthcare professionals. The Neurophilia Podcast is our attempt to help dispel the growing issue of neurophobia in the medical community. We engage in meaningful, interdisciplinary conversations with leading physicians to better connect neurology with other fields of medicine. Our hope is that with each episode, our listeners learn to appreciate, and perhaps even develop a love, for clinical neurology. Hosted by Dr. Nupur Goel, Neurology Resident at Mass General Brigham, and Dr. Blake Buletko, Program Director of Cleveland Clinic's Adult Neurology Program.
The Neurophilia Podcast
Fellowship and Early Attending Career: Part One
The leap from neurology residency to attending brings a critical decision - fellowship training or direct practice? In this compelling episode, Harvard neurologists Dr. Galina Gheihman and Dr. Denis Balaban share their contrasting post-residency paths, offering a roadmap for trainees wrestling with their next career steps.
Dr. Gheihman opted to bypass traditional fellowship, instead pursuing a "primary care neurology" role while simultaneously earning a master's in medical education. Her candid perspective on readiness resonates deeply: "You aren't confident, but you are competent - and there's a difference." For those intimidated by independent practice, she provides practical strategies for managing the transition and emphasizes that general neurology remains a fulfilling, academically rich career path.
Meanwhile, Dr. Balaban shares his journey through multiple fellowships, including a rare industry-sponsored position that offered unprecedented insights into pharmaceutical medicine. His behind-the-scenes look at clinical trials, drug development timelines, and the physician's role in industry pulls back the curtain on career possibilities rarely discussed during training.
Both neurologists tackle the challenging question of whether three years of residency adequately prepares physicians for the growing complexity of neurological care. They explore innovative educational models, from specialty tracks to competency-based approaches, while emphasizing the critical importance of strong mentorship in visualizing diverse career paths.
This conversation offers honest, practical guidance for navigating the post-residency landscape. Whether you're considering fellowship, direct practice, academic medicine, or industry roles, you'll gain valuable perspective on aligning your next steps with your true professional passions.
Don't miss part two of this illuminating discussion, coming soon to the Neurophilia podcast. Subscribe now to continue exploring the transition to attending life with our experienced guests.
Hosts:
Dr. Nupur Goel is a second-year neurology resident at Mass General Brigham in Boston, MA. Follow Dr. Nupur Goel on Twitter @mdgoels
Dr. Blake Buletko is a vascular neurologist and program director of the Adult Neurology Residency Program at the Cleveland Clinic in Cleveland, OH. Follow Dr. Blake Buletko on Twitter @blakebuletko
Follow the Neurophilia Podcast on Twitter and Instagram @NeurophiliaPod
Welcome back to the Neurophilia podcast, a conversational med ed podcast focused on dispelling neurophobia, one conversation at a time. We are your hosts PGY2 Neurology resident Dr Newberg-Oyle and program director Dr Blake Bilecko. Today we have the absolute honor of sitting down and chatting with Drs Galina Gehman and Dennis Balaban. Stay tuned to hear our conversation regarding fellowship training and the transition to attending life. Training and the transition to attending life.
Speaker 1:Dr Galena Gehman is an assistant professor of neurology at Harvard Medical School and an attending physician in general neurology at Mass General Brigham in Boston, massachusetts. She attended the University of Toronto for her undergraduate studies. She earned her medical degree at Harvard Medical School and then she went on to complete her neurology residency at Mass General Brigham, where she served as chief resident. Dr Dennis Balaban is an instructor in the Division of Neuroimmunology and Neuroinfectious Disease at the Massachusetts General Hospital. He serves as a clerk clerkship faculty member in neurology at Harvard Medical School. In addition to his educational roles in the MGH Neurology Residency and Advanced General Autoimmune Neurology Fellowship, his research projects focus on neurosarcoidosis, vasculitis and optic neuritis. Choroidosis, vasculitis and optic neuritis. Galena and Dennis, thank you so much for taking the time to join us on the Neurophilia podcast Excited to be here.
Speaker 3:Thank you for the invitation.
Speaker 1:Yeah, well, I know that we all kind of ran into each other when we were in San Diego, where it was much sunnier and prettier than any place that we're recording right now. How was your experience at the AAN? Do you have any general reflections that you want to share with our audience members?
Speaker 3:I mean, I love AAN and I think that this year was no exception. I think it's getting better every year that I go, probably because I'm meeting new people and seeing old friends, and that circle of friends is growing each year. I was especially excited to be part of a lot of the events in the education room, which is a new opportunity that's been present for the last two years, where we have dedicated programming for educators. I had a role in setting up some of the activities and it was really exciting to see it be a success for another year. Of course, though, I'd be remiss if I didn't say my highlight, which was, of course, teaching salsa with Dennis at the Wellness Hub.
Speaker 2:I can only agree that that was a top like experience. I love teaching salsa with Galena. It's our second year running. Hop like experience. I love teaching salsa with Galena. It's our second year running. Always a good time and well attended and people leave with smiles on their faces and we encourage them to also think about how dancing might apply to their future neurologic practice. And, much like Galena and we can, I would be happy to talk more about that later but, AAN it's.
Speaker 2:It's always an excellent experience. As one goes to more and more AANs, you realize that you start to approach them differently. Like when I first started, I was like all about like the learning and education sessions, which are always great, but as I've, you know, accrued a few more years in practice. Now it's more about just seeing the people, having conversations, reconnecting with people you might not have seen since the last AAN. So we had a great dinner at one of my colleagues' parents' Italian restaurants for the Neurosarcoidosis Consortium meeting. The food was great. If you ever go to San Diego, you got to go to Sardina's Italian restaurant. It's been in business for 50 years. And then I had the pleasure of being a part of one of the education sessions as well, teaching the neuro exam to medical students. It was a blast.
Speaker 1:I'm bummed that I missed the salsa session.
Speaker 2:I feel like it would have been a lot of fun to watch the two of you teach. If only you went to an institution where there were two neurologists who also taught salsa, nipur. If only that were the case.
Speaker 1:Yeah, well, I guess we can, we can catch up on it. We all, we all live near each other.
Speaker 4:But, blake, any reflections from your end, from the end, I'm gonna say, whenever you said that everybody was walking away with smiles on their faces, I'm like if I would have been there, it would have been a lot more than just smiles, it would have been a lot of laughing, because I would have just been laughed at. So I can be a guinea pig for you maybe in the coming years. But no, I thought it was great Because one thing that I've noticed is I've seen more and more students and trainees at the AAN. It seems like more and more every year. I mean the networking and the ability to go as a medical student, and some medical students are going multiple times during their medical school years and I think that that's just absolutely phenomenal. So you know, as we've talked about before on this podcast, you know we didn't have the opportunity to do anything like this at our med school, and so the seeing how many people and young pipeline people are coming through with an interest in neurology and coming back multiple times, it's just very cool to see.
Speaker 3:Can I add one point? About that I would agree with you, Blake, and I actually want to. I won't name names, but I want to give a shout out to a wonderful medical student who was a resident in Brazil, who approached me last year and who I was mentoring over the course of the year, now matched in neurology this year. So I feel like those connections can really go a long way. Even just one spark of a conversation and I've definitely benefited myself from people I've met. It's exciting to say hey, this project that you know it's come together this year started last year and last year's AAN, so trying to get more trainees in is, I think, a huge advocacy point for all of us as educators trying to think about how to make those places more accessible for others.
Speaker 1:All wonderful points and before we move on to our actual conversation, I will say that I wanted to thank anyone who came up to me or Blake and mentioned that they listened to our podcast or are fans of our podcast. It really meant a lot to meet some of you at the AAN, and so hopefully we get to meet you in many years to come. The first thing that we always ask our guests when they come on to the podcast is what drew you to neurology as a career in the first place. So, galena, I'll start with you when was your first encounter and love with neurology, and walk us through that experience as well as your path to becoming an attending physician.
Speaker 3:Starting with the hard questions already. Thank you for that question. You know it's funny because I think it was the biggest person who was surprised about me going to neurology was me. I think no one else was really surprised. But for me the love of the brain, neurosciences, neuroanatomy, really goes back to, I'd say, high school, maybe even earlier. I always loved biology. I had a friend in high school who I tutored in biology. He tutored me in physics, so it was a good exchange and we both made it through.
Speaker 3:As I entered university, I took an undergraduate class in neurophysiology and as I looked around me it felt like I was the only one who wasn't crying. Literally our textbook was called neurophysiology, without tears, and I read it like front to cover to back and was like so it was so difficult but our instructor was so passionate that he really made it worthwhile. And then I realized I was kind of premed but I didn't really like the crowd. They were kind of like, you know, competitive and and stressed, and so I thought well, it seems like no one going into neurosciences seems to be going into medicine after, because these are challenging classes, and so I stuck with it. I did neurosciences as an undergraduate. I majored in it, I was really interested in psychology and so did neurosciences and psychology minor, and thought I would end up as a scientist and then, long story short, ended up working in a Alzheimer's disease lab, then moved on to kind of clinical trials and then eventually moved more closer to the clinical setting, realizing that I really wanted to be with people, with patients and with stories.
Speaker 3:In medical school I struggled. I wasn't sure if I wanted to do internal medicine, psychiatry or neurology, because I'm most interested in the intersection between the body and the mind. And I realized that you kind of can't get away from neuroanatomy and I love neuroanatomy, and I always thought I could add a little bit of medicine or a little bit of psychiatry to neurology, which I think I kind of do today. But I felt like if I went into medicine or psychiatry it'd be hard to add a little bit of neurology back in, and so I ended up choosing neurology. And then it was a surprise to no one else, because they're like yeah, you studied neuroscience, why are you so confused? Or you had so many mentors in neurology, why was this a surprise? I think it was a surprise to me because I never thought I'd be a specialist.
Speaker 3:I always thought I'd be a generalist. I always thought I'd be a primary care physician. I really love longitudinal relationships, complex chronic care. I love diagnosis, I love partnering with my patients and so to this day I sort of joke. Now that you know, looking back, it kind of makes a lot more sense.
Speaker 3:I call myself a primary care neurologist. I'm a generalist. I love to care for my patients and try to keep them when I can and try to get consultation from some specialists like dentists when I'm not sure what to do, and so some of that has really come full circle. And the last thing I'll say why I love neurology is because of the teachers I've had in neurology and as I look back it's kind of like it was faded. I mean, aaron Berkowitz was one of my first attendings. He's a legend in neurology. Marty Samuels was, you know, at Morning Report in my clerkship. Neurology was my first clinical clerkship. It was the first time I really was the physician, you know, as a second year medical student, and it was hard and it was challenging and difficult and yet everyone in it loved it and I loved it too.
Speaker 1:You know something that Casey Albin said on one of our episodes I will always remember this term, but she she described her path to neurology as a drunken stagger, where she she felt like it was kind of something that she stumbled her way into. And what we have, the benefit of this podcast, is to sort of look at a bird's eye view of your path and say, well, obviously it makes sense that you ended up where you are today, but it's cool to see you walk us through and see you know what happened at every step that led to where you are today, and I'm glad that you're still loving it. Dennis, walk us through your journey. Where did you first encounter neurology? Was your path linear or did you have a drunken?
Speaker 2:stagger along the way. So I would say that my path to neurology was more linear. I had been interested in the brain since probably high school. At first it was more of this philosophical interest because I had kind of known I wanted to be a doctor since about age six, honestly, and that's thanks to my dad, who he himself is a professor, but in food engineering. And back when I was six he took me to the library in Alachua County and we got these reference books of like you know, lots of pictures on like the how the body works and everything, and he would just tell me stories based on these books like, and would use the pictures as like illustration, so, like, so this is what the lipids look like, this is what the protein looks like and this is how they get digested and form food and that food becomes, like you know, kind of energy and like, almost like money for the body, like we spend that to do things for biology and the human body and that stuck.
Speaker 2:And so now I'm in high school and thinking about like, what area of the body? And like the brain. That seems like the logical, easy choice, because it's the only organ that makes us who we are. It's the only organ that helps us shape our reality. It's the only organ that can try to understand itself. That's fascinating. In medical school, I gravitated towards trying to be the person who could. The professor asked a question, talking about something that was like two months ago, and I wanted to be the person who could like oh yes, that thing from two months ago that I'll pull out of a hat. Aha, yes, I love like being able to think broadly about things, broadly about things.
Speaker 2:And so in third, year I was on internal medicine, I was on neurology and both of them were just ripe for that sort of like want and wish. But then at the end of the day I was never going to be more interested in anything else than the brain, so I chose neuro, came to residency at Mass General, Brigham, Then I pursued the Advanced General Autoimmune Neurology Fellowship with Dr Gopal, Venna and Hatem Ratta. It was autoimmune encephalitis, it was vasculitis, it was neurosarcoid, it was intravascular lymphoma, it was neurologic complications of Gaucher's disease, like all of these fascinating things that I may see again and I may never see again. One thing that we kept running into was well, what's the best way to treat that? And the answer was well, some experts who saw that several times think this If we want to try and answer these big questions on treatment, we need to know more about. You know how to study these diseases prospectively, and so I want to learn more about clinical trials.
Speaker 2:And after speaking with people you know in that space, someone said hey, Dennis, there's this translational neuroscience fellowship at MGH that partners with Biogen. You should think about this. And so I applied, I was accepted and I spent two years, kind of half-half between Biogen and Mass General, and I had the benefit of working with some of the medical directors there, learning about how they approach clinical trials in multiple sclerosis, and that was an invaluable experience and it has served me well. And now I'm a part of a clinical trial at MassGen on optic neuritis and I may soon to be part of another trial in MS. We'll see how that goes. But yeah, and so that's kind of been my training path at least. Yeah, and so that's kind of been my training path at least.
Speaker 1:What's so interesting about both of you is that you have very, very different experiences when it comes to fellowship. Dennis, you did multiple fellowships, both in the clinical realm as well as translationally, and then, Galena, you actually went straight from residency into a career as a general neurologist, and so I think that there's a lot for us to cover here. Maybe we'll start with Galena and talk to you a little bit about the decision to you know. Last year you finished your neurology residency, you graduated, you're in attending now. What sort of went into that decision to sort of go straight into practice? Are you considering fellowship in the future? I have many questions to ask into practice.
Speaker 3:Are you considering fellowship in the future? I have many questions to ask. I think fellowship year is an incredibly special opportunity for self-directed learning. It's a chance to invest in your own development in a certain area, and for many people that's a clinical area. So you've done your general neurological residency training and then you've decided I'd like to get to know more about, you know, autoimmune neurology or multiple sclerosis or movement disorders and neuromuscular medicine things that maybe you didn't get to do quite as much of a deep dive on in residency.
Speaker 3:For myself, I wasn't sure if I wanted to kind of get that additional clinical training, not that I didn't want to, I kind of wanted it all. I was like, oh, I can equally do stroke or movement or neuromuscular, like there's so much to learn. So what I would say is I wasn't 100% committed to any one clinical approach. What I knew more of, I had more certainty of, was that I wanted additional training in medical education, was that I wanted additional training in medical education. That is actually what drove my decision. So, in addition to the non-pursuing of a fellowship and starting general practice, I actually talked with my department about supporting me to pursue a master's in medical education and so while I did take on a faculty role, I'm actually only 50% clinical and I'm actually 50% non-clinical. So you could argue that I'm doing a med ed fellowship. It's an extended one, it's a four-year part-time program. But when I kind of joke with some people who find what I did to be quite different, I kind of say, oh, don't worry, it's like a med ed fellowship, I'm just getting some additional training. But I think kind of buried into that decision I'll try to make it more explicit than the implicit aspects was that I think it's a time to reflect on how you want to design the next stage of your career. There is a, you know, a big kind of conveyor belt that takes us through training and I say fellowship offers that like final structured step and for many that's the right answer. For others who want to explore, there are these more non-traditional fellowships even, for example, like the translational fellowship that Dennis did. Some programs actually have formal fellowships, like emergency medicine programs offer that and there's others out there. And so whenever I counsel people or share my path, I sort of say you know, what is that next step that you want to invest in? And for some I mean even investing in becoming attending is an important year. I think the fellowship to attending transition helps the clinical transition a little bit.
Speaker 3:The biggest change for me was actually finding myself alone, with the clinic door closed and truly on my own.
Speaker 3:I mean, that was definitely a learning curve that took some time, but it's been also exciting to really see myself as committed to and gaining some professional development in medical education, program development, evaluation, research, which is something that I do see myself pursuing in the future in my career, and so I don't know if I'll go back and do another clinical fellowship or yours is a long time but I do know that I'm excited to continue to build this kind of generalist career.
Speaker 3:Interestingly enough, a lot of my teaching has to do with finding ways to help make neurology more approachable for the non-neurologist. Whether that's our medical students who are being introduced for the first time, our colleagues in internal medicine, emergency medicine, I love to teach the residents, those residents about neurology, and then increasingly the advanced practice provider population, which is a wonderful wave of influx into our subspecialty field, and so I've had a lot of opportunities to kind of teach neurology for the non-neurologists, and so I really think that, you know, I probably have enough neurology to do that, but I need a little bit more medical education training. So that's what I've decided at this point. Stay tuned, we'll see what's next.
Speaker 4:Kalina, this is like a program director's, because we always hope that at the end of a residency training program that someone feels comfortable and confident going out and practicing as a general neurologist and a great general neurologist. And so you had said something about people ask you about this and you say, don't worry. I'm kind of doing this almost like justifying that you're doing something that's still worthwhile with your med ed stuff. But I guess we all live in a very academic world. Training programs take place at academic institutions, and so what? What advice do you give to those people who may be undecided and may just want to go and start their career and feel confident and comfortable as a neuro hospitalist or a general neurologist?
Speaker 4:This happens every single year, to where I almost feel like some people talk to me like they feel forced into a fellowship just because it's something. If you want to be a neurohospitalist, go do vascular, go do epilepsy or go do a neurohospitalist. You want to be a general neurologist? You see a lot of headache. Maybe you should go to a headache. You know fellowship. So I guess how do you help counsel a lot of us who train in academic environments that you can still be an academic general neurologist and that's perfectly acceptable and it's the right path for maybe a lot more people than what they feel comfortable admitting out loud.
Speaker 3:I think that there's a lot of advocacy that has to be made for general neurology. At the same time, I think it's very important that we are open about the challenges that residents are facing. Neurology is very complex. It's getting more complex. That's a good thing. We have treatments for things we didn't. We have names for things we didn't know before. We have treatments for these things that didn't even have names five years ago, and so it's, I think, a little bit ambitious to try to fit all of neurology into three years. It's also ambitious to try to fit all of outpatient neurology, which is the vast amount of neurology that's practiced when we are providing a service role in the hospital and that are mostly seeing hospital based conditions like stroke, you know, emergency neurology and some of our, you know, other type of hospitalized conditions. So it's challenging.
Speaker 3:I try to empathize with the residents who say I'm not feeling quite ready and I try to talk with them about well, what are you going to get out of this fellowship? You're like what are your goals when you go in? What are you going to get out of it? How is it going to serve you? And for those who maybe still want to go into generalist practice but, for example, want to do competently EMGs or read their own EGs, not a bad idea to get a neurophysiology fellowship, you know, if you know where, that's where you're heading to next and that is a process on, that is a beneficial step on your journey. I would encourage residents to do that. If I'm hearing, when I'm mentoring someone, I kind of like I don't know what to do. Maybe I'll just like hide for another year with this fellowship cap, I try to uh, inquire gently, um, as to you know what the motivations are, what the fears are, what the options are. Um, sometimes it's, you know, not being sure, and then I say, okay, well, have you considered practicing for a year and coming back? We have examples of people who've done that. Have you considered, maybe, a flexible fellowship that, like say, has a research year built in? You kind of have a little bit of time, or maybe you just want a little break.
Speaker 3:The more that we can talk about this openly, the more that we can point to role models who are doing this, the more that we can offer support, saying, hey, you've got the backup of the department behind you. I mean, when people say, how are you ready? I was like I wasn't ready. I just knew who to ask. So, you know, I just knew who I would ask for help and I trusted them, and that was one of the reasons I actually chose to stay at my institution for my transition, which is some other advice that I give people if they are going into that first year as an attending, because it's a big learning curve.
Speaker 3:However, kind of going back to your point of encouragement, I do think people are more ready than they think. So I like to tell my residents as they transition from year to year you aren't confident, but you are competent and there's a difference there. And so that's the idea that you have the skill set to know what you know, what you don't know, to ask for help, to make a thorough evaluation. And so I think we need to encourage more people to embrace their competence, to know that confidence is a developmental phase that comes with time and practice. And yet I think we also should be kind of, I think, careful in our mentoring and kind of inquiring with curiosity, like what the motivations are, the fears, and trying to support those, as opposed to a specific decision from the residents as they leave our programs.
Speaker 3:But I think we need to do more for general neurology and outpatient neurology, and that's an educational question, right? How can we change our training? How can we support residents to get that outpatient experience, to feel that confidence leaving? And you know, do we need to design programs differently? Maybe we need to. I don't know this is like heretical, but like longer programs, maybe you know in the sense of or competency-based medical education, where they're not time limited or time bound, but rather competency bound, where they're not time limited or time bound, but rather competency bound. We've also talked in our residency. Do we need tracks Like, maybe you know you want to do neuro ICU, so you just do neuro ICU rotations, versus you know you want to be an outpatient generalist, so you're the one who kind of takes on all the clinic weeks. I'm open to these ideas. I'm going to turn it back to you, blake, as program director. You know, what can program directors do in terms of innovation?
Speaker 4:uh, to support and create the workforce that we're going to need to address the neural, the rising neurological need in our society. You just brought up so many points that I don't even know where to start. Um, all points that have crossed my mind and been outward conversations on many occasions, um, I think, uh, it's important too that there's some modeling that's happening, and I think that we've all had conversations in this podcast especially. You ask people how they got to where they got to, and a lot of it has to do with some sort of mentoring, some sort of person that they saw in front of them that did something that they really liked, and I think I'm seeing a resurgence of general neurologists and more academic general neurologists than I've ever seen. I know our institution.
Speaker 4:A lot of people are general neurologists that are having resident facing interactions all the time. I try to practice what I preach. I'm cut from a similar cloth. I am vascular trained, but I want to be a good general neurologist. I think before you're a subspecialist and a great subspecialist, you have to be a good general neurologist. I think before you're a subspecialist and a great subspecialist, you have to be a good general neurologist. So I'm the only vascular person who does our general service and our general continuity clinic and my colleagues all tell me I'm a big glutton for punishment, but I love it. I'm on general neurology service right now as we speak, and it makes my brain work in different ways and I think if no one ever sees people doing general neurology, it's hard to imagine yourself going into a field that you never get to see your model. So I think it's becoming more and more prominent.
Speaker 4:I think that there's been a resurgence. There's definitely a need to your point. So, almost like this need has been borne out some academic interest and here we are. So I hope that we're moving in that direction. But all of your other points about tracking and CBME, I mean it's they're hot topics right now. I'll be interested to see what happens, but that could probably be a podcast all in of itself.
Speaker 4:So if I switch roles a little bit, you know it's usually like, okay, you have this path into general neurology, we'll talk a little bit more about that. But my converse of that are the residents that I deemed forever fellows. But my converse of that are the residents that I deem forever fellows and that maybe brings us to Dennis a little bit more of fellowship after fellowship or different aspects of fellowships and I hear the opposite or some similarities of like, I still don't know what I want to do. I really like this, but then I also like this.
Speaker 4:And then you see them doing stroke and then ICU and then an autoimmune neurology because they want to be the vasculitis person who only takes care of vasculitis in ICU. You know, you get to these ultra niches and I love these people because anytime that we have these cases like that's the person, that's the person I want to go to about this. But I guess, dennis, we heard a little bit about how you got there, but can you give us a little bit of a quick synopsis of your experience, especially I'm curious into kind of the clinical trials and your love for that and your passion for that. So maybe your non-clinical fellowship experiences to start with and we'll see where we go from there.
Speaker 2:Yeah, absolutely. So I would say that I've always seen myself as a more of a clinician and educator, because I absolutely love teaching and spreading the gospel that is neurology Research is something that I became more curious about and more interested in, especially seeing examples of people like Shamik Bhattacharya is the first person I think of who is a fantastic clinician, educator, who is also a wonderful researcher. I've had several people like in the past tell me well, the tripartite mission of academia of being a good clinician, being a good educator, being a good researcher there's just not enough time in the day. You got to pick two. Okay, Let me see what the research side is like, Let me experience it. I'm still very early on in my career. I'm still very early on in my career.
Speaker 2:Honestly, the way I had initially viewed this industry-sponsored fellowship is there's three potential paths I could take. I could either A just fully jump ship and go to industry, which is a fairly common path for those industry-sponsored fellowships. Oftentimes people self-select and they know they already want to go to industry and this is kind of like a pipeline. So that was one potential path. Two is I decide that actually industry and clinical trials aren't for me. No, thank you, I gave it a shot, it was a great experience and back to the clinic for me and back to education for me and that's it.
Speaker 2:Or third, actually I love clinical trials and I'm going to keep doing them at MGH and let's go Um, I sort of have picked a, a middle middle path, sort of a path, two and a half, so to speak, in which I still have my foot in the clinical trial space and I can contribute to those efforts which I think are very important. But I may not be the person who's like writing the grants, for example, to get those funded. Every clinical trial is going to need a good clinician to make referrals, and if that same clinician is also can speak that language easier, that can only be of benefit can speak that language easier.
Speaker 4:That can only be of benefit. I think we talk a lot about the clinical space here, but not a lot about the trial space and what does industry mean? So maybe you could just give everybody like a very quick blip of like what is industry, what does it mean to be a physician in industry, like what does that look like? If you could give us and our listeners just like an overview of like what that life looks like.
Speaker 2:It's something that we haven't talked about Absolutely. This is an excellent question. I think it's one that's not discussed as much in academia, except maybe in hushed tones, but it's a completely viable career path I think could be a great fit for people, but not for everybody. So what is the role of a physician in like basic research, statistics et cetera? They're going to be an assistant medical director or medical director of a portfolio of different trials and they are working with a well-oiled machine of a team that comprises safety, pharmacovigilance, no-transcript, and being able to be in on those meetings and see what's talked about, it felt like taking away the blinders of what the landscape of medicine and neurology is like, because, as the clinician, my experience was I have me, the patient, the rest of the clinical team and the literature and this is it Like, whereas on the industry side of things, what you're thinking about is, yes, that experience, but also I want to we need to think about what the microbiology of this disease looks like.
Speaker 2:What is the mechanism of this? How does our you know, how does our molecule fit in to that pathophysiology? Do we have the data necessary to prove that what we hope our medication does actually does that? Or do we have enough of a biologic rationale to run that test? Is it worth doing that? Have we and this is a phrase that's often said in industry have we de-risked that enough? Aka, do we? Do we? Is this more of? How much of a sure thing is this that I can have a good return on my investment for funding this study, for example? You know, so that's like on way on one spectrum of the research side.
Speaker 2:Then you can think about okay, well, we have all of this, we have the molecule. We need to put it into people to see if it works. How do we do that? So now you're talking to biostatistics and they can say, okay, well, you need this many people and this many arms, and we could think about seven different ways. We could spin this on how to try to answer the many questions that we have and then we can talk to our regulatory of, okay, actually these four questions that we might have, we don't have the endpoints to actually get that done. Or well, we are interested in these endpoints, but these are completely exploratory and this won't fly with the FDA. We need to use this, that and the other endpoint and then maybe we can also look at these to build a case that maybe these could be used in the future, but that's not going to be on the label for the medication. And if you can get something on the label, the FDA label, you're golden, because that is what the FDA is looking for on how to put this on market.
Speaker 2:And then you can look at marketing speaking of, and then you can say, ok, well, this is all well and good, our development team and our research team, what you do is fascinating. But the truth of the matter is, if we don't get this drug out to market by 2028 or what have you, our competitor's drug is going to be off patent and all is for naught, and all of this is wasted money and resources and this will never go to market. Can we get this done by this date? And if the answer is no, maybe we shouldn't be doing this date, and if the answer is no, maybe we shouldn't be doing this. So it was just fascinating being in on such conversations, just like seeing everything from A to Z like that. This is something I was never exposed to in any of my training, and so it really opened up how to think about the trajectory of a field and where is it going and how can we?
Speaker 2:track where it's going. Industry likes to play things close to the vest whenever possible, because that's their proprietary information. That's how they can, you know, make a profit and differentiate themselves from their competitors. But there are things that, if you know how to read between the lines of what's publicly available, you can glean a lot of info Like what endpoints are they using, what biomarkers are they using, how are they designing that trial, what indications are they going for with this medication? And you can quickly see okay, the field is really going for this but if everyone's going for that, what are they not going for?
Speaker 2:What's missing here? And so that's an opportunity that either your group, your company, whatever can look for. So these are some of the questions that, as a physician in industry, you have the luxury to think about and answer. The question I often get as well is can I still see patients and be in industry? The answer is yes. However, your clinical time is going to be quite low, because it's maybe like 10, at most 20 percent. Um might be a half day of clinic a month. Um, it might be some days of uh, teleneurology that you're doing um, but it's mainly just to many people. Um want this, um, because they want to keep their clinical skills up. They want to not forget what it's like to be a doctor or a physician seeing patients, I should say.
Speaker 2:The other thing I get asked about is well, with academia, you have to like get all these grants and you have to like kind of slog for the resources and funds in order to do the thing that you want to do, and you know, especially with what's going on with the NIH these days, that has become even harder. So why shouldn't I go to industry? They have, they're flush with cash. Usually they have all these resources, they have an entire team that they just plop in your lap as the director and say go to work. And so my answer to them is well, it depends.
Speaker 2:That might be a great answer for you, but industry also has some drawbacks. The leadership tells you what you're going to be doing. You don't get to decide this pet project of yours that you could have been working on for two years. They say no, not a priority anymore. We have a new CEO and that's not on the table. You're being reassigned to this project, or actually the entire division in which you work might no longer be a priority. You've been laid off. You know there were layoffs when I was a fellow, and so several team members I had worked with were no longer with the company, but many of them landed on their feet working for various other companies.
Speaker 1:Thank you for demystifying industry because, to your point as a resident, no one really talks about industry Like it's kind of like the black box that's just sort of adjacent to the clinical practice, and so hearing you sort of talk about like the greatest takeaways you've had from industry and how you're incorporating it into your daily practice now is helpful for us to know as residents. And you said something when you first started talking about how people talk about industry and sort of like a hushed tone it's something that's not like broadcasted generally. Do you find now being in the clinical realm back in academia where you're interfacing with a lot of young residents who are thinking about the next steps in their training? Are you being much more transparent about industry and if people are interested, you're talking to them about your experience, or you're making that option known quicker to people so that way they can consider it as a career? How are you sort of letting young residents know about this?
Speaker 2:I would say that if I ever, if I encounter, a resident or a trainee who's wondering about, like, what am I going to do with my career? I kind of just like try to gauge what their interests are. I try to understand what, what motivates them, what drives them, what brings them joy at the end of the day. And if, if they tell me that they love research, if they tell me that they love trying, like trying to figure out these questions about a disease, if they tell me that they love trying to figure out these questions about a disease, if they tell me that they love trials, then I bring it up.
Speaker 2:I say have you ever thought about this? And some people have, some people haven't, and I have a very open and honest conversation. But I think that it's a viable career path, but it's not for everyone. But it's not for everyone. The idea is to pair the person with a you know, a possible career that they would find themselves encountering less resistance in their day to day work, being able to run full steam ahead with their passion. And you know, even if it's maybe not, if the subject matter maybe is less of a concern, like an industry, for example, where you could be going from one project to another, to another, but if the day-to-day work is like. I love thinking about how to design a trial and do that perfect um how to uh design a trial and do that perfect.
Speaker 2:Um, so are curious or want to chat more.
Speaker 1:Thank you so much for listening to this episode of the Neurophilia podcast. We will be releasing a second part to this episode in the upcoming weeks, so make sure you listen to that one as well. As always, thank you for following our podcast and being supportive, and we'll see you in the next one. Thank you.
