Audio Insights: Chat with the Chair—An Interview with Andrew Feldman, M.D.

William Morice, II, M.D., Ph.D., Chair of the Department of Laboratory Medicine and Pathology (DLMP) at Mayo Clinic in Rochester, Minnesota, and President of Mayo Medical Laboratories (MML), sits down with Andrew Feldman, M.D., Vice Chair for Research within DLMP at Mayo Clinic. Connect with Dr. Morice on Twitter @moricemdphd to let him know what you would like to hear next.

Transcript

Dr. William Morice, II: Hi, Everybody. This is Bill Morice, your friendly neighborhood department chair here today with our Vice Chair of Research for the department Dr. Andy Feldman. Andy, good morning.

Andrew Feldman, M.D.: Good morning.

WM: Andy, I know you’ve been in the role almost, well, really two years now.

AF: Yes.

WM: And, you’ve been really active, and I just kind of wanted the department to get to know what our goals are together for research, and what your vision is for research for the department, so thanks for taking the time to join us this morning. So, first of all, could you tell us a little bit about how you got interested in research and your background in research?

AF: Yes, sure. I did my residency originally in general surgery and went to the National Cancer Institute (NCI) for a research fellowship in surgical oncology, got interested in research then, spent four years in the lab, and then ended up staying at NCI for my pathology residency and then heme-path fellowship, and then came to Mayo Clinic. And when I came to Mayo, it was originally, really, as a pure clinical position. I sort of decided that a clinical sign-out was really important to me and didn’t really see an opportunity in many of the places that I was interviewing to blend the degree of clinical interest that I had with a research career, so I came here really as a "signing-out pathologist," and then little by little, I got back into research, which I think is one of the unique opportunities that Mayo offers, you know, our strength with our translational research infrastructure—the clinical annotation and biospecimens that we have really allow integration of clinical practice and research.

WM: Yes. I agree.

AF: So yeah, I started out receiving a career development award through the lymphoma SPORE (which stands for "Specialized Program of Research Excellence"), which just provided me a little bit of time and then sort of built on that.

WM: Well, I know I had the privilege of serving as your division chair for part of that time, and also, having gotten my Ph.D. here, I’m aware of some of the challenges of doing basic science, basic research in our department, which is so clinically focused like many of them. So, you are a real trailblazer in my mind in terms of creating the role of someone who is really engaged in the sign-out of hematologic malignancies, particularly lymphomas, as well as crafting a career in research and, of course, that’s why I thought you’d be the perfect candidate to be our vice chair of research for the department because I think that you and I have a shared passion for growing opportunities for people like you to do research that have really engaged in pathology as a profession.

AF: Yes, I think, in a sense, I was sort of in the position of being the first one to kind of do this, coming from a straight clinical position, as far as I’m aware, and there were some challenges with that. And I think one of the things I want to do in a vice chair role is make it easier for the next group of people. I think the real message is, "It’s definitely doable."

WM: Yes. Exactly.

AF: We just have to provide the infrastructure and the administrative support, you know, the mentorship, and just provide those opportunities and really mentor our junior staff and trainees to make it easier for them to do the same thing.

WM: I know you and Ken Saling (research administrator within DLMP) have already done a lot in terms of providing some of that administrative and infrastructure support for pathologists who want to get interested in doing research, and maybe you could just speak to what you’ve done already and how successful that has or hasn’t been.

AF: We’ve taken a number of approaches, trying to do things one at a time. So I think the first thing that Ken and I sort of tried to do was broaden our sense of community and establish the kind of annual "research retreat" just to get people together and more familiar with what each other is doing because we are a very diverse department, and we felt we needed some kind of hub or community to bring people together. The next thing was to create the Research and Innovation Office (RIO). The main goal of RIO is to provide consultants with organizational and administrative support for doing their research. Our experience had been that consultants have to do a lot of the leg work, traditionally, to get research projects done—a lot of which aren’t really scientific tasks. They are administrative tasks. The IRB (institutional review board) is negotiating many of the institutional bureaucracies dealing with tissue registry and biospecimens requests, and we felt that a lot of that process could be taken over by RIO and really facilitate research. I think one of the opportunities and challenges in our department is that we are very clinically oriented. We have very high volumes, which provides us incredible material, but at the same time, it really leaves very limited time to do research-oriented activities. So, we want to see as much of that time as possible going into the innovation and scientific aspects of research rather than filling out IRB forms. So, we developed the RIO concept where research coordinators and administrative staff to do a lot of this work for the consultants and sort of "un-burden" the time that the consultants do have to leave them free to think and create.

WM: Yes, sort of the "easy button," if you will, for some of the administrative tasks around getting research started. How many research coordinators do we have in the Research and Innovation Office?

AF: We’ve got a staff of seven now, and the office is going really well. We started with sort of the basic IRB biospecimens requests and tissue-registry activities. We then expanded to include study-participant consenting for pathology-oriented research projects that require consents, and so we now have a team that’s able to do that. We’ve got a core group in the Stabile Building on our downtown campus. We’ve got two people now in the Hilton Building (floor 11) in Anatomic Pathology (AP) to directly interact with the AP Division, which obviously is a very big division and a big user of this resource. The next phase, really, has been expanding into facilitating funded research, and so the RIO activities are now expanding to support grant submission, the organization of all of the materials required for the National Institutes of Health (NIH) and other grant applications which, as you know, can be fairly burdensome.

WM: Yes.

AF: They are recruiting an additional person now to help administratively with specific experience in grant preparation, and so the RIO group continues to expand.

WM: As we create this culture of mentorship in the department, what would you see the future for a young person coming on to be? I mean, how does that work? There are some awards that new staff can apply for that kind of launch them in the track. You had one. I believe it’s called the K award. Is that correct?

AF: When I came to Mayo Clinic, I originally started with some limited funding through the lymphoma SPORE and then gradually built up to apply for a K-level or foundation award and got a Damon Runyon Scholarship, which is sort of K-equivalent. And what those awards do is provide protected time, a research budget in a mentored setting, usually for three to five years, and I think that’s a very critical early period of development because after a fellowship, once you start sort of signing out 100% of the time, it’s very hard to kind of . . .

WM: . . . de-differentiate, if you will, into a research person.

AF: Yes, correct, so I think, very early on, it’s sort of important to mentor and provide a structured and protected environment to develop those research skills.

WM: Yes, I think this is critically important for the department. I mean, as I look at it and as we talk, I mean you saw the path forward for yourself to carve that kind of corral. I think for us to really be a vibrant department going forward—it’s not that we aren’t now—but in the future in terms of investing in the future of our profession, we need to create an environment where people with interests like yours, but maybe not the same kind of experiences that you had, that you could see how to do it on your own with some support. You know, I’ve always said that we want to be a “pull department” rather than a “push department.” So, you guys kind of pushed your way through because there wasn’t a path forward. We want to find people that have the same aptitude and interest that you do and be able to pull them into our department and create this kind of culture that actually draws those sorts of people in and becomes a wellspring for future investigators. And I think it will represent a commitment. The nice thing about having the K award, in my understanding, is that the intent is that the investigator becomes R01-funded or R01-equivalent-funded, you know, with you really establishing someone, as you say, for a career in extramurally funded research. And with that kind of culture, we can draw those people in, and we can also work with the divisions to make sure that we don’t have to justify every position based purely on its clinical service but also on the research as well, and we can really create a vibrant culture of research where we’re bringing young people into our department. I think that’s something you have passion about as well.

AF: Yes, absolutely. I think once we are able to increase sort of the "critical mass" of more mid-career to senior-level investigators who have R01s and can provide mentorship, then we’ll be sort of better able to mentor those K awardees. And then, ultimately, I think this extends all the way down to our trainees so that M.D./Ph.D. people who are coming through our residency and fellowship programs already sort of have a track lined up so that there aren’t obstacles to them kind of seamlessly going through the Mayo scholars program or other similar programs that we might even be able to create to really allow them to bridge that gap. And ultimately, it will actually change the nature of young people who we can recruit here because they’ll see the track already established, and they’ll see the opportunities here.

WM: Yes, that’s a great vision. And for me as department chair, I’ve already been in it almost, well 2½ years already. You know, I hope by the end of my tenure that we will have a department that really attracts those sorts of people into our program, into our department, and not just for their own betterment, but for the betterment of all the consultants and staff in the department because it will create a culture of team science. So, I think there’s a lot of people who will want to continue to be primarily service-focused but will always have research interests or want to work collaboratively with people who are doing more basic science in some of the diseases that we are diagnosing, and those opportunities exist today. A lot of times, though, they exist outside our department, and over time, I want to be able to actually build those within the Pathology Department and we’re actually having that whole environment of collaborative research, including strong investigators who are coming through the department. I think that’s our shared vision. Did I get that right?

AF: Yes, absolutely.

WM: Well, thank you very much for taking the time this morning, Dr. Feldman. Thank you very much for what you’ve done already to really buff out the research shield of DLMP. I think it’s a very exciting time for me to have the opportunity to work with you and Ken Saling on this, and I think it’s a really exciting time for the department as well. I really appreciate all that you’ve done already.

AF: Great, thank you, Dr. Morice.

moricemdphd

William Morice, II, M.D., Ph.D.

William Morice, II, M.D., Ph.D., is the Chair of the Department of Laboratory Medicine and Pathology (DLMP) at Mayo Clinic in Rochester, Minnesota, and President of Mayo Medical Laboratories. Dr. Morice received his M.D./Ph.D. degrees from the Mayo Graduate School in 1993 and completed his subsequent pathology residency and hematopathology fellowship at Mayo Clinic.

Responses

Commendable effort, best of luck. It is difficult to understand why, on a large scale, Pathology has such a low percentage of research-intensive clinical faculty compared to Medicine, Pediatrics or Surgery. I know only a handful practicing pathologist with at least 50% protected research time. I know a lot of hematologist / oncologists and other specialties with that type of appointment. Why is that ? Hope you can increase this ratio in your department.

I would like to thank the author for the supportive comments and insightful question. I know that academic pathology departments differ in the proportion of faculty heavily engaged in research, so I can speak only for the Mayo Clinic DLMP. As a large department serving an integrated medical and surgical practice as well as the reference laboratory market, we have seen an organic shift to dedicate resources (human and otherwise) to patient care services. For the pathology consultant staff, this has manifested as a greater proportion of time spent on direct patient care activities and the hiring of new staff with focus on the practice “shield” of the Mayo mission. Other departments at Mayo Clinic, including those mentioned, have experience similar pressure, and some experienced similar trends among their staff. Ensuring that these departments maintain a rich blend of research- and service-oriented faculty requires a thoughtful, long-term approach that includes plans for faculty development and mentoring, and support for competitive application for extramural funding (grants) beginning at the trainees and early faculty level. – William Morice II, M.D., Ph.D.

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