My real job

It’s an odd thing, but I spend far more time talking about the stuff that doesn’t pay the bills than the stuff that does.  It’s not because the stuff that pays the bills isn’t important to me.  It’s that I have so much trouble explaining what it is.  It’s so much easier for my parents to brag about my book, or my wife to talk about my radio or TV appearances, or my friends to ask about my blog or writing.

But no one ever asks about my research.

I bring this up because the NIH deadline is next week.  That means nothing to the vast majority of you, but those of us who understand what that means, this week is crunch time.  It’s especially bad for me because I’m overseeing four R01 applications going in.  I’m a PI on one, a co-I on two more, and shepherding the fourth.  There’s somewhere between $5 and $8 million dollars on the line (we have to lock that down).  It’s a huge deal, and it’s really what my job is all about.

Most of my research is about how we can use information technology to improve the health care of children.  We’ve built a novel clinical decision support system/electronic medical record which allows us to prioritize information to be delivered to clinicians based on data we collect from parents and children.  We’ve written a number of papers on it.  We started with preventive care, but we’ve since moved on to disease management, and have had some luck in getting grant funding to help with ADHD diagnosis and management, Developmental Screening, and Autism Diagnosis and Management.  Next week, we’re sending in a number of applications, most of which are tasking the system with helping us to do a better job with obesity and type 2 diabetes (part of my recent interest in the subject).

But research is glacial work.  Most people have no idea how it gets done.  First, someone like me has to think up an idea.  (Yes, contrary to what you may have been told us non-industry people have new ideas all the time)  Then, I have to do pilot work or small studies that show my idea has potential.  If I’m lucky, I can scrape together some internal funding to do that work.  If not, I need to go get some grants.  Let’s say I want an R03 – which will typically fund about $100,000 over two years.  I have to write the grant, and submit it.  They will usually review it within six months.  If I’m lucky, I get a good score and get funded on the first try, maybe 9 months after I submitted the grant.  If not, I resubmit at the nine month mark and then wait another 9 months to either get my money or not.

So now I’ve already waited 9-18 months to start the preliminary work on my idea.  I can spend another 2 years doing the research.

Then if all goes perfectly, with no delays, it’s time to send in a R01.  That’s big time.  The same timelines and waiting apply.  If the stars align, 9 months after submitting that application, I get my money.  If not, maybe18 months.  Or maybe never.

I shouldn’t minimize the grant writing process either.  It takes up to months, and a lot of hard work, to get a grant application together.  If it doesn’t get funded, then you have sort of wasted all that time.  It’s maddening.  The average age of an MD getting his or her first R01 grant is was 44 in 2005.   Many people wash out.  In fact, less than 25% of those who manage to get career development awards (grants that still aren’t easy to get) managed to get an R01 within 5 years; less than 50% of them manage to do it within 10 years.

In a perfect world, 4-5 years after I have my big idea, I can actually start to work on it.  If not, it could take years longer.  Or maybe never.  The overall success rate for R01 equivalent grants at the NIH in 2009 was 17.8%.  Those are not awesome odds when your job is on the line.  That’s why academics fret about getting grants.  Another thing that people don’t often understand is that these grants pay my salary (and many other people in my division).  In fact, most of the money awarded in grants pays for salaries – that’s where most of it goes.  If I don’t get those grants, I don’t get paid, and many others don’t get paid.  People could get fired; they depend on me.

When faced with these odds, you need to go big or go home.  It’s taken years, but we have finally brought our work to a point when it can justify R01 level funding.  We’ve been lucky (and maybe a bit skilled) to bring our work to the point when we can make some real progress.  It’s taken 8 years to get here.  It will take us many more to show some results.  That’s after we get published, which is a story in and of itself.

It’s glacial work.  It’s baby steps.  And none of it makes headlines.  It’s what happens behind the scenes.  It’s the real work of research, the blood, sweat, and tears of grinding it out to push the ball just the tiniest bit forward.  It’s not easy to explain, nor is it exciting to watch.

But it is important, and I absolutely love what I do.  Unfortunately, it isn’t cheap.  Which is why I need to go back, hunker down, and get these grants done.  Next week will be so much better.

That is, until the next NIH deadline.

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