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We join hematologist Toyosi Onwuemene who shares her transformative journey from clinician to scientist. A decade ago, she faced obstacles trying to build a research career without support, funding, or training. Now, she sheds light on the common struggles many physicians face when balancing clinical responsibilities and research aspirations. We explore the untapped potential of physician-scientists and the need for specialized training and mentorship.

Toyosi Onwuemene is a hematologist.

She discusses the KevinMD article, “Unlocking the hidden potential of physician scientists: the key to research breakthroughs and health care innovation.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Toyosi Onwuemene. She’s a hematologist. Her KevinMD article is titled “Unlocking the hidden potential of physician scientists: the key to research breakthroughs and health care innovation.” Toyosi, welcome to the show.

Toyosi Onwuemene: Kevin, thank you for having me.

Kevin Pho: So let’s get into the article a little bit. First off, briefly share your story and journey.

Toyosi Onwuemene: Sure. I was a new faculty member 10 years ago looking for a job as a clinician scientist, and I was told that I wasn’t qualified. I didn’t have the right number of publications, I didn’t have the right funding, and they couldn’t make the case for me that I could take on the job as a clinician scientist. So it took me years to make that transition from full-time clinician to mostly clinician researcher, and I realized that it really takes transformation to make that transition, and many clinicians don’t have the resources to make it. So what I do is I help people make that transition and negotiate their academic careers so that they can lead the research programs and make the breakthroughs that they want.

Kevin Pho: Now, for those who aren’t familiar with the career of a physician scientist, talk more about what that is.

Toyosi Onwuemene: Oh, absolutely. We all get the clinician training. Some people will go on and do a PhD as part of that, but for the most part, there isn’t really dedicated time in our 10 years or more of clinical training for research training. So really, the initial part of that career, starting as a faculty member, is learning, getting the research training and the research skills that are needed to actually lead an independent research program. Over time, as you acquire those skills, you’re really able to lead people to accomplish a certain research vision in looking at and answering questions related to patient care, so that you can ultimately enhance patient care.

It really takes time. It takes years to really answer a question well in a way that leads to the kind of breakthroughs that we’re looking for, and that’s why there’s the need for investment up front, because a lot of that initial investment is really training to get people to where they need to be.

Kevin Pho: Now, how did you yourself learn about that whole research component, leading a research division, leading a lab? How do you learn about that?

Toyosi Onwuemene: That is a really great question. I will tell you that when I first started, all I knew is that I wanted to do research. That’s all I knew. I didn’t even really understand what it entailed. Over time, what I recognized, as I started having mentors, especially external mentors, coming into my life and sharing the pathway with me, was that I was totally unprepared.

Some of that looked, for me, like creating structure around my writing. When you’re a research scientist, you’re actually a communicator. You’re communicating with funders to get them to support your research. You’re communicating with your peers so that they can look and see where your blind spots are in considering the research. And you’re also communicating with the public, because people need to know what you’ve discovered so that they can apply it to also enhance future discoveries. So even just creating the kind of structure that allowed me to succeed and manage my clinical loads, so that I could really have research productivity, was something that was new to me, and it really took me time to learn it.

Kevin Pho: And just to be clear, during a traditional clinical medical pathway, a lot of these research skills that you just mentioned aren’t typically taught. Is that correct?

Toyosi Onwuemene: Absolutely. Research skills such as actually learning to boil a big, huge, complex research question down into something that you can answer, I mean, that really does take time to learn. Things like learning to write scientifically, learning to shepherd manuscripts through the publication process, learning to write research proposals and what to do when proposals are rejected: Those are all skills that take time to learn. So no, none of it is part of our clinical training.

Kevin Pho: Now, how many years did it take you before you felt proficient or comfortable in that research component?

Toyosi Onwuemene: Wow, that’s a really great question. I will tell you that it’s an ongoing journey, and I don’t think anyone ever feels like they’ve arrived. I would say that now I would call myself a clinician scientist, but it wasn’t my story initially. Maybe it wasn’t even the first grant. It wasn’t the first published manuscript. It was just this growing realization that I had made a mindset shift that allowed me to really call myself a clinician scientist.

Kevin Pho: All right, and we’re going to talk more about that in your KevinMD article titled “Unlocking the hidden potential of physician scientists: the key to research breakthroughs and health care innovation.” Now, tell us, how did your article come together?

Toyosi Onwuemene: Well, I’ve been thinking a lot about the process of the transformation. What I realize in retrospect is that it’s actually impossible. It’s impossible to make this transformation while you’re 100 percent clinical, because clinical work is, and I don’t have to tell our audience, all-consuming. To be able to do that, you really do need to gradually negotiate your way into the protected time that you need to get this training and to launch the research career.

So as I was thinking about my process, and starting really to share it with faculty that I coach, I had to think about where this all started from, what it takes and why it’s important that clinicians are encouraged to lead research programs if that’s what they want to do. That’s really what led me to start thinking about putting it into words, so that others have a sense of the importance and the urgency of making this possible for other clinicians.

Kevin Pho: So tell us some of those coaching tips that you mentioned. If a clinician comes up to you, where you were years ago, and says, “I want to do research as part of my career,” what do you advise them?

Toyosi Onwuemene: Absolutely. One of the things I advise is to think about your negotiations in two ways. Number one is the macro negotiation, and everybody’s aware of that. You’re negotiating salary, you’re negotiating space, you’re negotiating your schedule. Some people come prepared for that. I think most clinicians are actually unprepared for those negotiations, but those are the big negotiations that everybody’s familiar with and at least to some extent prepared for.

The negotiations that clinicians are not as prepared for are the micro negotiations. How do you negotiate your schedule? How do you negotiate collaborations? How do you negotiate your mentoring relationships? Those are the things that ultimately impact your life as a clinician scientist more, because they’re happening every day. So if you’re going to master the art of negotiating your career, you’re going to do it in the micro negotiations, in the day-to-day negotiations that allow you to really carve out time to do the work that’s needed.

Now, you may negotiate 75 percent protected time on paper, and then you get to a clinic that’s overflowing, and there’s no way that 75 percent is materializing. So how do you negotiate what you have on paper into reality? Those are things that are important, that my clients and I talk about often.

Kevin Pho: I talk to a lot of attorneys when it comes to physician contracts, but this is specifically for clinician scientists and for researchers, which seems like a pretty specialized field. Where can they turn for advice? Are there coaches and mentors like yourself? Are they pretty prevalent? Because a lot of those micro negotiations that you mentioned, I wouldn’t even know to ask those questions. Where can they turn first for help?

Toyosi Onwuemene: Absolutely, those are great questions. I would say that there’s a growing body of us who are helping faculty negotiate on the micro level. For us, we actually have an Academic Negotiation Academy that we do. It’s a 12-week boot camp helping people really hone the skills to negotiate well, and we actually have a master class that we’re doing August 21st, and that’s for anybody who’s interested in just learning what that could entail.

So definitely, there are a lot of coaches arising in this area, because the need is great. I think faculty need to succeed, and what happens when they don’t succeed is they’re dissatisfied, they’re burned out in their jobs and the institution doesn’t win either. So it really is a win-win for faculty to negotiate the jobs that they want as clinician scientists.

Kevin Pho: I was wondering if you could share with us a couple of anecdotes or stories. Tell us a story where a negotiation didn’t work out in the favor of the clinician scientist, and maybe tell us a contrasting story where it was a success story and the right questions were being asked and answered. So just give us two contrasting stories about potential pathways of clinician scientists.

Toyosi Onwuemene: Sure. I will use myself as an example. When I came to my first negotiation, I kind of knew the commentary around “women don’t negotiate,” and so I was so prepared. I was like, “I’m going to negotiate.” And all I thought to negotiate was my salary. At the end of that negotiation, I did negotiate a higher salary than was proposed to me. However, I missed that I didn’t have administrative support. So I started my faculty job without administrative support, doing all these clerical tasks, and what that effectively did was decrease the value of the salary I had negotiated, because I was doing extra work that was uncompensated. So what came out of that for me is just the importance of considering all aspects of the negotiation in order to ensure success.

What is a contrasting story? Clearly, I’m a clinician scientist now. I have the resources I need to do the research and to lead my research program, and some of that really came from sitting down and saying, “Hey, this is the path that I am taking. This is the value that I bring.” Part of that is this: Do you recognize the value you’re bringing, so that you can negotiate value for value? It took me a while to figure out, “Wait a minute, this is the value I bring.” So I was able to sit down and talk about, “OK, in order to really enhance this value and accelerate and really do the work that enhances my institution, these are the resources I need.”

This particular negotiation was really more formal. It was like, “Here is the letter,” and you respond, and then I would respond. It’s not that it wasn’t friendly, but it was really important, because it needed to be taken seriously. I think I’m giving the example of a macro negotiation, but really there were many micro negotiations to get there. By this time, I had improved my publication record, I had some funding under my belt, and I had demonstrated that with the little I had, I could make something happen. And then it was, “Well, if I’m going to go to the next phase, this is what’s necessary. Are you willing to put your money where your mouth is?”

Kevin Pho: Now, as you know, a lot of physicians aren’t comfortable directly negotiating with their employer, right? So a lot of times they do this through a third party or an attorney. Is this something that’s typically done through an attorney, or is it something that the physician scientist should do?

Toyosi Onwuemene: Wow, that’s a really great question. I would say that if you’re thinking about involving an attorney, that’s probably at the very beginning, with the contract negotiation piece. The reality, I think, for many faculty at academic centers is that what’s written on paper and what happens when you show up to the job can be quite different, and bringing an attorney in at that point may not help the faculty member achieve the goals that they want. So really, I think there is a nuanced strategy to negotiate for what they want. It can’t be confrontational, because you’re going to continue to work in this job, and you want to. You’re at that institution because you recognize that there are resources that help you succeed. So in the end, what you’re really doing is helping to get your institution on the same side of the table as you, seeing that this is going to be a win-win.

That’s why I think there are many of us coaches springing up in this area, because we recognize that it’s not like the hardball negotiation that we think about. It really is: How do you even create space so that you can say, “These are the wins I have, and now let’s take the wins and expand them”? It’s really understanding the intricacies of the academic environment and what it really takes to be successful.

Kevin Pho: How about the variations between academic environments? You’re at Duke, and there are hundreds of academic environments out there. So do you see some variation across the country?

Toyosi Onwuemene: Yeah, that’s a great question. I would say that one of the things I teach my clients is that you’ve got to get external mentors, external peer mentors and external senior mentors, because at the end of the day, institutions are a little bit different, but the big overarching themes are the same. What is the value that you’re bringing to scholarly activity? Do people know your work? How are you contributing? So in general, things like publications and grant funding are important across institutions. How do different institutions solve these problems? They solve them differently. So it’s helpful to have the external perspective, because then you can say, “Oh, this is working here. How can I take it back to my institution and make it work for me?”

For me, that was one of my biggest aha moments: “Wow, other people are doing it, but doing it differently, and doing it in a way that’s effective. How can I take that and use it for myself?” So I always encourage my clients, “Don’t just stay within your institution. Don’t do all the career development programs that your institution has without considering what else is out there.”

Kevin Pho: So we’ve talked about things that the clinician scientist should ask for and look out for. Now let’s flip the coin. What are some red flags that you typically see among your clients, or with academic institutions, that they should watch out for and be aware of when they’re negotiating a potential position as a clinician scientist?

Toyosi Onwuemene: That’s a really, really great question. I would say the red flag on the part of the client is desperation. You cannot be desperate going into a job negotiation. You’ve got to be able to walk away if it doesn’t get you what you want. I think it’s important that clients are considering the long game. If you’re going to go into a career in research, you’re not going to get the rewards of your investment in a year or in two years. It really is a long game, so you’ve got to be prepared to negotiate for the long game and to do what it takes to get there.

Sometimes what I see clinicians doing is just taking the first thing that is thrown at them, just because they’re like, “I desperately need a job. I have so much debt. Give me a job right now.” And the reality is that we have so many options, and if we don’t get the job right away, it’s OK. But just consider that we can’t be desperate when we go in to negotiate.

I was going to say, red flags from the perspective of the institution are just to see how faculty are doing. Who are the people two or three years ahead of you in the same kind of role? Who has left, and why have they left? Having all that information is important, I think, so that faculty are making an informed decision.

Kevin Pho: How about red flags during that negotiation process? Anything that should raise alarms when a clinician scientist is listening to what the academic center has to say?

Toyosi Onwuemene: That’s a great question. I do think that listening and trying to get the information is going to be really important. I do think one of the challenges is that there’s a big power differential, right? The faculty member barely has any negotiation experience. I don’t know about you, but negotiation training was not part of my clinical training. But the academic institution has decades, and sometimes centuries, of negotiation training under its belt, and certainly thousands of academic negotiations. So to be honest, I think that no faculty member should go into this negotiation without help, and the more help people have, the more successful they are.

So I would say that if the institution is saying, “Well, no, you can’t have help,” or, “No, you don’t have time to think about this,” or, “No, we’re not going to budge on that,” those are red flags, because if people are not congenial and able to give and take, then you know. I mean, they’re on their best behavior. So if you’re getting any kind of negative vibes and you can’t clearly articulate what that’s about, you just need to pause and try to clarify what those are, because when you go into the job, you’re kind of stuck.

For many faculty, I don’t think anyone can clearly say, “Oh, this was a total surprise to me.” I think the flags are evident, but sometimes it takes somebody else objectively walking you through the process so that you can more objectively appreciate the concerns. At the end of the day, there’s no perfect job, and that’s why micro negotiations are important, because whatever you get, you’re going to keep negotiating and renegotiating until you get to satisfaction. And to be honest, we’re never satisfied. So it’s like you get to the point of satisfaction, and then it’s, “What else could I become?” And that’s another series of negotiations. So ultimately, there’s no perfect job, but making sure that you have resources and help can help you avoid some of those.

Kevin Pho: My final question: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Toyosi Onwuemene: Sure. I would say that clinicians are capable of anything. They can do everything. And to be honest, we’re great negotiators, because we negotiate for our patients, and we negotiate well. What we do need to do is just get the information that we need to be able to negotiate on behalf of ourselves. It is hard. That’s why it makes sense to have someone come alongside you. Some people have mentors that can help them do it, but many of us actually do have to seek out the services of a coach. I would just say that no matter what you need, and no matter what your circumstances or your resources, reach out for help. Don’t go it alone. You may already be in a job you’ve negotiated poorly. It doesn’t matter. You can negotiate and negotiate again.

Kevin Pho: Toyosi, thank you so much for sharing your time and insight, and thanks again for being on the show.

Toyosi Onwuemene: It’s been a pleasure to be here. Thanks, Kevin.