The field of urology prides itself on being a champion of medical progress. Urologists have received 2 Nobel Prizes and have made numerous advances in the understanding of diseases and applications of novel technologies. In fact, contemporary urologic research takes on many forms. Pure basic science, translational science, clinical research, and health sciences / comparative effectiveness research are just some areas of scientific investigation that urologic clinicians pursue.
Rewards and Challenges
Participating in research is central to the job satisfaction of many physicians. The opportunity to advance medicine, to live on the cutting-edge of clinical care, and to be immersed in the world of ideas clearly satisfies some of the intrinsic rewards that many physicians sought when entering medicine. Furthermore, success in research also affords opportunities for leadership roles within one's institution, professional groups, and often offers a seat at the table with policy makers and industry leaders. Importantly, clinician researchers continue to remain leaders in training the next generation of practitioners. Clearly, participation in research has its well-known challenges such as dwindling funding, significantly fewer like-minded peers, "publish or perish" pressures, lack of successful role models and mentors, research community is increasingly outside of urology, and in some instances the opportunity costs of foregoing income from clinical activities. As such, individuals motivated to establish a dynamic research career must be well informed and well prepared.
Research as a Job Function
After completing residency/fellowship, the new practicing urologist interested in pursuing research is faced with a new challenge – how to best manage both, a clinical practice and a research program, efficiently and productively, and how can one best assure long term success.
Two major goals of a clinical practice are to make sure one can provide effective and safe care, and to be available to patients and their families. One of the major goals of the research program is to pursue discovery that will impact the current knowledge and contribute to the future well-being of patients. Nonetheless, both areas have to be financially viable and sustainable long-term.
When considering a career with a significant research component, junior faculty members need to have a clear understanding of several factors that are critical to success:
- Finding a mentor is the first and probably the most important step. This is someone who has "been there and done that" and can provide crucial career and research guidance.
- Know exactly what type of institutional support/commitment each potential job is willing to provide (i.e. startup funds, cost-sharing of salary short falls, etc.).
- Assess the types of resources that are available. Will you have to start your own tumor bank or can you draw on an existing one. Is there a database already established or will you need to build one on your own.
- Survey potential collaborations available institutionally or regionally (i.e. other institutes, industry, etc.) is key. The strength of each must be weighed against the type of research you want to pursue and your ultimate career goals.
Numerous public and private sources support scientific studies that include the U.S. Department of Defense Research Program and foundation support for investigator-initiated grant awards, but the National Institutes of Health (NIH) is the nation's largest funder of academic research. The NIH Guide (grants.nih.gov) is a comprehensive resource for funding opportunities and materials to guide researchers through the process.
The Research Project Grant (R01) is the original and historically oldest grant mechanism used by NIH. The R01 provides support for health-related research and development based on the mission of the NIH. R01s can be investigator-initiated or can be in response to a program announcement or request for application.
The following research awards are also available for beginning investigators:
- Mentored Research Scientist Development Award (K01)
- Independent Scientist Award (K02)
- Mentored Clinical Scientist Development Award (K08)
- Small Grant (R03)
- Academic Research Enhancement Award (R15)
- Exploratory/Developmental Grant (R21)
- Career Transition Award (K22)
Grant applications are peer-reviewed by standing or ad hoc review groups and scored based on significance, investigator credentials, innovation, and research approach and environment. Funding decisions are determined by the score, the "fit" with the mission of the institute and approval of the institute's External Advisory Council.
Clinical trials to evaluate new drugs, tests, and devices have traditionally been carried out in academic institutions, but private medical practices or in healthcare organizations with little or no academic affiliation are also getting involved.
Dedicated staff is needed to provide support for the activities that will be performed. It is also necessary to have certain equipment and space, both of which vary depending on the nature of the clinical trial. The requirements for management of data, regulatory and institutional review board concerns, marketing, patient recruitment, and documentation of clinical visits are different for clinical trials compared with clinical care.