Orthopaedic clinician scientists travel different roads to find funding success

If you not only love doing surgery but also enjoy delving into the science behind it, life as an orthopaedic clinician scientist may be your calling. Funding that dual career, however, can present unique and formidable challenges.

For many clinician scientists, the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH/NIAMS) is an important source of funding. The following stories demonstrate that the road to that funding is sometimes a smooth path while in other situations one may encounter difficult terrain.

Persistence and perseverance pay off
If there is one message that Academy fellow Constance R. Chu, MD, would like to communicate to orthopaedic clinician scientists in the first 5 years of their careers, it is this: “Do not measure research progress by clinical yardsticks and give up.”

In her first year of practice, Dr. Chu had been awarded several developmental grants for her research, including an NIH/NIAMS R21 grant.

“These types of grants will give you the money to get started,” explains Dr. Chu. “But research is expensive and getting the R01 grant is important to continuing your work. Although you may be able to develop a good clinical practice within 2 to 3 years, demonstrating the commitment, innovation, and publication record to support a successful R01 application takes much longer—particularly when you have to find the time for research between clinic and surgery.”

After 5 years as an orthopaedic clinician scientist and several unsuccessful R01 and foundation grant applications, Dr. Chu felt her dual career had taken such a personal, financial, and professional toll that she came close to ending her research career and concentrating solely on her clinical practice.

“As my search for new treatments to delay or prevent osteoarthritis led to three different research areas—cartilage tissue engineering, cartilage bioimaging, and chondroprotection—I collected sufficient data in each area to turn in applications,” Dr. Chu says. She submitted three R01 applications.

“It was not simply that the applications that I submitted were repeatedly returned with criticisms from reviewers,” says Dr. Chu. “I did not fully understand the process—that this type of grant is rarely awarded on the first, or even second, attempt. The NIH was facing budget constraints as well, but I felt I was failing when I literally was on the verge of success.”

Fortunately, her department chair, Freddie H. Fu, MD, continued to support her efforts, and she improved and resubmitted the applications. When she received her first R01 grant, she was the first orthopaedic surgeon at the University of Pittsburgh to be so honored in more than 30 years. Now, in addition to her three R01-level grants, Dr. Chu has also been awarded the 2007 Kappa Delta Young Investigator Award.

As a result of her experiences, Dr. Chu is a strong proponent of the programs that the AAOS, the Orthopaedic Research and Education Foundation, and the Orthopaedic Research Society now offer for orthopaedic clinician scientists.

(See “Tools for young investigators”)

“Getting R01 funding is not easy,” explains Dr. Chu. “It doesn’t matter who you are or what stage you are at in your career. Everyone who applies gets questions from reviewers and experiences rejections. To be innovative, you have to stand alone at times.

“The first response by reviewers is probably not going to be overwhelming acceptance,” Dr. Chu continues. “It is much more likely to be criticism. If you understand this, it helps you dig inside yourself and find the resolve to stay the course. If you believe in what you are doing and your idea is novel and is supported by sound data, it will eventually be supported—even with enthusiasm.”

Finding funding success
Martha M. Murray, MD, a pediatric orthopaedic clinician scientist, speaks passionately about her work with anterior cruciate ligament (ACL) reconstruction and finding a biologic solution to aid healing. She frequently sees teenage girls with torn ACLs and is concerned about the long-term consequences of current ACL surgery.

“If you are 14 years old with an ACL tear, the chance of having an arthritic knee by the time you are 30 years old is very high,” says Dr. Murray. That concern drives her interest in finding a better solution for these tears.

“When the ACL tears, the two ends bleed but instead of making a clot that encapsulates the two ends, the synovial fluid causes a hemarthrosis. Because a clot doesn’t form, there is nothing to rejoin the ends,” Dr. Murray explains.

Dr. Murray launched her research career with grants from NIAMS and continues to receive funding from this agency. “The first grant I received from NIAMS was a 3-year R03 grant,” says Dr. Murray. “It was critical in helping me generate the data to begin to prove my hypothesis—making all future grants possible.” Then came a K02—an independent scientist award—which helped with salary support.

“It was very helpful to have funding like this when negotiating for protected research time for my first job,” Dr. Murray says. “I was also very fortunate to have James R. Kasser, MD, as my chairman. He was willing to help me apportion time each week for my research.”

Multiyear translational research funding
Highly experienced orthopaedic clinician scientists James Weinstein, DO, MS, and Randy N. Rosier, MD, PhD, have conducted groundbreaking research with NIAMS grants. Dr. Weinstein is the principal investigator of the Spine Patients Outcomes Research Trial (SPORT)—a 5-year, multicenter study. For more information on that trial, see the article in the March/April AAOS Now, online at www.aaos.org/news

Dr. Rosier and fellow researchers from the University of Rochester department of orthopaedics received $7.8 million in 2006 for a NIAMS “Center of Research Translation” (CORT) grant. This is the largest grant the department of orthopaedics has ever received. These NIAMS grants strongly promote translational research—bringing novel solutions from the “bench to the bedside.” The focus of the research is “Translating Molecular Signal Pathways to Orthopaedic Trauma Care.”

David S. Guzick, MD, PhD, dean of the University of Rochester School of Medicine and Dentistry, said trauma was the overall research theme of the CORT grant. With it, researchers are investigating “the possibility of developing predicative and potentially preventive strategies for osteoarthritis after knee injuries, accelerating fracture healing in the aging, and rapidly converting allograft bone to living bone for reconstruction of bone loss.”

Good research gets money despite budget
NIAMS funding has faced some stiff challenges on the Federal budget front. But NIAMS Director Stephen I. Katz, MD, PhD, reassures orthopaedic clinician scientists that funding is available.

“It is not impossible to get funding,” he told AAOS Now. “Good research is going to be funded. Moving the fields of musculoskeletal medicine and research forward is our goal.” (Read the complete interview here.)

Annie Hayashi is the senior science writer for AAOS Now. She can be reached at hayashi@aaos.org