Nidhi Garg, MD, FACEP
In the month of March, I was able to speak with Dr. Lance Becker who is a world-renowned resuscitation scientist. Dr. Becker is also the Chair of Emergency Medicine at Hofstra Northwell School of Medicine and Academic Chair of North Shore University Hospital and Long Island Jewish Medical Center. Dr. Becker is an Emergency Physician by training and has done research in cardiac arrest for over 25 years. He has won several awards for his work and is an inspiration for the young investigators and scientists of next generation. We sought to ask him some questions regarding his career planning and career path.
Dr. Garg: How did you become interested in cardiac arrest research? In other words, when and how did you decide that this is going to be your niche?
Dr. Becker: It was a gradual process. I have been interested in really sick patients from the time I was young. In residency, I flirted with the idea of going into critical care. I distinctly remember being taught during the advanced cardiac life support course (ACLS) course that there should be 18% survival of cardiac arrest patients. But I knew that when I took care of cardiac arrest patients there was nothing close to an 18% survival rate. I thought that I must be doing something terribly wrong in my practice, or perhaps I had the darkest cloud ever hanging over me. This led me to working on the CPR Chicago project where we looked at all 7000 cardiac arrests in the city of Chicago over two years. We found that the survival rate was less than 2% which matched better with my experience. That finding really propelled me into research. All this was a long-winded way of saying– I made an observation clinically that didn’t jive with what I was being taught and through my research we were able to learn a lot. Which is why I’m a real believer in translational research. I think it is important for clinicians to ask the important research questions. For me it was investigating how we were doing in terms of cardiac arrest and my research started from there.
Dr. Garg: You did the ACLS as a resident or attending? Was it mandatory at that time?
Dr. Becker: Exactly, I was a resident and it was a mandatory course and I did it relatively perfectly. I knew that the patients were not responding the way that they were supposed to or at least the way they described in the textbook. I couldn’t understand how Washington and other cities could have an 18% cardiac arrest survival rate and Chicago’s survival rate could be so poor. That launched my research career.
F/U Q: Regarding the CPR Chicago project -was it more like a community project? Would you like to expand on that?
Dr. Becker: I started my research as a resident. I wrote a proposal and I had no idea what I was doing. I had no idea what my hypothesis was or how to get funding. But I had an emergency medicine mentor who said – “well, the American Heart Association can provide some funding to study interesting questions – why don’t you write an application to do a study of Chicago?” So, I proposed this project as an interesting question and one thing led to another. Before I knew it I had a small grant and then a bigger grant and then a really big multi-year grant to study the survival rate for the entire city of Chicago.
Dr. Garg: That’s really great and inspirational for residents to hear.
Dr. Becker: I think any resident can find a good question and they can turn it into a full-fledged research question that can last a whole career if they are passionate about it.
Dr. Garg: You transitioned from being a clinical researcher to a basic science researcher. How many years did it take you to start your own lab? What were the hurdles and how was the journey?
Dr. Becker: It was actually a pretty difficult thing to do and the only reason that it worked was because I had a lot of help and support. I had a lot of people who were willing to help me along the way but the first thing is that it came from a question that I generated. I thought about cardiac arrest clinically and I thought that we needed to learn something at the cellular level so that we could really up our gains and save more lives. It was a very simple and almost naïve approach. I thought that something about cardiac arrest must have something to do with cell death. I thought that if I could learn something about cell death, I might be able to then bring that back to the clinic and to cardiac arrest patients. I have spent the last 30 years trying to do that.
I’m still on that quest and I’ve learned a lot along the way. However, I was basically a pure clinician when I started asking these questions so I had to retrain myself as a basic science investigator. That was one of the more difficult and challenging things that I did in my career because I didn’t really have the background. I never got a PhD, I had a little bit of biochemistry background but I had not been in a laboratory for years. So, I found a number of mentors in the basic sciences. It was fun because as very reductionist basic science researchers they had never thought about cardiac arrest. We established a really good partnership despite these differences. I pushed them to think outside their field and they did the same for me. Like any good mentor-mentee relationship, we all got a lot out of the partnership. I think that’s something that young people sometimes don’t understand –in a good mentor-mentee relationship, the mentor who is often the mentees senior, learns every bit as much as the mentee.
My mentors name was Paul Schumacker and Dr. Schumacker taught me wonderful and amazing things like how to run a laboratory and how to do reactive oxygen species testing and how to use microscopic techniques. However, I also helped him alter his approach to research at the basic level because we brought brand-new techniques into the laboratory that he hadn’t tried. After a little while he liked it. He improved my techniques and together we improved the quality of the research immensely.
It was an amazing environment at the University of Chicago because I was at a place where there were people who were willing to help me out. I, of course, contributed an essential ingredient in my own right. I worked hard, I was persistent, and I didn't give up. I knew that it would take several years for me to make up for never having done a four-year PhD. It took me about four years to really make that transition and I worked very hard during that time but I had an enormous amount of help.
Dr. Garg: So, you were a clinician at that time? How did you balance your time? How much protected time did you have for research?
Dr. Becker: I was a full-time clinician at the beginning which was challenging because I didn't have much protected time. I got a little bit of protected time from my department but it wasn’t nearly equivalent to the amount of time that I put in.
For several years, I would work 70 -80- 90 hours a week. If you include writing time I would often exceed 100 hours a week. It was the only way that I could balance a full clinical schedule and also spend the necessary time in the laboratory. In addition, I had educational activities, completion of charts, conferences, and other things of that nature that took a significant amount of time. To be honest, I don’t recommend that young people do it the same way I did. I think that it's much better to do a fellowship where you have protected research time.
If I had done a two-year fellowship I probably would've saved five or six years in my career because I would have so much more time to devote to learning the things that I needed to learn. I'm a good case study to see what happens if you don’t have fellowships in the service. Back in the 1980s there were very few fellowships for emergency medicine. Now I recommend the K-12 program, T32 programs or other even less formal research fellowships. I am very bullish on the idea that young people should take two years or so and really devote themselves to research. This will allow them to get the protected time and support they need to become successful independent researchers.
(To be continued.)
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