Fellows: Career Profile
Dr. Bessie Young - Minority Nephrologist
I became interested in nephrology after completing a nephrology rotation as a resident. I was attracted to the diversity of patient cases we encountered during that consulting month, and was impressed by the depth and breadth of medical knowledge the nephrologist on service mastered. I pursued and was accepted into a nephrology fellowship, and had to quickly decide what type of research to embark on, as our program required the second year to be a research year. At that time, I wanted to conduct basic research on a disease that disproportionately affected African Americans, and began working with on evaluating mechanisms of glomerulosclerosis in a rat model of diabetic nephropathy.
During my time in the laboratory, I was exposed to rigorous thinking regarding generating hypotheses and evaluating potential renal disease mechanisms. Utilizing the streptozotocin rat model of diabetic nephropathy, we determined that macrophages were important in the initial glomerular response to elevated glucose, and cytokines played an important role in matrix production leading to diabetic glomerulosclerosis. Although I enjoyed my time in the laboratory, it became clear to me I was more interested in conducting more clinically relevant research. Hence, I switched my research focus to epidemiologic clinical research.
Because I wanted to become an independent clinical researcher, I felt I needed to acquire new research tools in order to be successful. I applied for and was accepted into the Veterans Affairs Health Services Research and Development General Medicine Fellowship, during which I obtained a Masters' in Public Health (MPH) in epidemiology at the University of Washington. I again focused on diabetes and diabetic nephropathy research and began to investigate racial and ethnic disparities in the prevalence and progression of these conditions. Important to my success at that stage were my mentors: Noel Weiss, MD, DPH, Professor of Epidemiology, Edward Boyko, MD, MPH, Professor of Medicine, and Stephan Fihn, MD, MPH, Professor Medicine and Head department of General Internal Medicine. These stylistically diverse mentors allowed me to pursue my dream of becoming an epidemiologic/health services researcher and helped me with developing my research questions, producing papers, and eventually writing grants. These interests lead to my development of a research program in which we evaluated racial and ethnic differences in diabetic kidney disease in the VA and in the Group Health systems. Several publications on racial and ethnic differences in diabetes, diabetic nephropathy, amputations, microalbuminuria and endstage renal disease (ESRD) were written and published. In addition, I applied for and was awarded grants through several agencies. Most recently my research has expanded to developing and evaluating educational materials aimed at increasing awareness of chronic kidney disease (CKD) and transplantation among African American communities.
In reflection, the keys to my success focus on 3 crucial factors: 1) mentoring; 2) research tools and environment; and 3) research interest and motivation.
The first and foremost critical factor for success is to find a Good Mentor. This has to be underlined, bolded, and italicized. A good mentor can make or break a research and academic career. I had several mentors who were instrumental to my success in different ways. Early mentors helped me develop research questions and in writing papers. My clinical and epidemiology mentors helped me develop as an independent researcher. They were willing to spend significant time and effort to help me develop and focus my clinical research questions so that I could be successful in publishing my work and applying successfully for grants.
The second most important factor is developing the right research tools and being in a supportive working environment. I decided that it was important for me to go back to graduate school to get an MPH in epidemiology, which included classes in biostatistics, epidemiology, and health services. Graduate school is not for everyone, but if one wants to become a clinical researcher, I feel that this education is vital for a successful, independent research program. Learning how to organize and analyze data for the clinical researcher is like having a “wet lab†for the basic researcher. Clinical researchers should be facile at analyzing data, reading the literature, and developing hypothesis that can be pursued by data analysis or initiation of a research study.
Third, I feel that it is vital to develop a research program that is both intellectually interesting and inspirational, which will sustain your enthusiasm for academic pursuit and motivate you to continue a research career. As a minority nephrologist, I had to find a question that was interesting, motivating, and, relevant to me, my patients, and my community.
Life as a clinical researcher in the physician scientist pathway has several advantages and a few limitations. The advantages are that one can pursue interesting research that is driven by clinical questions. The limitations are that one is responsible for research program funding; pursuit of funding, however, can be stressful, especially since applying for funding has become more and more competitive. If I had to do it again, I would be more focused during the early years of my fellowship and choose a research track (clinical, translational, or basic) relatively early. Although not available when I was a fellow, translational research programs as a necessary interface between basic and clinical activities, are being launched by many training programs and may lead to exciting new research opportunities.
Finally you can't give up if you want to be an academician, particularly a researcher. Many people would like to pursue an academic career even though it can be highly competitive, difficult, and challenging. Pursuing a research program evaluating racial and ethnic disparities in diabetes, CKD, ESRD, and transplantation allowed me to maintain my clinical interest, while keeping me motivated to pursue interesting research questions relevant to the African American and other minority communities. This combination combines my academic, cultural, community, and clinical interest into a satisfying and busy academic career.