"Meet the Expert": A conversation with Dr. Tatyana Kushner
On Sunday August 28th, LFN hosted it’s second “Meet the Expert” session. These sessions are facilitated through our Workroom platform. In this session, Dr. Tatyana Kushner from Mount Sinai Hospital in New York City provided her valuable insight into building a career in clinical research.
Below is a summary of the conversation:
Can you start off by sharing your medical training journey with us and how you incorporate clinical research in your daily practice?
Sure! I completed medical school and then internal medicine residency at the Icahn School of Medicine at Mount Sinai in New York. I then went onto fellowship in gastroenterology at UPenn. I then moved west to UCSF to complete my Transplant Hepatology Fellowship. And then I returned to Mount Sinai for a faculty position as Assistant Professor in the Division of Liver Diseases. I have been here now on faculty for almost five years!
I view clinical research as an important and integral part of my daily practice. I love it and have been fortunate to have dedicated time to move my clinical research program forward. I currently have around 50% protected time for clinical research, which I have had since I started on faculty. What I love most about what I do is that I have been able to build a clinical practice around the niche(s) in which I conduct clinical research: namely liver disease in pregnancy as well as in viral hepatitis.
How did you decide on programs as you advanced in training? Was the geographical diversity in training beneficial?
That’s a great question! I think that in my experience it was definitely beneficial! I think that obtaining training in different institutions, and different geographic regions really opens your eyes to how things are done differently in clinical practices across the country, which can be quite distinct. I also found it extremely helpful for building a mentorship team and collaborators across the country. My current research mentors still include mentors who I have met during my training at other institutions. In addition, different programs have different strengths - for example, some institutions may be more research focused than others, some may have more active clinical programs (i.e. larger liver transplant programs) than others - gaining exposure to this can really give you a broader perspective on career opportunities and breadth of the field.
I think that one of the aspects that drew me to UPenn for GI fellowship is that I was ready to leave NYC and experience something different, and thought that I would obtain a new perspective (after already spending 7 years at Mount Sinai). I then pursued UCSF because I had met Norah Terrault at AASLD (who remains one of my mentors) and sought out the fellowship to have the opportunity to work with her. UCSF also had an excellent reputation for transplant hepatology training which I was very excited about! Although it was a big move (at the time I had two 4.5 month old twin kids) and we moved cross- country with them, it was definitely worth it in the end!
Protected time in academia is a huge perk. Do you have advice for trainees currently looking for jobs on how to negotiate and secure protected time for clinical research especially early in career?
I very much agree - definitely a perk of academia! I still recall an attending at UCSF once telling me that clinical research as part of an academic career is "Medicine's best kept secret". And I think that one of the reasons, in addition to the exciting aspects of publishing papers, attending conferences, collaborating with colleagues with similar interests, advancing our field, is the flexibility that protected time allows - to allow you to come up with new ideas, build a niche that you love, and not feel the constant pressure to generate 1000s of RVUs from clinical practice.
I think that one important piece of advice is to try to secure protected time initially. It is much harder to get protected time later on if you start your position with little or no protected time. It is important to have a vision and a plan for what you think you can accomplish with your protected time, and when you are interviewing/ discussion positions, to be able to convey your plans to achieve your goals.
Having been at three different institutions (and interviewed at others), I've learned that institutions have vastly different views/ policies about protected time, so it is also important to assess whether the institution provides the type of supportive environment that would allow you to grow your research, even before you may have funding, and support you in this growth
What does your typical work week look like?
My typical work week is a nice balance of clinical research and clinical practice. Mondays and Thursdays are dedicated research days. Every other Tuesday is also a research day. In addition, I do half a day of endoscopy every other Tuesday. Wednesday mornings I run a Women's Liver Clinic - this is a clinic that I started which is co-located in the Obstetrics department where I see patients with liver-related complaints during pregnancy and postpartum. Wednesday afternoons I supervise a fellow's clinic. And Fridays is my general hepatology clinic day - where I see patients all day.
Oh yes, that leads us to the question we had about Women's Liver Clinic. It's so unique that you combined your clinical practice interests and advocacy in this manner. Maternal mortality rate in the US is one of the highest amongst developed countries
Yes, for sure! and there is so much work to be done in the field, which I think leads to research opportunities and can improve the clinical care (and outcomes) that we provide to women with chronic liver disease as well as in women with liver diseases unique to pregnancy for example.
I have had a broad interest in liver disease in pregnancy since IM residency, and initially was not sure if this could be research and clinical focus, but I have been pleasantly surprised as I progressed in my training and career, that there is support and interest in developing this field.
One of the visions I discussed when interviewing for my faculty position was the idea of building a dedicated Women's Liver practice. I was fortunate to be connected to an exceptional mentor at Sinai in the Obstetrics department who was very supportive in this, and has helped me along the way. We were able to develop this practice jointly - and to my initial surprise, my Division and the institution were also fully supportive of this!Having this dedicated practice has allowed me to build a name for myself in New York focused on liver disease in pregnancy, which has led to more referrals, but also has allowed me to see so many interesting cases that I can learn from - and that can inform research ideas that ultimately can hopefully benefit our patients.
You obtained a master’s degree in clinical epidemiology during GI fellowship. We were curious on how you decided to obtain an advanced degree during a busy fellowship and whether it informs your current practice?
That/s a great question! I would say that obtaining the master’s degree in clinical epidemiology (MSCE) has been one of the smartest decisions I have made in my training (and my career) to date. In the GI fellowship at UPenn, at least when I was there, fellows were required to select a track – either the MSCE track (which was what I did), basic science track, or the educator track. Of the three tracks, the MSCE was the most interesting to me.
To be quite honest when I was applying for GI fellowship, I had been interested in clinical research, but was not sure it would be a large part of my future career. But being part of the MSCE program is what inspired me to do so! The nice thing about the program was that it allowed dedicated time during years 2 and 3 of GI fellowship to work on a masters thesis, do coursework, and really gain the tools to conduct clinical research (which was a really nice change after a very clinically rigorous first year of GI fellowship). Through the program I also had the opportunity to work with exceptional research mentors and work on developing a research focus. After I completed the MSCE program, I was inspired to pursue a career where clinical research was an integral component.
The research methods and experience gained from the program (for example how to use STATA to do stats and how to design clinical research projects) are aspects I use in my career today!
What advice do you have for trainees interesting in incorporating clinical/translational research especially the funding aspect? We would love to hear your experience applying and winning the AASLD Early Career Investigator Awards
Yes, the funding aspect is quite important, and challenging, but do-able! And as in everything, practice and perseverance are what pay off in obtaining funding!
I recall that in my GI fellowship, our division chief encouraged all of us to apply for the NIH Loan Repayment program (LRP) grants - because he said its "free money" and there's no reason not to apply. This was the first grant that I wrote - and although I did not get it on my first attempt, I tried again (possibly two more times!) and eventually got it - and with every subsequent grant, the process of writing a grant becomes less daunting, and more manageable.
I then applied for the AASLD Clinical Translational and Outcomes Research award which was funded during my first year of faculty (and I had worked off of what I learned by applying for the LRP).
I think important pieces of advice for grants early on are to 1. Identify a mentor (and/or mentorship team) that is supportive and committed to your success, 2. Perseverance - it may take a few tries, but hopefully will work out 3. Creativity in seeking out funding opportunities - foundations, NIH, Industry - all are great options!
What advice do you have especially for our female trainees interested in transplant hepatology as a field in terms of career advancement opportunities, mentorship, and pay disparity, if any?
I think that Transplant Hepatology is an excellent field - and hope that more female trainees pursue it! There are exceptional female leaders/ mentors in our field - Lupe Garcia Tsao, Norah Terrault, Gyongyi Szabo, to name just a few, all of whom were or will be AASLD presidents. There is also an increased focus in our field on the importance of women's health in liver disease - for example, last year the first ever Reproductive Health Guidelines were published by the AASLD - which demonstrates the commitment of the field to women's health in liver disease - and also the need for female providers. The AASLD also has the Women's Initiative Committee and the Women's luncheon, among other programs/ groups which are always looking for ways to promote women in our field. I would encourage female trainees to seek out mentors who have participated or led some of these groups, and who they can learn from to help their own careers.
Although the issue of pay disparity is still present across Medicine, I think it is important to be mindful of this in applying for jobs, and selecting where you want to start your career, but I'm hopeful that in Hepatology that we are moving towards bridging those gaps!
I truly think it is a wonderful field that offers so much in a career. I'm available and happy to answer any questions today or in the future about my own experience and about pursuing a career in hepatology!