Fellowships give breathing room

Joan Larrabee, instructor in medicine at Joslin Diabetes Center, hopes to discover whether there is a distinct subtype of neuropathy in patients with diabetes.

But as a single mother of two young girls, she needs to provide a certain income for her family – one that she meets treating patients in a clinical practice at Joslin Diabetes Center. Research, unfortunately, does not pay the bills very well.

Until now. Larrabee is one of 51 recipients of a $25,000 fellowship from Harvard Medical School’s (HMS) 50th Anniversary Program for Scholars in Medicine. She and the other fellows – physicians and scientists on the lower rungs of the HMS faculty ladder – were joined by their families for a celebration Nov. 20.

While not all recipients are women, the Scholars in Medicine fellowships were established in 1996 to mark the 50th anniversary of the entry of women into HMS by offering a stipend to junior faculty at the most vulnerable point in their careers, when family concerns press in on valuable research time.

“They don’t leave medicine, but they may give up and go into 100 percent clinical medicine,” says Eleanor G. Shore, HMS dean for faculty affairs. “Which is very important, but it doesn’t get them to be a professor.”

What does propel a junior faculty member to full professor is, of course, research and teaching. Yet for doctors like Larrabee, research is largely funded through one’s own grantwriting and other initiatives – initiatives that take time.

That’s an elusive commodity for junior faculty, who are often at an age when family responsibilities mount, says Shore. “They’re trying to raise little kids, they often take the major responsibility for taking care of sick parents, they

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Embracing families and medicine has always been at the core of the fellowships. ‘A generation back, we were trying to learn how to have professional careers and families.’

– Eleanor G. Shore, dean for faculty affairs, HMS

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generally take on more of the clinical assignments, which doesn’t give them time to write research grants, write papers, develop educational curriculum, or do what is required to get to the top of the academic ladder,” she explains.

Women, in particular, feel the burden of these concerns, and it shows in their representation on the HMS faculty. While there are as many, if not more, women in medical school and almost as many at the training and instructor levels, women fall off steadily as they progress through the ranks of assistant and associate professor. Currently, says Shore, just 12 percent of the full professors on the HMS faculty are women.

A boost to research

For Larrabee, her Joslin Diabetes Center Fellowship in memory of Priscilla White, M.D., puts her closer to discovering whether small-fiber peripheral neuropathy exists in diabetes. If so, she says, it could lead to alternative treatments of peripheral neuropathy, a common complication of diabetes that damages the peripheral nerves and can lead to pain and numbness in the extremities.

Because no good, clinically simple, objective tests exist for small-fiber neuropathy, it’s been difficult to detect. Working with Seward Rutkove, associate professor of neurology at Beth Israel Deaconess Medical Center, Larrabee has developed a questionnaire to use in concert with objective tests to identify those with small-fiber neuropathy. The fellowship gives her the financial resources to devote more time to her research; previously, providing for her family kept her in her clinical practice for 75 percent of her time.

In addition to financial constraints, Larrabee has another strike against her in the competitive world of academic medicine: She entered medical school late in life, after working as a nurse for a decade. “That put me behind where many people would be at this point in their careers,” she explains. “This scholarship kind of gives me a boost. Other people might accomplish their research goals when they don’t have these family obligations.”

Families and medicine: Not either/or

Larrabee’s daughters, 5-year-old Carolyn and 1-year-old Molly, who was adopted just two months ago, joined her at the Scholars in Medicine celebration last month. They had plenty of playmates at the family-focused event, for which the caterers provided peanut butter and jelly sandwiches and the organizers turned a conference room into a kids’ activities center.

Embracing families and medicine has always been at the core of the fellowships, says Shore, who helped develop the awards with some of her senior women colleagues at HMS.

“A generation back, we were trying to learn how to have professional careers and families,” says Shore, who describes a Radcliffe fellowship she received early in her career that replaced some of her home duties – from child care to housecleaning – with paid help so she could continue her own medical training. As HMS approached its 50th anniversary of admitting women, “a group of senior women decided that we should give a gift to the younger generation of women to help them overcome some of the obstacles that we all faced,” says Shore.

The award has grown healthily since its first 10 fellowships in 1996; since its inception, the program has granted 239 fellowships at a total value of $6 million. They must be used to either buy academic time for a physician or, for a scientist, research assistance.

A unique feature of the fellowships is that funds come from a variety of sources. A committee of four – Shore as well as Margaret Dale, associate dean for faculty affairs; Roslyn Orkin, assistant dean for faculty affairs; and Wolbach Distinguished Professor of Pathology Lynne Reid – solicits support from inside and outside the medical community throughout the year.

“The success of this program is because of the conviction of many different institutions, schools, departments, offices, hospital foundations, faculty, and friends, that their investment in a junior faculty member’s career is the best investment they can make,” says Shore.

To Larrabee, that investment means caring for her daughters as well as researching peripheral neuropathy. “It frees up some of my time. As a provider for my family, I have to have a certain income, and if I don’t get the income through research, I would have to give up the research and just do clinical time,” she says. “So this allows me to pursue the research. It gives me time to get more established.”