On leaving academia. Hello Career?

So I just spent the past [too many] years of my life in academia at the big institutions up and down the Charles River.  And then I just did a job search and landed a job: an enormously non-trivial task summed up in one short mini sentence.

So what can I say?

Lol STEM shortage, lol higher education, lol advanced degrees, lol biomedical research.

The Problem:

There is a large gap in distribution between topics with open positions in academia and industries with open positions outside.  Consider that in life sciences (and likely others, although I am less familiar with others) the percentage of graduate students that do go on to tenure track faculty positions sits at < 10%.  That is agnostic of other factors such as how prestigious is your institution and PI or if you happen to get into the next big thing.  By and large you are > 90% likely to have a career outside of academia.

Within academia, life sciences trainees and non-life sciences trainees alike are funneled into biomedical research projects (figure 1).  Likely because biomedical research garners the most federal funding dollars plus lay public warm fuzzy feelings.  And then > 90% of those trainees finish and have to look for careers… Doing what?

Figure 1. AAAS federal funding distribution for sciences.

Apply for biopharma jobs aka “go to industry” lol.  Where hiring managers immediately pop academics’ CVs straight into the electronic trash.

They do?  But why?

Because no experience.  Because you think you’re so smart because Fancy Lineage – Prestigious Institution – All The Awards – Famous PI.

Perhaps it wasn’t this hard 10 years ago (I don’t know, but see historical trend and NIH bump in 2000), but it certainly is now.  Hundreds of life sciences trainees are applying for every open job posting :(.

So how to have a Career?

All is not lost though!  There is life!  Here are my thoughts based on my recent experience:

Get out of the bubble with the right attitude

First, the biggest barrier to entry is your attitude.

Unless you were doing something directly hot and translatable like clinical work in immune-oncology or CRISPR starting 5 years ago, you’re going to have to be adaptable and learn new things.  Your thesis topic is likely of no interest to anywhere in industry.  In fact, your thesis topic doesn’t really matter.

Your biggest marketable asset is that you are smart enough to learn and can do a project(s).  The main value of your PhD (or MS or postdoc) is technical experience that says you can do a project(s) and are smart enough to learn.

Focus on the Process, ask for help & listen

Second, ask for help with how to find a career and listen to all that advice.  Read books and career websites.  Keep asking for advice.  Advice from people out there that is, with or without PhDs.  Talk to strangers through the alumni network.  It feels awkward to ask strangers for help, but really people have all been there and are happy to give advice even if they can’t or won’t give you a job.

Take the generic advice to heart because you aren’t any better in the world than the highschool dropout looking for a job.  You’re both unemployed with little to no credible work experience (sorry, but academia doesn’t count as real work experience to most people).

And I don’t mean go to the Nature Career Expo and talk to other academics about “alternative careers”.  The point of all the talking is not exactly to find a job, but to learn how the culture out there works.  It’s crucial to learn to speak to what is considered successful out there.  Learn the language people use.  People out there will also help you understand and correctly word your transferable skills.  They can help you figure out which direction or industry you might be able to get into that is poised to do well in the future.  That direction may not be the most obvious to you and it may not have anything to do with life sciences!

Analyze and improve your process

Analyze each conversation to figure out how you can get a more favorable response in the next conversation.  The first one will be hard and likely won’t be great.  Keep revising your resume.  Improvement is a continual process.  No matter how smart, accomplished, and well-respected you were inside – you will get rejections.

Look widely and keep at it

Consider outside of biopharma.  And not just in consulting, but high-tech, medical devices, any tech, finance, law, etc.  Keep asking for help, do informational interviews, do alumni networking, learn the job titles that are appropriate for you and the career tracks within each of those industry segments, and keep at it.

Even when you feel like people are just giving you hollow cheer-leading, go ahead and take it.

All those people you know who went from your Big Name Institution to Industry Big Name Place or Big 5 Consulting and made it look easy?  Well it wasn’t easy.  They’re not telling you the half of how much they ran around, how many applications, how many people they talked to, how many follow-ups went unanswered, how many resume revisions, how many career articles read, how much practice interviewing… It’s not easy.  Everybody is just pretending (me too IRL).

Goodbye embryos, hello Future

Not sure if anyone will read this.  Maybe my future self?  But completely happy to help anyone else going through this process so feel free to ping me!

 

Do I have hypochondria?

Background

In the past months, maybe year I have been increasingly feeling sick 1-2 hrs after eating. I get shaky and clammy, sweaty and uncoordinated. I have to lie down and eat something to feel better, but I never really feel normal. This sounds kind of like hypoglycemia [1]. The result is I typically delay eating for as long as possible and then eat every 2 hrs thereafter.

I didn’t have a primary care doctor for unrelated reasons. So I found one off a list somehow and had an appointment. She said my symptoms were not possible, gave me a basic metabolic panel to shut me up, and sent me on my way.

image
Doctor’s office empty, probably should have taken that as a warning sign.

I felt so depressed. Am I a hypochondriac? That little insecure girl in me wanted to hide and cry. The scientist in me said this is stupid, go read some papers and do experiments to make science & evidence based conclusions. MDs just follow flow charts to diagnose.

Hypotheses

After a couple days of depression, I did some reading [2,3] and formulated a couple hypotheses:

  1. too much insulin, extended insulin, or hypersensitivity to insulin causes lowered blood glucose
  2. hypersensitivity to epinephrine or too much epinephrine causes hypoglycemic symptoms in the absence of lowered blood glucose
  3. hypoglycemic symptoms can also be brought on by fast fall in blood glucose, regardless of actual glucose values

Experimental Plan

To test these hypotheses, I went and bought the cheapest blood glucose meter at Target and some strips. Happens I worked on the research and development on the product my first job put of college. Cool!

I chose two tests to emulate [4]:

  • fasting glucose
  • time course after meal

The fasting glucose will give me a baseline, to understand whether a sharp rate of change is responsible for symptoms (3).

The post-meal time course will show me whether or not blood glucose is actually lowered when I feel symptoms (1) or (2).

Taking the time course is important to me, in case there are some dynamic differences from normal that can be informative. Many patient oriented informational sites only list high end values and single time points. So I had to do some digging to find some normal values to compare my results to (fig 1).

Figure 1. Normal blood glucose after eating a meal. Average in blue, 2 standard deviations from the mean upper and lower bounds in brown.  From http://www.phlaunt.com/diabetes/16422495.php.
Figure 1. Normal blood glucose after eating a meal. Average in blue, 2 standard deviations from the mean upper and lower bounds in brown. From http://www.phlaunt.com/diabetes/16422495.php.

Methods

Meter accuracy – test blood glucose twice in a row to see variance inherent to assay.

Fasting – after 8 hrs no food first thing in the morning I measured my blood glucose.

Meal – after meal take measurements 15 min to 3 hrs, half hour intervals and then 15 min intervals after 2 hrs when I expect to feel sick.

Results

Two subsequent measurements yielded the same blood glucose value, suggesting accuracy of testing equipment.

Fasting blood glucose is 122mg/dL.

Meal blood glucose rose to 200mg/dL shortly after lunch and peaked at 223mg/dL approximately 60min post meal. Blood glucose fell about 100mg/dL between 60 and 120min. Hypoglycemic symptoms onset at 120min coincided with sharp fall, but a normal range reading of 125mg/dL. Readings in 15 min intervals thereafter showed some additional decrease but relative stabilization of blood glucose levels. The lowest reading was at 96mg/dL (fig 2).  The experiment was stopped prior to the planned 3 hr time course because I had to eat something.

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Figure 2. My post meal blood glucose time-course. Meal included hot & sour soup, eggroll, tofu, green beans, and white rice. Blood glucose peaked just before 1hr, and then fell sharply by almost 100mg/dL by 2 hrs.

Discussion

I was expecting to find hypoglycemic readings, but instead found that my blood glucose is high to the point of possible pathology accompanied by high variability.

My fasting level of 122mg/dL is near the top end of the prediabetic range at 125mg/dL [5]. Fasting blood glucose greater than 125mg/dL indicate diabetes has developed, rather than pre diabetes condition. I do not meet this criteria for full diabetes, although I am approaching this threshold.

My peak blood glucose level at 223mg/dL 1hr post meal is in the diabetic range and exceeds prediabetic levels [5].

However, I am able to reduce blood glucose levels from peak back into a normal range. This dynamic pattern is consistent with prediabetes rather than full diabetes [6].

It is possible that my blood glucose falls into the hypoglycemic range at times due to the sharp fall in blood glucose from peak [7], but hypoglycemic blood glucose values were not observed here. Likely hypoglycemic symptoms are often due to the high rate of change rather than actual hypoglycemic blood glucose.

A prediabetic condition is supported by the post meal dynamics and most blood glucose measurements. Only my peak post meal blood glucose at 1 hr is alarmingly hyperglycemic supporting full diabetes.

This dynamic pattern suggests a loss of first phase insulin release, which occurs within 2 minutes of first food intake in normal people and prevent rise over 140mg/dL [7]. The second, sustained insulin release appears to be intact which explains the fall in my blood glucose between 1 & 2 hrs. However, overcompensation in the second insulin release due to hyperglycemic conditions at 1hr could explain the subsequent sharp fall in blood glucose and hypoglycemic symptoms [7].

Loss of the first insulin response is a feature of prediabetes or Impaired Glucose Tolerance [7]. Asians are reported to have higher incidences than Caucasians of developing diabetes, 95% of whom develop type 2 diabetes [8]. Many, if not all, develop type 2 diabetes through loss of first phase insulin response which causes subsequent beta cell loss or dysfunction, impairment of the second insulin release, and insulin resistance in other tissues [7,8]. Loss of both phases of insulin release characterizes full diabetes [7].

I probably have prediabetes and need to see an endocrinologist for proper diagnosis and treatment. I will probably not return to the primary care doctor who thought I was a hypochondriac.  I will probably repeat these experiments for a total of 3 times to demonstrate reproducibility [UPDATE: this doesn’t seem possible because stabbing my finger 1-4x per time point to get enough blood hurts].

I have a lot of reading to do to better understand the normal physiology, pathological physiology, disease progression, underlying mechanisms, population incidences, existing treatments, and relevant drug development pipeline.

Understanding my particular disease development and its treatment may be a challenge because my BMI is 19 and I have hovered on this cusp of underweight for my entire adult life.  Most diabetes information and prediabetes treatments focus on slowing disease development by losing weight.  It is likely my disease onset is caused by a factor other than obesity-related lifestyle choices since I am not obese, so modifying my lifestyle may have no effect on my disease progression.  An additional impediment for me to this common  method of treatment is that I cannot really lose weight.

In conclusion, do I have hypochondria?  Sadly it doesn’t seem so.

References

  1. Hypoglycemia, Wikipedia
  2. Blood sugar regulation, Wikipedia
  3. Reactive hypoglycemia site
  4. American Diabetes Association diagnosis
  5. American Diabetes Association
  6. Blood sugar chart
  7. The beta cell and first phase insulin secretion, Medscape
  8. Joslin Asian American Diabetes Initiative

* I do not necessarily endorse or believe all information contained in the references above.