Profile A Conversation With Dr. Lance Becker on Building an Academic Research Program

A Conversation With Dr. Lance Becker on Building an Academic Research Program

By Daniel Jourdan, MD and Jonathan Gong, MD on behalf of the SAEM Faculty Development Committee and SAEM Research Committee

Lance Becker, MD, is the chair for the department of emergency medicine at North Shore University Hospital and Long Island Jewish Medical Center at Northwell Health. He is a professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and the Institute of Bioelectronic Medicine at the Feinstein Institutes for Medical Research, and the Dorothy and Jack Kupferberg Professor of Emergency Medicine. Dr. Becker is an elected member of the National Academy of Medicine and specializes in translational research on cardiac arrest. He has close to 300 research publications. His cardiac arrest research evaluates methods to advance life-saving therapies for cardiac arrest while protecting against brain

Lance Becker death. He has mentored numerous young investigators in research over three decades.

Dr. Jonathan Gong: Dr. Becker, how did you initially get into research? Dr. Lance Becker: There’s this book called “The Accidental Tourist.” My book would have been called the “The Accidental Researcher.” I felt that in the area of cardiac arrest, there was a lot that we did not know. I had the good fortune of being around mentors who helped me publish some papers and get some grants, and then suddenly I had some money coming in. I was able to get some protected time for my research. I started a laboratory on resuscitation science because I was convinced that it was not enough to just do better CPR. We needed to fundamentally revolutionize the way that we thought about resuscitation and the human body and cells, and that led me to mitochondria. Emergency medicine is so rich with research opportunities and so many research targets that people know very little about. Dr. Jonathan Gong: Was there a specific case or patient that sparked all this interest? Dr. Lance Becker: I thought that I had a horrible dark cloud because I knew that my survival rates for the cardiac arrests that I took care of were not very good. I don’t know the exact numbers, but I would have 10 cases and maybe one that survived. Reading literature from Seattle that survival rates were 20% did not jive with my reality. I did not think that 20% was real, so I measured it for the city of Chicago and it ended up being 1.8%. So the statistics that we were teaching people across the country were off by a factor of 10. That

is when I realized that there is so much more that we can really do. I started on the population side of that, and as I read more, I had colleagues that drew me in. I got involved with the American Heart Association and became the chair of the BLS Subcommittee. I had the chance to rewrite the resuscitation guidelines for the United States and helped form an international liaison committee. At that point, I had the chance to redraft the world’s basic life support guidelines. The process transformed my life. Then I really got involved in mentoring a new generation of researchers. I had the chance to be involved in education and teaching both directly at the bedside, and via teaching things with papers that we would write. It reinvigorated my own passion about how important it is for the world that emergency medicine figure out important science. There has never been a better opportunity than today for young people to make discoveries. Dr. Jonathan Gong: You mentioned you had a few mentors earlier in your career. What were some of the things that you looked to them for and how did they help shape your direction of research? Dr. Lance Becker: I was really lucky, and I really owe my career to my mentors. I found so many people able and willing to mentor me, and many were from emergency medicine, but many were from cardiology and from surgery. When you communicate with somebody about something that is an idea, it's probably one of the most exciting things. I remember meeting one of the giants of cardiac resuscitation. After his talk, I asked him about a slide that he had shown. He said, “I'm not really sure about that” and then he handed me his box of slides (no PowerPoint in those times). He said “Well, just look through these and tell me what you think and let me know if you would make them any better.” This person was the top leader in the field, Mickey Eisenberg, who basically invented how to get CPR into the community. He had just given me all the slides from his entire talk. That sort of welcoming thing I had from people from all over the world, and they would reach out and help me. Fundamentally, we formed our own community, and these are people who stay with you. Even though I moved from Chicago to Philadelphia, and then to New York, the mentors that you have are people who stay with you for life. They are your second family. Dr. Jonathan Gong: How did you balance your clinical responsibilities as you were developing your research career? Dr. Lance Becker: It is very time-consuming and challenging and you have to be into it because you love it and know that you are not going to get paid for most of your time. In the beginning, for every hour you spend trying to pursue research, it's just something you do because you love it. I don't have a lot of secrets other than I don't believe in work-life balance. I believe in work-life integration and what I mean by that is the way you set things up in your life. I did it late at night for years and I would do it every day, but you figure out a way to integrate it into your life. I made sacrifices with my career like making less money than my colleagues and where I lived. There is no real game book on how to do this. I have so many more rejected grants and rejected papers than probably any of you out there. I am still writing NIH grants and I'm putting three in this next cycle. I counted my NIH grants just the other day and I had 49 rejected NIH grants. Dr. Daniel Jourdan: How do you find and develop a niche? Dr. Lance Becker: I don't want to say that it's completely at random, but I think you have to follow your heart. There are so many niches in emergency medicine that if there's nothing that interests you, go find another specialty. The area of critically ill patients is just ripe with emergency medicine, whether it's cardiac arrest, sepsis, stroke, or critical care. We are also the safety net for the entire country in terms of being sure that people have equitable access to care. The whole area of justice and health care in access to health care in disparities, in trying to right some of the wrongs of people who have difficulty, or are being taken advantage of in some way, I think that that whole area is what is called social emergency medicine, societal emergency medicine, and population health. The whole area of prehospital (EMS) care is just beginning to open and the future will involve much more care at home. I hope that emergency medicine will be the specialty that oversees the appropriate use of home health care to avoid a hospital admission. The whole area of women's health is just really undergoing a transformation. Finally, the topic of climate change and health of humans on our planet, is tied up with our existence as a species, and a new area of research. I think, again, emergency medicine can be at the forefront. Dr. Daniel Jourdan: For a resident who is interested in an academic career, what advice beyond just getting involved in research would you give? Dr. Lance Becker: For residents and young faculty, I would suggest putting yourself in the right environment so that you get support. What are your resources going to be in terms of both collaborators and mentors? Maybe people could work for you to make some of the work easier. Do you have opportunities for that? One of the things that we do well in emergency medicine is we network. In emergency medicine, you can network with nearly any of the top people, the gurus of the field, just by sending them an e-mail and saying, “I need advice.” Part of my success is because I developed a supportive research infrastructure. For example, we developed a research associates program that would take young people, train them in research, and they could then help faculty with projects to ensure completion. Everyone benefits from programs like this. Despite all the challenges of pandemics, societal unrest, overcrowding, disparities, and lack of resources, emergency medicine has so many important discoveries to contribute to medicine. There has never been a time with so many opportunities for discovery in emergency care.

ABOUT THE AUTHORS

Dr. Jourdan is a PGY-3 in the combined emergency medicine/ internal medicine residency program at Henry Ford Hospital. He currently holds the position of member-at-large on the SAEM RAMS Board. Dr. Gong is the director of the critical care division at Long Island Jewish Medical Center, Department of Emergency Medicine. He currently holds positions in both the department of pulmonary, critical care and sleep medicine and the department of emergency medicine, and is an assistant professor of emergency medicine at the Donald and Barbara Zucker School of Medicine. His research currently focuses on improving care of the critically ill, with specific focus on sepsis syndromes.