Commentary: What Contributes to a Successful Career in Epidemiology in the United States?

Ross C. Brownson1, Jonathan M. Samet2 and Stephen B. Thacker3

1 Department of Community Health and Prevention Research Center, Saint Louis University School of Public Health, St. Louis, MO.
2 Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
3 Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA.

Received for publication September 24, 2001; accepted for publication March 14, 2002.


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 APPENDIX
 REFERENCES
 
The authors conducted a study examining perceived enabling factors and barriers to a successful career in epidemiology, the role of mentoring in facilitating one’s career, where graduates are most often being employed, and key competencies for future epidemiologic training. During June to August 2001, they surveyed senior epidemiologists across the United States (n = 248) in four sectors: state health departments, the Centers for Disease Control and Prevention, the National Institutes of Health, and schools of public health. The top enabling factors were dedication to hard work and having an intrinsic curiosity and a sense of discovery. The most frequently cited barrier was balancing career and family life, except among minority respondents, for whom an unsupportive supervisor was the leading obstacle. Influential characteristics of a mentor were high integrity and the provision of inspiration and encouragement. The top competencies anticipated for the next 10 years were skills working in multidisciplinary teams and in using modern information technologies. Important competencies varied somewhat according to work sector. These findings may be useful in training and career planning among aspiring epidemiologists and for educational policy development among organizations promoting training and mentoring.

career choice; epidemiology; mentors; public health; research support; training support

Abbreviations: Abbreviations: CDC, Centers for Disease Control and Prevention; EIS, Epidemic Intelligence Service; NCI, National Cancer Institute; NIH, National Institutes of Health.


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 APPENDIX
 REFERENCES
 
Organized public health efforts—the prevention of disease and injury and the promotion of health and quality of life—rest on the scientific core of epidemiology (1). Within a public-health system, epidemiology contributes to etiologic research, planning and evaluation of interventions, public health surveillance, and health policy formulation (26). Accordingly, leaders of state health departments ranked epidemiologic skills highest among 11 areas of importance to their agencies (7).

Although several studies have addressed the current supply of epidemiologists and anticipated future needs (811), there has been little assessment of factors that contribute to a successful career in epidemiology. The field is evolving, and we need to consider the competencies that will be necessary in the future. In a commentary, Harlow (12) provided a discussion of career frustrations encountered by epidemiologists and how these issues might affect those who are newly trained or are considering epidemiology as a career. These included the difficulty of obtaining research funding and the barriers to publication in peer-reviewed journals. Harlow also suggested several possible solutions and opportunities, including the need for interdisciplinary collaboration, the potential for analysis of existing data sets, and the crucial role of mentoring by senior epidemiologists. Although considerable literature on the attributes of sound mentoring exists in health sciences and business literature (1317), there is little similar information in epidemiology and public health.

One large, comprehensive study has examined career success among scientists in the United States (18). Researchers conducted a mailed survey of 699 persons and 200 open-ended interviews with fellows of the National Science Foundation, the National Research Council, and Bunting Institute at Radcliffe College (18). In this study, the most important attributes appeared to be the choice of institution from which a scientist graduates, the choice of hot research topics, and hard work. For many persons, access to a strong mentor has been noted as one of the most important career advantages (14, 15, 17, 18). The key characteristics of a successful mentor include strong academic skills, accessibility, problem-solving skills, and the ability to develop trust with the recipient of mentoring (14, 15).

To address these characteristics and related issues, the objectives of our study were fourfold: 1) to understand the relative contributions of perceived enabling factors and barriers to a successful career in epidemiology; 2) to explore the role of mentoring in facilitating a career; 3) to understand where graduates are most often employed; and 4) to describe the key areas and competencies for epidemiologic training in the future.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 APPENDIX
 REFERENCES
 
We surveyed senior epidemiologists throughout the United States in four sectors: state health departments, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and schools of public health. Within health departments, the State Epidemiologist was designated as the senior epidemiologist within each state or territory. The State Epidemiologist is the person in each state or territory who is responsible for public health surveillance of diseases and conditions of public health significance (19). At CDC, persons were identified who had at least 12 years of experience in public health and also had formal academic training in epidemiology or had completed the Epidemic Intelligence Service (EIS) Program (20). At NIH, the primary concentration of senior epidemiologists is within the National Cancer Institute (NCI). NCI uses a tenure system similar to that in academe; therefore, tenured epidemiologists within NCI were surveyed. In seven other institutes of NIH that do not follow a formal tenure process, the senior leadership of each institute (e.g., the deputy director of the institute) was asked to identify epidemiologists whose seniority would be similar that of persons from NCI being surveyed. In the academic setting, we selected full professors within departments or divisions of epidemiology in the 30 schools of public health that are currently accredited by the Council on Education of Public Health (21).

On the basis of our input and of previous literature (12, 1418, 22, 23), we developed an initial questionnaire. The survey was pilot tested with eight persons who were similar to our target sample. After revision, the final questionnaire included 14 questions (some with multiple parts), covering six areas: 1) a person’s educational background; 2) the relative contributions of key enablers and barriers to career success; 3) important qualities of a mentor; 4) career paths for recent graduates; 5) needed epidemiologic skills and competencies; and 6) demographics (i.e., age, sex, race/ethnicity). Key questions are shown in the Appendix, and the full questionnaire is available from the first author upon request.

The survey was conducted by e-mail from June through August 2001. After an initial e-mail, a second reminder was provided 2 weeks later. From our initial sample of 471, a total of 26 persons were removed from the eligible pool because of a nonworking e-mail address or being on sabbatical or other extended leave from the office. This resulted in an eligible group of 445. A total of 250 surveys were returned. Two surveys were omitted because of a large proportion of missing data. Therefore, the final response rate was 56 percent (248 of 445). The response rates varied by sector: state health departments, 64 percent; CDC, 66 percent; NIH, 60 percent; and schools of public health, 43 percent.

We conducted descriptive analyses. A mean score (arithmetic average of the five-point Likert scale) was calculated for each factor for the total sample and for various subgroups (i.e., sex, ethnicity, training, employment setting). Within each distribution (e.g., enabling characteristics), factors were ranked by quartile; quartile differences between subgroups are noted in Results for group differences of two or more quartiles. For the question about where recent graduates are employed, 27 respondents did not rank-order settings and therefore were eliminated from the final analyses.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 APPENDIX
 REFERENCES
 
The characteristics of the sample are shown in table 1. Approximately 50 percent of the respondents were in their 50s, 75 percent were men, and nearly 90 percent were Caucasian. The largest percentage of respondents worked for CDC, followed by universities, state health departments, and NIH. The highest degree held by most respondents was MD. A total of 55 percent of respondents held a master’s or doctoral degree in epidemiology, and 52 percent were graduates of the CDC’s EIS Program.


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TABLE 1. Characteristics of participants in the careers in epidemiology study, United States, 2001 (n = 248)
 
Respondents were asked about facilitators and barriers to success in their career (table 2). The top enabling factors were dedication to hard work and having an intrinsic curiosity and a sense of discovery. Other key enablers were being trained in a high-quality program, having a supportive mentor, and having a strong background in medicine and/or biology. Several enabling factors varied by work setting. For example, priority on publishing results ranked in the highest quartile for participants from NIH and universities, in the third quartile among CDC respondents, and in the fourth quartile for participants from state health departments. The characteristic passion for improving population health ranked in the second quartile for state health department and CDC participants and in the fourth quartile for NIH and school of public health respondents. As expected, having a strong background in medicine or biology was ranked in the highest quartile for MD epidemiologists and in the lowest quartile for those who were PhD trained. Similarly, a strong quantitative background was ranked in the first quartile for PhD epidemiologists and in the third quartile for persons trained as MDs. The highest-ranked barrier for the total sample and for nearly every subgroup was the difficulty in balancing career and noncareer activities (marriage, family). Women rated the barrier of balancing the career and noncareer functions more highly than did men. The exception was among minority respondents, who reported that an unsupportive supervisor or leader of their unit was the most important barrier (average score = 3.65). For minority respondents, three other barriers ranked higher than difficulty in balancing career and noncareer activities: little chance for advancement, low salary and benefits, and lack of colleagues doing similar work.


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TABLE 2. Enabling factors and barriers to career success in epidemiology, United States, 2001
 
A total of 89 percent of our sample reported having one or more important mentors during their training and career. Among these persons, mentoring qualities were rank-ordered according to their importance. The ranking of factors was: high integrity (average score = 4.33), inspiration and encouragement (average score = 4.25), thorough knowledge of subject matter (average score = 4.09), accessibility (average score = 4.03), asking of challenging questions (average score = 4.00), willingness to share credit (average score = 3.99), willingness to make education a priority (average score = 3.70), and numerous good contacts in the profession (average score = 3.69). There were no differences of two or more quartiles in important mentoring qualities within settings, sex, or ethnic subgroups.

Respondents were asked to rate 12 issues based on question 5 in the Appendix. Responses are presented for the entire sample and by work setting (table 3). The top competencies were skills working in multidisciplinary teams and using modern information technologies. Across various employment settings, knowledge of molecular biology ranked in the highest quartile for NIH respondents and in the third quartile for participants from state health departments and CDC.


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TABLE 3. Important skills and competencies in epidemiology for the next 10 years by setting, United States, 2001
 
Among persons directly involved in training and placement of new epidemiologists (46 percent of the total sample), eight placement options were ranked. The rank-ordered placements for master’s degree graduates were as follows: 1) state or local health departments, 2) federal agencies (e.g., NIH or CDC), 3) continuing their education with another degree, 4) universities, 5) nonprofit agencies (e.g., the American Heart Association), 6) pharmaceutical companies, 7) health-care organizations, and 8) international organizations. Among doctoral graduates, the order differed: 1) federal agencies, 2) universities, 3) state or local health departments, 4) international organizations, 5) nonprofit agencies, 6) pharmaceutical companies, 7) health-care organizations, and 8) continuing their education with another degree.


    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 APPENDIX
 REFERENCES
 
This study was carried out to address our limited understanding of the factors that determine having a successful career in epidemiology. Several perceived enabling factors were consistent among all subgroups in the study, including hard work and intrinsic curiosity. Barriers were scored lower in importance as career influences than nearly every facilitating factor. Although they did not quantify factors in the same manner, Sonnert and Holton (18) reported some similar findings regarding success in scientific careers. For example, they suggested several lessons for aspiring scientists, including attending high-caliber educational institutions, prioritizing publishing results of research, locating supportive mentors, and discovering ways to coordinate career and family life.

Mentoring can be critical in career development for many persons and professions (1418, 24, 25). Mentorship is the foundation of the doctoral experience through the advisor-advisee relationship and is fundamental to the teaching of research generally. In our study, high integrity, inspiration, and encouragement were key mentor characteristics. This finding agrees with those of other studies showing the importance of personal ethics and trust as key attributes for mentors (14, 15). Evidence in the literature indicates varying keys to a successful career and effective mentoring according to sex and ethnicity (17, 18). We did not find many differences in the factors by sex or race/ethnicity, although the small sample sizes for various racial/ethnic groups limited our ability to analyze mentoring attributes in depth. Barriers did differ, however, between racial/ethnic groups. Having an unsupportive supervisor or team leader was seen as a greater barrier among minority respondents than among Caucasians. In a related finding, a survey of EIS alumni found that minority graduates more often learned of the program through an academic advisor, who often might be a mentor, than did nonminority EIS officers (26). In our study, the sample sizes themselves illustrate the relatively small proportion of women and ethnic minorities in the senior ranks of epidemiology.

Our data offer insights on future training needs and show variations in needed competencies among employment settings. In our study, top-ranked competencies for the next 10 years were better skills for working in multidisciplinary teams and in using modern information technology. In part, the emphasis on information technology may reflect a sample who became epidemiologists when many currently employed technologies were not available. Our results seem to support the need for different or varied skills and competencies depending on the employment setting. Departments of epidemiology should give consideration to the differing competencies needed by graduates who plan to enter different settings. For example, being highly trained in molecular biology appears to be valued more among NIH respondents than among persons from state health departments or CDC. If a master’s or doctoral student in epidemiology plans to work in a state health department, it may be advantageous to supplement training in epidemiologic methods with skills in working with the media or with culturally diverse populations (e.g., through an elective course during training or via an internship).

Although our study provides useful information, it has several limitations. Determination of the case definition for a "successful" epidemiologist was challenging. Among any group of scientists and practitioners, the concept of success is likely to differ depending on one’s background and the type of work being valued. In our survey, we first selected senior epidemiologists and allowed them to self-define success. In university settings, academic rank is a reasonable and accepted definition of success. Consistent guidelines for tenure within CDC and NIH are nonexistent, and therefore, we relied on the judgment of senior administrators within various agencies to define our sample. To some extent, our study equates longevity with success. Our academic sample was limited to schools of public health and therefore excluded many epidemiologists who teach and conduct research in schools of medicine and other academic departments. We did not survey senior epidemiologists in private settings such as health maintenance organizations or the pharmaceutical industry. In studying now-senior epidemiologists, our findings do not reflect the consequences of a trend for increasing numbers of epidemiologists to be trained in the relatively new PhD programs in schools of public health and other university settings. In addition, the study is descriptive and lacks a comparison group. For example, particularly when barriers were examined, it would have been preferable to identify epidemiologists who otherwise would have succeeded but faced one or more barriers that could not be overcome. By focusing our efforts on senior epidemiologists, we have limited our survey to persons who, to a great extent, have managed to overcome barriers. Finally, the response rate was 56 percent, and although we cannot quantify any resulting differences, respondents and nonrespondents may have different views.

Our study was largely quantitative in ranking perceptions of various factors. To probe more deeply, some topics could also be examined with qualitative methods, such as those used by Sonnert and Holton (18) in their examination of career success in science. For example, respondents from schools of public health ranked management skills in the highest quartile as an important competency for the next decade, yet management is multifaceted, and it is unclear whether this category relates to the ability to manage a study or skills in managing people and programs within an organization (e.g., personnel, budgeting).

There are also several ways in which the issues in this article might be explored in future research using epidemiologic methods:

• Follow a cohort of master’s and doctorally trained students from their time in school through their early career to determine predictors of success;

• Conduct a study of epidemiologists who are not as far along in their careers, yet are already deemed successful;

• Conduct a study to understand what factors initially motivate persons to pursue a career in epidemiology;

• Examine a larger sample of minority persons to better determine differences between minority and Caucasian epidemiologists;

• Conduct similar studies in other countries and settings where epidemiologists are less often employed (e.g., managed care organizations).

In summary, success in science reflects a combination of hard work, training, mentorship, balancing work and family life, and serendipity (12, 14, 18, 27). This study shows that the same factors are often operative for epidemiologists, and it provides a strong rationale for training programs to assure that mentorship is of the highest quality and that it should be sustained after formal training is completed. Some of our findings may be relevant for planning educational and organizational policies. For example, policies that facilitate both work and family life (e.g., telecommuting and family leave) may help in balancing competing time demands. Our results also identify the need to match competency-oriented teaching to the settings where graduates plan to work. We need ongoing approaches to monitor workforce needs and competencies in epidemiology.


    ACKNOWLEDGMENTS
 
This project was partially funded through Centers for Disease Control and Prevention contract U48/CCU710806 (Centers for Research and Demonstration of Health Promotion and Disease Prevention).

The authors are grateful to the following persons, who assisted the authors in selecting respondents, developing and pilot testing the instrument, or inputting data: Stephen Bacak; Kathleen Gardiner; Shah Roohi; and Drs. Lawrence Friedman, Eugene Lengerich, John LaMontagne, David Nelson, Patrick Remington, Eduardo Simoes, Gerhard Sonnert, Donna Stroup, Douglas Weed, Fredric Wolinsky, and Shelia Zahm.


    APPENDIX
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 APPENDIX
 REFERENCES
 




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    NOTES
 
Reprint requests to Dr. Ross C. Brownson, Department of Community Health and Prevention Research Center, Saint Louis University School of Public Health, Salus Center, 3545 Lafayette Avenue, St. Louis, MO 63104 (e-mail: brownson{at}slu.edu). Back


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 APPENDIX
 REFERENCES
 

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