CAREER OPTIONS IN ACADEMIC MEDICINECAREER OPTIONS IN ACADEMIC MEDICINE

ADAM S. MORGENTHAU, MDADAM S. MORGENTHAU, MDCo-Director, Sarcoidosis ClinicCo-Director, Sarcoidosis Clinic

Assistant Professor of MedicineAssistant Professor of Medicine

Division of Pulmonary, Critical Care & Sleep MedicineDivision of Pulmonary, Critical Care & Sleep Medicine

The Mount Sinai School of MedicineThe Mount Sinai School of Medicine

• QUOTATION: QUOTATION:

““When drinking water, think of its source.”When drinking water, think of its source.”

WHAT IS ACADEMIC MEDICINE?WHAT IS ACADEMIC MEDICINE?

• Medicine practiced at a University or SchoolMedicine practiced at a University or School

• Involves patient care +/- research +/- teachingInvolves patient care +/- research +/- teaching

• Academic physicians pass knowledge and/or skills Academic physicians pass knowledge and/or skills onto others, especially traineesonto others, especially trainees

• GOAL: Trainees create new knowledge that is used GOAL: Trainees create new knowledge that is used to improve patient care.to improve patient care.

THE ACADEMIC MISSIONTHE ACADEMIC MISSION

ResearchResearch TeachingTeaching Patient CarePatient Care

Fleming et al..JAMA Sept 7, 2005—Vol 294, No 9; 1101-1104Fleming et al..JAMA Sept 7, 2005—Vol 294, No 9; 1101-1104

HISTORY OF FACULTY TRACKSHISTORY OF FACULTY TRACKS• 1900—19701900—1970 Faculty excel in Research, Teaching, Patient Care simultaneously (TRIPLE THREAT). Faculty excel in Research, Teaching, Patient Care simultaneously (TRIPLE THREAT).

• 19701970 Designated Promotion/Tenure Tracks; Researchers vs. Clinicians Designated Promotion/Tenure Tracks; Researchers vs. Clinicians

• 1980s1980s Clinician-Researchers vs. Clinician-Educators Clinician-Researchers vs. Clinician-Educators

• Late 1980sLate 1980s Tracks Further Specified based on time spent: Tracks Further Specified based on time spent: Clinical time vs, Educational activities vs. ResearchClinical time vs, Educational activities vs. Research

• Early 1990sEarly 1990s Money Money NOTNOT saved through new Track System because… saved through new Track System because…

Old “yardsticks” (number of peer-reviewed articles and number of NIH grants) used to measure progress Old “yardsticks” (number of peer-reviewed articles and number of NIH grants) used to measure progress in new Track System…in new Track System…Therefore…high rate of turnover of clinicians; Institutions lose moneyTherefore…high rate of turnover of clinicians; Institutions lose money

• Late 1990sLate 1990sCreation of Categories of ProductivityCreation of Categories of ProductivityMandatory Documentation of ProductivityMandatory Documentation of ProductivityTrack Systems become heterogenous and Institutionally-DependentTrack Systems become heterogenous and Institutionally-Dependent

• 2000s2000s Development of a Classification System for the Academic Physician Development of a Classification System for the Academic Physician

Fleming et al..JAMA Sept 7, 2005—Vol 294, No 9; 1101-1104Fleming et al..JAMA Sept 7, 2005—Vol 294, No 9; 1101-1104

CATEGORIES OF PRODUCTIVITYCATEGORIES OF PRODUCTIVITY

Fleming et al..JAMA Sept 7, 2005Fleming et al..JAMA Sept 7, 2005Vol 294, No 9; 1101-1104Vol 294, No 9; 1101-1104

CLASSIFICATION OF THE ACADEMIC CLASSIFICATION OF THE ACADEMIC PHYSICIANPHYSICIAN

ACADEMIC ACADEMIC PHYSICIANPHYSICIAN

CLINICIAN CLINICIAN EDUCATOREDUCATOR

PHYSICIANPHYSICIANINVESTIGATORINVESTIGATOR

PHYSICIANPHYSICIANSCIENTISTSCIENTIST

Modification of Text: Holcombe, RF. Academic Medicine, Vol. 80, No. 10; Oct 2005; 905-907.Modification of Text: Holcombe, RF. Academic Medicine, Vol. 80, No. 10; Oct 2005; 905-907.

ACADEMIC PHYSICIANSACADEMIC PHYSICIANS

CLINICIANCLINICIAN

EDUCATOREDUCATOR

PHYSICIAN PHYSICIAN

INVESTIGATORINVESTIGATOR

PHYSICIANPHYSICIAN

SCIENTISTSCIENTIST• Primary commitment to Primary commitment to education ( > 50%)education ( > 50%)

• AdministrationAdministration

• Research in educationResearch in education

• Clinical care and Clinical care and bedside teachingbedside teaching

• Research and clinical Research and clinical activities; (percentage of activities; (percentage of time for each of these time for each of these varies)varies)

• Usually clinical researchUsually clinical research

• Principal investigator or Principal investigator or co-investigator in a clinical co-investigator in a clinical trialtrial

• Funding from foundation Funding from foundation or pharmaceutical companyor pharmaceutical company

• Mentors traineesMentors trainees

• Teaches or serves on Teaches or serves on committees.committees.

• MD or MD-PhD trained MD or MD-PhD trained researcherresearcher

• 70-80% of their time is 70-80% of their time is dedicated to researchdedicated to research

• Usually basic science Usually basic science researchresearch

• NIH fundingNIH funding

Holcombe, RF. Academic Medicine, Vol. 80, No. 10; Oct 2005; 905-907.Holcombe, RF. Academic Medicine, Vol. 80, No. 10; Oct 2005; 905-907.

TRACKS-How you spend you timeTRACKS-How you spend you timeRESEARCHRESEARCH CLINICAL CARECLINICAL CARE EDUCATIONEDUCATION ADMINISTRATIONADMINISTRATION

Investigator orInvestigator or

Tenure TrackTenure Track

Clinician Educator Clinician Educator

or or

Academic ClinicianAcademic Clinician

oror

Clinical EducatorClinical Educator

Teacher Clinician Teacher Clinician oror

Educator TrackEducator Track

Administrative Administrative PositionsPositions

• Mostly researchMostly research

• Remaining time Remaining time on other academic on other academic activitiesactivities

• Greater than 50% Greater than 50% patient care, patient care, emphasis on clinical emphasis on clinical teachingteaching

• Greater than 50% Greater than 50% educatingeducating• Remaining time on Remaining time on other academic other academic acitivities (Medical acitivities (Medical education research)education research)• Not at all schoolsNot at all schools

• Faculty generally Faculty generally serve institution in serve institution in any path before any path before taking an taking an administrative administrative positionposition• Time variesTime varies

Non-tenure Non-tenure Research TrackResearch Track

Clinical Service Clinical Service Track or Track or

““Clinical Faculty”Clinical Faculty”

• 90%-100% 90%-100% researchresearch

• At least 80% time At least 80% time spent delivering spent delivering health care serviceshealth care services

Association of American Medical Colleges—Association of American Medical Colleges—Careers in Academic MedicineCareers in Academic Medicine

WHAT IS THE CURRENT STATE OF WHAT IS THE CURRENT STATE OF AFFAIRS IN ACADEMIC MEDICINE?AFFAIRS IN ACADEMIC MEDICINE?

• Remember the Chinese Proverb?Remember the Chinese Proverb?

Perspective

The Attrition of Young Physician-Scientists: Problems and Potential Solutions

Mark Donowitz, Greg Germino , Fabio Cominelli and James M. Anderson ‡Department of Medicine, University of Virginia at Charlottesville School of Medicine, Charlottesville, Virginia

   Department of Medicine, Johns Hopkins

University School of Medicine, Baltimore, Maryland §Department of Cell and Molecular Physiology, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, North Carolina

Gastroenterology 2007; 132; 477-480.Gastroenterology 2007; 132; 477-480.

Viewpoint:Viewpoint:

Who’s Watching Out for the [Physician Investigator]?

Randall F. Holcombe, MDRandall F. Holcombe, MDDr. Holcombe is associate professor and chief, Division of Hematology/Oncology, and associate director for clinical research, Chao Family Comprehensive Cancer Center, University of California, Irvine, College of Medicine, Irvine, California.

Academic Medicine, Vol. 80, No. 10/ Oct. 2005Academic Medicine, Vol. 80, No. 10/ Oct. 2005

ATTRITION OF YOUNG PHYSICAN-SCIENTISTSATTRITION OF YOUNG PHYSICAN-SCIENTISTS

0

5

10

15

20

25

30

1980 2004

SCIENTISTS

BUDGET(Millions)

Donowitz et al…Gastroenter 2007; 132: 477-480.Donowitz et al…Gastroenter 2007; 132: 477-480.

Annualized Growth of the NIH BudgetAnnualized Growth of the NIH Budget

Loscalzo 354 (16): 1665, Figure 1  April 20, Loscalzo 354 (16): 1665, Figure 1  April 20, 20062006

PROBLEMS:PROBLEMS:• Salary differential between physician-scientists and full-time practitionersSalary differential between physician-scientists and full-time practitioners• Loan indebtednessLoan indebtedness• Lack of job securityLack of job security

WHO’S WATCHING OUT FOR THE PHYSICIAN-WHO’S WATCHING OUT FOR THE PHYSICIAN-INVESTIGATORINVESTIGATOR

PROBLEMS:PROBLEMS:• Lack of base salary supportLack of base salary support

• Poorly delineated promotional trackPoorly delineated promotional track

• Lack of monetary compensation for teachingLack of monetary compensation for teaching

Holcombe, RF. Academic Medicine, Vol. 80, No. 10/ Oct. 2005Holcombe, RF. Academic Medicine, Vol. 80, No. 10/ Oct. 2005

““If they don’t If they don’t spend time in spend time in the lab, the lab, publish in publish in NatureNature and and have an RO1, have an RO1, a researcher a researcher can’t be can’t be successful.”successful.”

THE ECONOMICS OF ACADEMIC MEDICINETHE ECONOMICS OF ACADEMIC MEDICINE

Weiss et al…Medical Economics Sep. 5, 2003;80:55Weiss et al…Medical Economics Sep. 5, 2003;80:55

PLANNING YOUR CAREER IN ACADEMIC PLANNING YOUR CAREER IN ACADEMIC MEDICINEMEDICINE

• There are rules and regulations for promotion at your There are rules and regulations for promotion at your institution institution (Dean’s Office, Human Resources, Faculty Affairs (Dean’s Office, Human Resources, Faculty Affairs Center)Center)

• There is a timeline for promotionThere is a timeline for promotion

PROMOTIONPROMOTION

SCHOLARLYSCHOLARLYACTIVITYACTIVITY TEACHINGTEACHING SERVICESERVICE

Dattel, BJ. Professional Devlopment. Vol. 56. No. 1.Dattel, BJ. Professional Devlopment. Vol. 56. No. 1.

LEADERSHIP IN ACADEMIC MEDICINE:LEADERSHIP IN ACADEMIC MEDICINE: Guidelines for a Successful Academic CareerGuidelines for a Successful Academic Career

1.1. Develop a Vision---Develop a Vision---Enhance your strengths, Improve your weaknesses.Enhance your strengths, Improve your weaknesses.

2.2. Cultivate a Plan—Cultivate a Plan—Develop essential skills.Develop essential skills.(personal, team-building, persuasive communication, conflict resolution, (personal, team-building, persuasive communication, conflict resolution, negotiation, interviewing, planning, financial management, expertise in negotiation, interviewing, planning, financial management, expertise in profession, knowledge or the organization.)profession, knowledge or the organization.)

3.3. Focus—Focus—Evaluate opportunities and prioritize; be a team playerEvaluate opportunities and prioritize; be a team player..

4.4. Seek Counsel---Seek Counsel---Find a mentor; develop a support system.Find a mentor; develop a support system.

5.5. Periodically Reassess---Periodically Reassess---Evaluate what you have accomplished, what Evaluate what you have accomplished, what you expected to accomplish and what you hope to accomplishyou expected to accomplish and what you hope to accomplish ..

6.6. Enjoy the Journey—Enjoy the Journey—Enjoy the process of developing an academic Enjoy the process of developing an academic leadership career.leadership career.

Duda, RB. Current Surgery. Vol. 61/No. 2. March/April 2004.Duda, RB. Current Surgery. Vol. 61/No. 2. March/April 2004.

THE FUTURE OF ACADEMIC MEDICINETHE FUTURE OF ACADEMIC MEDICINE

““President Obama’s administration has committed to significant changes in President Obama’s administration has committed to significant changes in the current health care system to address three issues: access, cost and the current health care system to address three issues: access, cost and quality. Leaders in academic medical centers (AMCs) must acknowledge the quality. Leaders in academic medical centers (AMCs) must acknowledge the root cause of the problems within the current system, recognize potential root cause of the problems within the current system, recognize potential change initiatives, contemplate the changing role that AMCs will play in the change initiatives, contemplate the changing role that AMCs will play in the health care system of the future and begin to adapt and respond.”health care system of the future and begin to adapt and respond.”

GOOD LUCK!GOOD LUCK!