Down to Earth

The First Academic Job Search

Eliza M. Park, M.D.

Charles W. Surber, M.D.

Psychiatry trainees who pursue academic faculty rolescan look forward to a fulfilling and viable career. How-

ever, like early-career physicians in all specialties, manyyoung psychiatrists struggle with the decision-making pro-cess of selecting their first academic job (1). The process ofidentifying desirable academic positions is far less struc-tured than the search for a suitable residency program,which leaves some trainees feeling ill-prepared for this im-portant task.

There are also significant developments in medicine thataffect today’s psychiatrists entering academic careers. Bythe 1980s, medical education in the United States becameloan-dependent, with rates of medical educational debt wellabove inflation (2). In 2010, the average debt of a medicalschool graduate had climbed to $158,000 (3). The conse-quences of this educational debt burden are substantial andmay be one of many factors contributing to the decliningpercentage of medical graduates seeking academic careers,because of the lower income generally available in academicmedicine than in non-academic positions (4, 5).

Academic medical centers and pathways to career ad-vancement in academic medicine have also changed. Overthe last two decades, most academic hospitals recruitedlarge numbers of clinician-educators to provide patient careandmedical education for trainees (6). Themajority of thesepositions are non-tenured (i.e., fixed-term), and there are atleast 36 faculty tracks across medical schools in the UnitedStates, with most schools offering 3–4 separate tracks forclinicians and educators (7). The recent movement towardtenure-eligibility within these tracks (7) may reflect a grow-ing appreciation of the importance of these faculty to themission of the academic center and a need to retain these key

individuals in academic medicine. The heterogeneity ofavailable tracks also reflects the high variability of roles inwhich faculty members may spend their time (2).

The current generation of psychiatrists considering theirfirst academic position therefore approaches this compli-cated decision through the lens of sizable student debt, anevolving mission of academic medical centers, and a desirefor work–life balance and collaborative work (8). One of thedefining characteristics of early-career physicians today isthe increase in the number of women inmedicine, and this isparticularly relevant to psychiatry, where over 50% of psy-chiatry residents are female (9).

There is substantial literature available on the factors as-sociated with selecting academicmedical careers. However,there are comparatively few reports that help psychiatrytrainees think through their various career choices and nav-igate the decision-making process for selecting an academicjob. Based on a review of the available literature, our dis-cussion with peers, and our own personal experiences inselecting our first academic positions, this article highlightsthe attributes of a desirable academic position and thedecision-making steps to better understand the selectionprocess of an academic psychiatry career.

What Are the Attributes of aDesirable Academic Position?

Physicians who pursue academic careers are driven bythe desire for intellectual stimulation, the availability ofinteraction among colleagues, and the opportunity to helpshape the next generation of physicians, as well as multipleindividual factors (4, 10, 11). The attributes of a desirableacademic position should be compelling enough to offsetthe financial costs of forgoing private practice or industryopportunities. We focus our discussion on the academicjob-search for psychiatrists pursuing a clinician–educatoror clinician–researcher track, as these represent the major-ity of available positions in academic medical centers to-day. Through our own experiences and discussion with

Received October 31, 2011; revisedMarch 29, June 3, 2012; accepted June12, 2012. From the Dept. of Psychiatry, University of North Carolina,Chapel Hill, NC, and the Dept. of Psychiatry, Brigham and Women’sHospital, Boston, MA. Send correspondence to Dr. Park; e-mail:leeza_park@med.unc.edu

Copyright © 2013 Academic Psychiatry

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colleagues, we have identified several job attributes that areimportant for the psychiatrist starting his or her academiccareer.

Departmental CharacteristicsAlthough difficult to clearly define, the psychiatry depart-

ment’s culture and atmosphere can be as important as its ac-ademic prestige. A desirable department is peer-orientedand brings opportunities to interact and collaborate withcolleagues who are diverse not only in background andtraining but also in age and career-stage. Most “GenerationY” trainees prefer peer-oriented and collaborative work (8),with opportunities to form relationships with colleagues. Anideal department is flexible and organized in a way that facil-itates interpersonal interactions in both informal and formalsettings. To help understand the department’s culture, candi-dates can request informal group interviewswith junior facultyto explore their experiences with their more-senior colleagues,their efforts to influence change in the department, and thedepartment’s track-record of junior-faculty promotion.The financial stability of the department and healthcare

system, as well as the availability of monetary and admin-istrative support for junior faculty members, are importantfactors to explore. The more desirable positions have suf-ficient staff andmonetary support to help facilitate both theirfaculty’s academic and clinical responsibilities. Finally,broader institutional respect for psychiatry and its uniqueroles in medicine, as well as collegiality among the hospi-tal’s departments, can affect a candidate’s decision-makingwhen selecting an academic position.

Job Flexibility and AutonomyHaving the flexibility and autonomy to adjust job re-

sponsibilities according to individual strengths and interestsover time is usually an important reason that psychiatristsseek careers in academic medicine. Many early-careerpsychiatrists joining an academic institution assume multi-ple roles, and it is not always clear to the department or thepsychiatrist which of these positions will provide bothparties the greatest opportunity to prosper. The most at-tractive opportunities allow early-career psychiatrists theflexibility to develop a niche and choose which duties theyprefer, rather than mandating that all physicians participatein teaching, research, administrative work, and clinical care.Flexibility with work-hours or working part-time may beequally important as priorities change over time.Most early-career psychiatrists of both genders prefer positions thatprovide the opportunity to balance the fluctuating needs offamily and career.

Protected TimeMost physicians in academic medicine report a desire for

intellectual stimulation and opportunities to teach and doresearch as primary motivators in pursuing an academiccareer (10). There is typically no shortage of opportunitiesfor committee or administrative work, clinical research, orteaching. Lectures and workshops by departmental or in-stitutional colleagues are also plentiful in most academicmedical centers. However, these opportunities are onlymeaningful if the early-career psychiatrist has the time topartake of them. Desirable academic positions offer clearlyprotected time and scheduling flexibility to foster this. In anera of growing clinical demands on medical faculty, can-didates pursuing careers in academic medicine should beexplicit about this need for protected time.

Clinical ResponsibilitiesIn academic psychiatry today, typical early-career posi-

tions have heavy clinical responsibilities as faculty mem-bers at academic medical centers are increasingly expectedto generate sufficient revenue from clinical work to supporttheir salaries (4). This pressure to generate income can leadto reduced time for research and teaching. Salaries largelydependent on clinical productivity can cause dilemmas forearly-career psychiatrists with high educational loan debt.Many graduates pursuing academic careers prefer salariedpositions with comparatively lower reliance on clinical in-come productivity, although these are not always available.Desirable positions provide clear descriptions of the clinicalwork environment, such as call responsibilities, availabilityof online medical records, clinical resources, and clinicalsupport staff.

Salary and BenefitsSalaries for new junior faculty vary at each academic

medical center, based on local cost-of-living and othervariables. Most academic settings cannot offer salariescommensurate with private practice or industry opportuni-ties, and, since most new graduates have sizable loans frommedical training, neither the applicant nor the hiring in-stitution can ignore these financial disincentives. Traineesseeking their first academic position should be clear howmuch money they will need to live reasonably comfortably,so that they do not get “seduced” by other factors into takinga job that will not meet their basic living needs. The early-career psychiatrists we interviewed were receptive to callresponsibilities that are rewarded with an additional stipendor incentive payment as a way to augment their salary.Candidates should remember that salary is not the only

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contributor to the amount ofmoney theywill have to live on,as benefits (medical, disability, life insurance, retirementcontributions, vacation time, etc.), either paid by the em-ployer or mandatory expenses for the individual, are alsoa component of a person’s working income.Many academicmedical centers can provide substantial paid benefit pack-ages that are appealing to candidates, and they shouldexplore and compare the above institutional benefits as wellas access to tuition assistance, faculty-development pro-grams, subsidized childcare, and relocation and “sign-on”bonuses (12).

MentorshipThe availability of accessible, effective mentoring is also

a requisite aspect of the first academic job. Ideal settingshave formal mentorship programs through the medicalschool department to help guide junior faculty through themaze of academic promotions, research, and educationopportunities. Informal mentorship is also important, anda departmental mix of early-, mid-, and later-career acade-micians is a benefit for gaining perspective and direction onbalancing competing roles.

The Decision-Making Process

Rarely does the “perfect” academic position exist for theearly-career psychiatrist immediately following the com-pletion of training. Although clarity about one’s “dreamjob” is important, the decision-making process for selectingan academic position begins with the establishment of per-sonal and absolute priorities that any job one seriouslyconsiders must meet (see Figure 1) (12, 13). The psychiatrytrainee should actively seek mentorship to help him/herdefine personal and professional priorities before begin-ning the job search. Since many opportunities are identifiedthrough professional contacts, having mentors who can linkthe candidate to such opportunities may have a direct impacton one’s job search.

For most early-career psychiatrists, personal and familypreferences about geographic location and opportunities forspouse or partner are important factors in identifying the lo-cation of a suitable academicmedical center. After identifyinglocations and specific positions, candidates undertake an it-erative process of comparing each positionwith their prioritiesand determining which opportunities meet their needs. For

FIGURE 1. Decision Tree for Selection of Positions in Academic Psychiatry

Begin by expanding or narrowing your priorities and the

desired attributes of your ideal position until you have 5-10

possible leads/contacts.

To be able to negotiate successfully,

you will need more than one offer thatmeets your priorities.

Weigh various job opportunities, using

pre-determined priorities and the attributes of your

ideal job.

Negotiate and weigh:

Quality of Mentorship

Protected time

Salary/Benefits

Support Staff

Flexibility

Yes

Interviews result in 2-3 good offers ?

Adjust search criteria if it

does not result in 2-3 good

offers.No

Apply and/or send letters to department chair. Go on interviews.

Type of Practice(inpatient, outpatient, etc)

Partner/Family Needs

Geography

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a candidate, going on several job interviews is often helpful infully clarifying one’s priorities. Even if the candidate desiresto remain at his/her training institution, it is important to knowwhat other programs are like, and interviewing at a variety ofinstitutions allows the candidate to compare and contrastemployment opportunities (14). Table 1 provides an overviewof several key academic medical center, departmental, andposition specifics to consider in this process.After family and geographic considerations, the strengths

of the department and the prospects for professional long-term growth often counterbalance and at times outweighthe more immediate issues of salary and benefits. However,when presented with options from equally strong institu-tions, the job that offers greater flexibility and protected timefor nonclinical responsibilities is typically more attractive.When possible, reviewing specific opportunities withmentorsand other early-career psychiatrists aids in decision-making.Since institutions heavily invest in young academic phy-

sicians, it is in their interest to create a position and workenvironment that is attractive to and will help retain talentedpsychiatrists (13). It is estimated that the average cost offaculty turnover is $110,000–$900,000 per faculty replace-ment in medical schools (15). Therefore, negotiation to findan agreement that is beneficial to both the candidate and thedepartment is critical for the long-term success of this re-lationship. Negotiation will be aided if the candidate hasclarity about his/her priorities and the offered position’sclinical, teaching, and research expectations, salary andbenefits, administrative support, and clinical coverage detailsbefore accepting any position.

Conclusions

Early-career psychiatrists today consider an academicposition within an environment distinctly different fromprevious generations. Academic medical centers, medicaleducation, and the provision of healthcare in America haveall changed greatly in the past decade. Regardless of gender,physicians today place more emphasis on family and per-sonal preferences than ever before. These differences affecthow current early-career psychiatrists approach the decision-making process for their first academic job search.Further research and programming will be needed to help

facilitate psychiatry residents interested in academiccareers. Although monetary compensation remains impor-tant for many early-career psychiatrists, we believe thatembarking on a career in academic medicine can providemeaningful intellectual satisfaction that is priceless.

The authors thank Drs. Jonathan Borus and Donald Rosensteinfor their assistance with manuscript review.

References

1. Borus JF: The transition to practice. J Med Educ 1982; 57:593–601

2. Greysen SR, Chen C, Mullan F: A history of medical studentdebt: observations and implications for the future of medicaleducation. Acad Med 2011; 86:840–845

3. Youngclaus J, Fresne J: Key Indicator in academic medicine:education costs and student indebtedness at U.S. medicalschools. Acad Med 2012; 87:242–243

TABLE 1. Key Characteristics to Consider When Selecting Academic Jobsa

Department Characteristics Position Specifics

Academic mission Adequate time dedicated to each roleAcademic prestige Clinical and administrative supportAvailability of faculty tracks Clinical productivity expectationsBenefits Immediate supervisorsClear promotion guidelines Job autonomyDepartment demographics/variety Job flexibilityDepartment “fit” with personality Job varietyFinancial stability Opportunity for specialty practiceFlexibility Patient mixMentorship and role models Protected time for researchOpportunity for collaboration Protected time for teachingResearch infrastructure and support Research opportunities and expectationsScholarly opportunities and expectations Salary supportStrength of training programs Teaching opportunities and expectationsVisa sponsorship (if applicable)

aFurther informationon selecting academic positions canbe found inHandbook of Career Development in Academic Psychiatry and Behavioral Sciences, editedby Laura Weiss Roberts and Donald M. Hilty (14).

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4. BorgesNJ, NavarroAM,Grover A, et al: How,when, andwhydo physicians choose careers in academic medicine? a litera-ture review. Acad Med 2010; 85:680–686

5. Adler DG, Hilden K, Wills JC, et al: What drives US gastro-enterology fellows to pursue academic vs. non-academiccareers?: results of a national survey. Am J Gastroenterol2010; 105:1220–1223

6. LevinsonW, LinzerM:What is an academic general internist?career options and training pathways. JAMA2002; 288:2045–2048

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9. American Psychiatric Association: Resident Census: Charac-teristics and Distribution of Psychiatry Residents in the U.S.:2009–2010. Arlington, VA, 2010

10. Straus SE, Straus C, Tzanetos K; International Campaign to Re-vitalise Academic Medicine: Career Choice in Academic Medi-cine: Systematic Review. J Gen InternMed 2006; 21:1222–1229

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12. Borus JF: The Transition to Practice Seminar. Boston, MA,Harvard Longwood Psychiatry Residency Training Program,2009

13. Holcombe RF: Viewpoint: who’s watching out for the clinicalacademician? Acad Med 2005; 80:905–907

14. Roberts LW, Hilty DM: Handbook of Career Development inAcademic Psychiatry and Behavioral Sciences AmericanPsychiatric Publishing, Inc., 2006

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1

Why I Love Being an Academic PsychiatristJanis L. Cutler, M.D.

“This is so cool!” exclaimed one of the first-year medical students sitting in front of me in their very cleanand unwrinkled white coats. Whereas more seasoned physicians might not have found the homeless,malodorous, cognitively-limited, psychotic man whom we had just interviewed to be particularly fascinat-ing, these students engaged enthusiastically in a thoughtful discussion that ranged from differential di-agnosis to social-systems issues to interviewing techniques.

Although I always knew that I enjoyed teaching, I didn’t anticipate the profound satisfaction that comesfrom designing and administering a medical student psychiatric curriculum. Figuring out how best topresent the field of psychiatry to medical students so that they attain not just the relevant knowledge but,at least as importantly, the appropriate attitudes toward the field and our patients has been endlesslyinteresting, challenging, and gratifying. I’ve gained further intellectual stimulation and fulfillment fromthe educational research and writing projects that have evolved from and directly affected my courses. Mymembership in national psychiatric educational organizations has provided an added bonus, as I havea network of friends and colleagues around the country who are available with support, encouragement,and information, as needed.

Although I always knew that I enjoyed mentoring, I didn’t anticipate what a privilege it would be toparticipate in the intense developmental process that students undergo over their 4 years of medical school.The transformation from idealistic, vulnerable, naïve, and anxious beginning students, to mature, confident,self-aware, and competent senior students is remarkable. The only experiences that come close to matchingthe pleasure and sense of accomplishment that I’ve derived from engaging with these bright young men andwomen during this process are the equally great privileges of treating patients and parenting my children.

My first-year student’s observation was more accurate than he knew; “so cool” indeed, and why I lovebeing an academic psychiatrist!

Dr. Cutler is with the New York State Psychiatric Institute, Columbia University, New York, NY.

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