CAREER OPTIONS IN ACADEMIC MEDICINECAREER OPTIONS IN ACADEMIC MEDICINE
ADAM S. MORGENTHAU, MDADAM S. MORGENTHAU, MD
Co-Dir...
• 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...
THE ACADEMIC MISSIONTHE ACADEMIC MISSION
ResearchResearch TeachingTeaching Patient CarePatient Care
Fleming et al..JAMA Se...
HISTORY OF FACULTY TRACKSHISTORY OF FACULTY TRACKS
• 1900—19701900—1970 Faculty excel in Research, Teaching, Patient Care ...
CATEGORIES OF PRODUCTIVITYCATEGORIES OF PRODUCTIVITY
Fleming et al..JAMA Sept 7, 2005Fleming et al..JAMA Sept 7, 2005
Vol ...
CLASSIFICATION OF THE ACADEMICCLASSIFICATION OF THE ACADEMIC
PHYSICIANPHYSICIAN
ACADEMICACADEMIC
PHYSICIANPHYSICIAN
CLINIC...
ACADEMIC PHYSICIANSACADEMIC PHYSICIANS
CLINICIANCLINICIAN
EDUCATOREDUCATOR
PHYSICIANPHYSICIAN
INVESTIGATORINVESTIGATOR
PHY...
TRACKS-How you spend you timeTRACKS-How you spend you time
RESEARCHRESEARCH CLINICAL CARECLINICAL CARE EDUCATIONEDUCATION ...
WHAT IS THE CURRENT STATE OFWHAT IS THE CURRENT STATE OF
AFFAIRS IN ACADEMIC MEDICINE?AFFAIRS IN ACADEMIC MEDICINE?
• Reme...
ATTRITION OF YOUNG PHYSICAN-SCIENTISTSATTRITION OF YOUNG PHYSICAN-SCIENTISTS
0
5
10
15
20
25
30
1980 2004
SCIENTISTS
BUDGE...
WHO’S WATCHING OUT FOR THE PHYSICIAN-WHO’S WATCHING OUT FOR THE PHYSICIAN-
INVESTIGATORINVESTIGATOR
PROBLEMS:PROBLEMS:
• L...
THE ECONOMICS OF ACADEMIC MEDICINETHE ECONOMICS OF ACADEMIC MEDICINE
Weiss et al…Medical Economics Sep. 5, 2003;80:55Weiss...
PLANNING YOUR CAREER IN ACADEMICPLANNING YOUR CAREER IN ACADEMIC
MEDICINEMEDICINE
• There are rules and regulations for pr...
LEADERSHIP IN ACADEMIC MEDICINE:LEADERSHIP IN ACADEMIC MEDICINE:
Guidelines for a Successful Academic CareerGuidelines for...
THE FUTURE OF ACADEMIC MEDICINETHE FUTURE OF ACADEMIC MEDICINE
““President Obama’s administration has committed to signifi...
GOOD LUCK!GOOD LUCK!
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  • “Choosing a Career Direction – Career Options in Academia”
  • Know who you’re talking to and understand from whom the advice you’re being giving is coming from. What is this person’s background? What is their perspective?
  • Origin of Tracks was designed to satisfy institutions by relieving their long-term financial obligations to tenured faculty.
    At the same time, it was believed that the track system would increase clinical revenue and reward faculty through promotion.
  • Some of these categories have overlapping and, occasionally, contradictory definitions.
  • Graph on the Left: Between 1980 and 2004, the number of scientists within the NIH has roughly remained constant at 14-15 thousand.
    The budget, however, has doubled during the same period of time.
    If you look at a graph of the growth of the NIH budget versus time, you can see that the NIH budget has not grown since 1970 but rather experienced fluctuations in revenue.
  • Scholarly Activity: publications, presentations, patients and clinical investigations.
    Newer Criteria: Development of original programs, mentoring future scholars, involvement in professional societies and organizations.
    Teaching: Quality (student evaluations, peer review, receipt of awards.
    Other: advising students, developing curricula, bedside teaching, patient care, continuing education, clinical research.
    Service: Evidence of nonclinical professional activities through which the faculty member advances the mission of the University. (participation on committees, community work..ect)
    CANDIDATES FOR PROMOTION MUST DEMONSTRATE EXCELLENCE IN 2 OUT OF 3 CATEGORIES AND BE ABOVE AVERAGE IN THE THIRD TO BE SUCCESSFUL.
    YOU DEMONSTRATE YOUR EXCELLENCE THROUGH THE CV.
  • CAREER OPTIONS IN ACADEMIC MEDICINE

    1. 1. CAREER OPTIONS IN ACADEMIC MEDICINECAREER OPTIONS IN ACADEMIC MEDICINE ADAM S. MORGENTHAU, MDADAM S. MORGENTHAU, MD Co-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
    2. 2. • QUOTATION:QUOTATION: ““When drinking water, think of its source.”When drinking water, think of its source.”
    3. 3. 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 skillsAcademic physicians pass knowledge and/or skills onto others, especially traineesonto others, especially trainees • GOAL: Trainees create new knowledge that is usedGOAL: Trainees create new knowledge that is used to improve patient care.to improve patient care.
    4. 4. 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
    5. 5. 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. CliniciansDesignated Promotion/Tenure Tracks; Researchers vs. Clinicians • 1980s1980s Clinician-Researchers vs. Clinician-EducatorsClinician-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 MoneyMoney 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 progressOld “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 1990s Creation of Categories of ProductivityCreation of Categories of Productivity Mandatory Documentation of ProductivityMandatory Documentation of Productivity Track Systems become heterogenous and Institutionally-DependentTrack Systems become heterogenous and Institutionally-Dependent • 2000s2000s Development of a Classification System for the Academic PhysicianDevelopment 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
    6. 6. CATEGORIES OF PRODUCTIVITYCATEGORIES OF PRODUCTIVITY Fleming et al..JAMA Sept 7, 2005Fleming et al..JAMA Sept 7, 2005 Vol 294, No 9; 1101-1104Vol 294, No 9; 1101-1104
    7. 7. CLASSIFICATION OF THE ACADEMICCLASSIFICATION OF THE ACADEMIC PHYSICIANPHYSICIAN ACADEMICACADEMIC PHYSICIANPHYSICIAN CLINICIANCLINICIAN EDUCATOREDUCATOR PHYSICIANPHYSICIAN INVESTIGATORINVESTIGATOR PHYSICIANPHYSICIAN SCIENTISTSCIENTIST 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.
    8. 8. ACADEMIC PHYSICIANSACADEMIC PHYSICIANS CLINICIANCLINICIAN EDUCATOREDUCATOR PHYSICIANPHYSICIAN INVESTIGATORINVESTIGATOR PHYSICIANPHYSICIAN SCIENTISTSCIENTIST • Primary commitment toPrimary commitment to education ( > 50%)education ( > 50%) • AdministrationAdministration • Research in educationResearch in education • Clinical care andClinical care and bedside teachingbedside teaching • Research and clinicalResearch and clinical activities; (percentage ofactivities; (percentage of time for each of thesetime for each of these varies)varies) • Usually clinical researchUsually clinical research • Principal investigator orPrincipal investigator or co-investigator in a clinicalco-investigator in a clinical trialtrial • Funding from foundationFunding from foundation or pharmaceutical companyor pharmaceutical company • Mentors traineesMentors trainees • Teaches or serves onTeaches or serves on committees.committees. • MD or MD-PhD trainedMD or MD-PhD trained researcherresearcher • 70-80% of their time is70-80% of their time is dedicated to researchdedicated to research • Usually basic scienceUsually 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.
    9. 9. TRACKS-How you spend you timeTRACKS-How you spend you time RESEARCHRESEARCH CLINICAL CARECLINICAL CARE EDUCATIONEDUCATION ADMINISTRATIONADMINISTRATION Investigator orInvestigator or Tenure TrackTenure Track Clinician EducatorClinician Educator oror Academic ClinicianAcademic Clinician oror Clinical EducatorClinical Educator Teacher ClinicianTeacher Clinician oror Educator TrackEducator Track AdministrativeAdministrative PositionsPositions • Mostly researchMostly research • Remaining timeRemaining time on other academicon other academic activitiesactivities • Greater than 50%Greater than 50% patient care,patient care, emphasis on clinicalemphasis on clinical teachingteaching • Greater than 50%Greater than 50% educatingeducating • Remaining time onRemaining time on other academicother academic acitivities (Medicalacitivities (Medical education research)education research) • Not at all schoolsNot at all schools • Faculty generallyFaculty generally serve institution inserve institution in any path beforeany path before taking antaking an administrativeadministrative positionposition • Time variesTime varies Non-tenureNon-tenure Research TrackResearch Track Clinical ServiceClinical Service Track orTrack or ““Clinical Faculty”Clinical Faculty” • 90%-100%90%-100% researchresearch • At least 80% timeAt least 80% time spent deliveringspent delivering health care serviceshealth care services Association of American Medical Colleges—Association of American Medical Colleges— Careers in Academic MedicineCareers in Academic Medicine
    10. 10. WHAT IS THE CURRENT STATE OFWHAT 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, MD Dr. 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
    11. 11. 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
    12. 12. 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’tIf they don’t spend time inspend time in the lab, publishthe lab, publish inin NatureNature andand have an RO1, ahave an RO1, a researcher can’tresearcher can’t be successful.”be successful.”
    13. 13. 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
    14. 14. PLANNING YOUR CAREER IN ACADEMICPLANNING YOUR CAREER IN ACADEMIC MEDICINEMEDICINE • There are rules and regulations for promotion at yourThere are rules and regulations for promotion at your institutioninstitution (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 SCHOLARLYSCHOLARLY ACTIVITYACTIVITY TEACHINGTEACHING SERVICESERVICE Dattel, BJ. Professional Devlopment. Vol. 56. No. 1.Dattel, BJ. Professional Devlopment. Vol. 56. No. 1.
    15. 15. 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 innegotiation, 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, whatEvaluate 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 academicEnjoy 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.
    16. 16. THE FUTURE OF ACADEMIC MEDICINETHE FUTURE OF ACADEMIC MEDICINE ““President Obama’s administration has committed to significant changes inPresident Obama’s administration has committed to significant changes in the current health care system to address three issues: access, cost andthe current health care system to address three issues: access, cost and quality. Leaders in academic medical centers (AMCs) must acknowledge thequality. Leaders in academic medical centers (AMCs) must acknowledge the root cause of the problems within the current system, recognize potentialroot cause of the problems within the current system, recognize potential change initiatives, contemplate the changing role that AMCs will play in thechange 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.”
    17. 17. GOOD LUCK!GOOD LUCK!
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