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Life After Residency: Academic Emergency Medicine

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  • Worked hard to get here What to do now? Huge variety of “academics” Goal -- understand range of opportunities Good news -- can do almost anything you want (appropriate direction and training)
  • Resources -- where to find more about jobs and fellowships
  • Used to build your career More like graphic equalizer (can adjust) Degrees of specialization within each pillar
  • Clinical not part of academic senate
  • Instructor, aP, AP, P Start I or aP Usually $ with each step
  • Research -- grants harder, no protected time,
  • Geography -- known entity, diversity good, talent/potential most imp. Clinical -- not usually needed, difficult to come back ($$)!
  • Research -- intramural funding, lab equipment, statistical support, research assts. Admin -- secretary, computer, office
  • …and go to a place where you can do what you love …maybe more difficult to open doors, but some easier than others
  • .
  • .

Transcript

  • 1. An Academic Career: Is It Right For You?
    • Peter Sokolove, MD
    • Susan Stern, MD
    • Jill Baren, MD
    • 2008 SAEM Annual Meeting
    • Washington D.C.
    • May 30, 2008
  • 2. Overview
    • Why academics?
    • Various settings
    • How to prepare
    • Fellowship training
    • Marketplace issues
    • Resources
  • 3. Academics
    • Pursuit of “scholarship”
    • Expanding knowledge
    • Passing on knowledge
  • 4. Why Choose Academics?
    • Career diversity
    • Pursuit of knowledge / research
    • Expertise development
    • Love of teaching
    • Advance specialty
    • Colleagues
  • 5. Why Choose Academics?
    • “Cutting edge” practice
    • Teaching hospital resources
    • Interesting cases
    • Longevity / pace / intensity
    • Schedule control
    • Sabbatical
  • 6. Downside of Academics
    • More total hours
    • Generally less money
    • Less “hands on” practice
    • Pressure to produce
  • 7. Academic Career Building Blocks Research Teaching Administration Patient Care
  • 8. “Traditional” Academics
    • Multiple academic tracks
    • Institutional variation
    • Research track -- various subgroups
    • Clinical track
    • Clinician educator track
  • 9. Research Roles
    • Research Director
    • Clinical Trials Director
    • Resident Research Advisor
    • Research Assistants Program Director
  • 10. Educational Roles
    • Residency Director
    • Associate Residency Director
    • Medical Student Director
    • Medical School -- IOR, Assistant Dean
    • Rotating Residents Director
    • Fellowship Director
    • CME Director
  • 11. Specialty Roles
    • Chest Pain ER Director
    • Toxicology / PCC Director
    • HBO Chamber Director
    • Ultrasound Director
  • 12. Administrative Roles
    • Chair / Chief
    • Vice-Chair / Associate Chief
    • EMS Director
    • Clinical Operations Director
    • Pediatric ED Director
    • CQI / Risk Management Director
    • Billing Director
  • 13.  
  • 14. Promotion and Tenure
    • Progressive ranks
    • Timelines
    • Criteria track-dependent
      • Publications
      • Grant funding
      • Regional/National recognition
      • Teaching evaluations
      • Clinical productivity
    • Area of focus
    • Tenure
  • 15. Clinical Teaching Spectrum
    • EMR primary site
    • EMR secondary site
    • EMR rotation site
    • Non-EM residency site
    • Medical students
    • FNP, PA, RN, EMT
  • 16. Community Based Positions
    • EMR secondary / tertiary training site
    • Clinical faculty appointment
    • Lifestyle and reimbursement
    • Bedside teaching predominates
      • Limited time
      • Conferences, CME
    • Research more difficult
      • Grants, time, support, collaboration
      • Can participate in clinical trials
  • 17. Preparing for Academics
    • Mentors
    • Relationships / networking
    • Join SAEM
    • Residency research project
    • Teaching opportunities
    • Chief resident year
    • Fellowship
  • 18. EM Fellowships
    • Administration Injury Control
    • Cardiovascular Emergencies Medical and Occupational Toxicology
    • Clinical Forensic Medicine Medical Education
    • Clinical Pharmacology Medical Informatics
    • Disaster Medicine Neurologic/Neurovascular
    • Disaster and Mass Gathering Pediatric Emergency Medicine
    • Medicine Research Policy
    • EMS Research
    • Environmental Health Sports Medicine
    • Faculty Development Toxicology
    • Geriatric EM Trauma/Critical Care
    • Hyperbaric Medicine Ultrasound
    • International EM Wilderness Medicine & EMS
  • 19. Medical Toxicology
    • ED clinical time
    • Poison Control Centers
    • Consultation services
    • Inpatient services
    • Teaching / research
  • 20. Pediatric EM
    • Children’s hospitals
    • Pediatric and adult patients
    • Teaching / research
  • 21. Sports Medicine
    • Sports medicine clinic
    • Team physician
      • High school
      • College
      • Professional
      • Olympic
    • ED clinical shifts
    • Teaching / research
  • 22. Undersea & Hyperbaric Medicine
    • Decompression chambers
    • Worldwide locations
    • ED clinical shifts
    • Teaching / research
  • 23. Job Search
    • Where?
      • AEM, Annals of EM
      • SAEM, EMRA newsletters / websites
      • EM meetings
    • When?
      • Begin fall / winter
    • How?
      • Networking / personal contacts
      • Send CV and letter
  • 24. Job Search -- FAQ
    • Does 3 vs. 4 year program matter?
    • Need post-residency clinical experience?
    • Will residency geography limit me?
    • What if I’m not yet sure what I want?
  • 25. Marketplace Forces
  • 26. Marketplace Forces
    • 2004-2005 EM Faculty Salary Survey
    • Mean salary $190K
    • Mean 1st year $154K
    • Geographic variation
      • Midwest $192K
      • Northeast $193K
      • South $183K
      • West $196K
      • Kristal SL, et al., Acad Emerg Med 2006.
  • 27. Evaluating Academic Positions
    • Know what’s expected of you
    • Clinical commitment
    • Administrative duties
    • Resources
      • research
      • administrative
    • Mentorship availability
    • Chair
  • 28. Final Thoughts
    • Ocean of opportunities
    • Do what you love
    • Mentorship key to success
    • Doors aren’t closed
    • Teach and lead
  • 29. Wide Spectrum of Opportunities in Academic Emergency Medicine Position with limited teaching of residents and medical students in the clinical setting Position with major academic responsibilities (research or education) outside of your clinical load
  • 30. Why Choose Academic EM?
    • Opportunity to advance and shape the future of our specialty
    • Chance to effect and improve the care of many more patients
      • Research leads to development of new diagnostic techniques, treatments, and policies
      • Education of medical students and residents
    • Opportunity to become expert in a given area
  • 31. Why Choose Academic EM?
    • Opportunity to help develop and mentor others
    • Opportunity to meet and work with a variety of people
    • Variety, intellectual stimulation
    • Greater control of your own time
    • May open other doors for you
    • Career longevity
    • Research and academics is FUN!!!!!
  • 32. General Considerations When Deciding on An Academic Career Path:
    • What are your long-term career goals?
    • What is your vision of the ideal emergency medicine faculty position?
    • Obviously very personal considerations and decisions.
    Talk to a wide range of faculty about their career decisions and pathway!!!!!! Educate yourself!!!!!!!!
  • 33. Specific Considerations When Deciding on An Academic Career Path:
    • What EXCITES you? What is your PASSION? Besides patient care, what do you absolutely LOVE to do? What ENERGIZES you?
        • TEACHING
        • RESEARCH
        • WRITING
        • ADMINISTRATIVE OR COMMITTEE WORK
    • Is there one topic that you LOVE to read, think, and talk about most?
    • What things do you NOT like to do (research, writing, administrative tasks, managing people)?
  • 34. Specific Considerations When Deciding on An Academic Career Path:
    • How do you want to spend your work week?
    • What percentage of your time do you want to devote to the various aspects of your job (direct patient care, medical student or resident education, administrative tasks, research, writing, committee work)?
    • How do you see yourself 10 years from now: as an educator, a researcher, an administrator, a department chair, a Dean, or even on Capitol Hill?
  • 35. Research or Discovery in Academic Emergency Medicine
      • There are an infinite number of relevant areas of study…..
        • clinical research
        • basic science research
        • education research
        • policy or social science research/work
        • clinical operations
    There is opportunity and room for you, whatever your passion may be!!!!!!
  • 36. Research or Discovery in Academic Emergency Medicine Some degree of research (or other form of scholarly activity) will be required in almost any academic position. Clinical educator track, career focused on administration – minimal, but some research Traditional tenure or research track: majority of academic time will be spent doing research
  • 37. Research or Discovery in Academic Emergency Medicine
      • There are an infinite number of relevant areas of study…..
        • clinical research
        • basic science research
        • education research
        • policy or social science research/work
        • clinical operations
    There is opportunity and room for you, whatever your passion may be!!!!!!
  • 38. Post-Graduate Training????
    • Do you need post-graduate training?
    • Why would you want to subject yourself to yet more training?
    • What are the benefits of such training?
    • And what are the opportunities for such training?
  • 39. Post-Graduate Training Opportunities
    • ACGME Accredited
      • Pediatric Emergency Medicine
      • Critical Care Medicine
      • Toxicology
      • Sports Medicine
      • Hyperbaric Medicine
      • Palliative Care
    Non – ACGME Accredited Research (clinical or basic science) Robert Woods Johnson Clinical Scholars Program Administrative EMS Ultrasound International Emergency Medicine Medical Education – M.Ed. MESP OJOC Programs MBA, MHA MPH, MPP, MSci PhD
  • 40. What are the Advantages of Post-Graduate Training?
    • Medical school and residency DO NOT adequately prepare you for an academic career
    • Post-graduate training facilitates becoming an expert in your chosen academic discipline
    • Post-graduate training enhances career satisfaction and your chances of academic success
  • 41. What are the Advantages of Post-Graduate Training?
    • Post-graduate training facilitates the establishment of mentoring and other important collaborative relationships.
    • Fellowship training is the only mechanism by which you will be granted adequate protected time to develop the academic skills required in the discipline of your choosing!
  • 42.  
  • 43. Preparedness of Graduating Residents for an Academic Career
    • Survey of EM residency directors:
    • only 29% of EM program directors felt that their EM graduates were prepared for an academic career that required original research.
    Stern, et al. Acad Emerg. 6: 262-270, 1999.
  • 44. Preparedness of Graduating Residents for an Academic Career Sanders AB, et al. Ann Emerg Med 1994; 23: 81-87.
    • Survey of practicing emergency physicians
    • Obstacles to research productivity:
      • Insufficent research training
      • Finding knowledgeable collaborators
  • 45. Effects of Post-Graduate Training on Career Satisfaction and Success Taylor JS, et al. Academic Medicine 2001; 76: 366-372 .
    • Examined the relationship between fellowship training and career outcomes
    • Surveyed 821 full-time primary care faculty at 24 representative U.S. medical schools
      • Results: Fellowship trained primary care physicians were more likely to have achieved senior academic rank than were their non-fellowship trained peers.
  • 46. Effects of Post-Graduate Training on Career Satisfaction and Success
    • Anderson KD, et al. Am J Surg 1995; 169: 329-333.
    • Surveyed 392 surgeons
    • Fellowship training in research correlated positively with professional confidence and career satisfaction.
    • Those without fellowship training were more likely to express career dissatisfaction, frustration, and professional uncertainty.
    • Levey GS, et al. Ann Int Med 1988; 109: 414-418 .
    • S urveyed full-time IM faculty in 123 U.S. medical schools
    • Post-graduate research training significantly enhanced the likelihood of success in an academic career.
  • 47. Why would fellowship or post-graduate training result in greater career satisfaction?
    • Fellowship training better prepares one for the challenges of an academic career:
      • Increased job skill mastery -  less stress
    • Greater sense of certainty with regard to career choice
    • Clear vision of career goals and future
    • Devoting more time to your specific career interest results in greater likelihood of you being able to achieve your career goals.
  • 48. Post-graduate training guarantees you protected time to develop the academic skills required in the discipline of your choosing! Broaddus VC, et al. Chest 1994; 105: 1858-1863.
    • Survey of junior academic pulmonary faculty:
    • Greatest obstacle to academic success:
      • LACK OF PROTECTED TIME
    • Employment agreements not honored:
      • 22% stated terms violated
      • most common complaints were unexpected  in clinical duties and  promised support
  • 49. Advantages of Post-Graduate Training: Establishment of mentoring and other collaborative relationships
    • Correlation between establishment of a mentoring relationship and:
    • 1) academic success
      • 2) career satisfaction
    • Palepu A et al. Academic Medicine 1998; 73: 318-323.
      • Survey of 3013 full-time faculty at 24 U.S. medical schools
      • Faculty with mentors (versus those without):
        • rated their research preparation and skills higher
        • rated adequacy of professional support from their institutions for teaching, research, and administrative activities higher
        • higher career-satisfaction scores
        • greater likelihood of being awarded research grants
  • 50.
    • “ Mentorship in the first years is critical for launching a productive career. Learning the informal network that supports productivity—the inner workings of professional associations and who the productive people are—is critical.” Blackburn RT. Cur Iss Higher Education 1981; 52: 369-377.
  • 51. What Specifically Will a Mentor Do for You?
    • Assist in setting and achieving your goals
    • Provide feedback regarding performance
    • Help build your confidence/ moral support
    • Read and critique your manuscripts, grants, proposals, and other academic projects
    • Get you involved in committee work
    • Introduce you to leaders in your field of interest
    • Keep you on track
    • Protect you
    Your mentor is your ADVOCATE!!!!!
  • 52. Considerations When Choosing a Mentor
    • Appropriate Expertise - Track record in your chosen area of academic focus
    • Available time / Must invest in YOU!
    • Good personality fit
    • No conflict of interest
    • You need more than one mentor
    • Look outside of EM
    One of the most important career decisions is the selection of your mentor!!!! CHOOSE WISELY!!!!!!
  • 53. Advantages & Disadvantages of Post-Graduate Training Greater control of your job structure and your time Facilitate the development of mentoring relationships and other collaborations Makes you more competitive for the ideal job positions Guaranteed protected time
    • Career satisfaction
    • Chances of success
    Brief further delay in reaching max salary potential Mastery of knowledge and skills in chosen area of study Disadvantages Advantages
  • 54. Academic Career Pearls & Pitfalls
    • Goodness of fit
    • Mentorship
    • Career focus
    • Long term planning
    • Balance
  • 55.  
  • 56. Goodness of Fit
    • 4 components of academic medicine
      • Research
      • Teaching
      • Service
      • Clinical care
    • What are your priorities?
    • Individual vs. institutional values
      • Harmonious or at odds?
  • 57. What characterizes the institution?
    • Little fish in a big pond?
    • “ Up and out” system
    • What’s rewarded?
    • What would happen if I leave?
      • Everyone is replaceable
    • Are there real opportunities for advancement?
  • 58. Ask not what I can do for the institution, but what the institution can do for me!
  • 59. Career focus: “A tale of two Suzys”
    • Two recent EM residency graduates pursue a career in academic emergency medicine….
  • 60. Profile - Suzy B
    • Developed a clinical interest in stroke as a resident
    • Resident member of department QI committee to improve stroke care
    • Helped neurology investigator enroll stroke patients in clinical trials while on elective “stroke” rotation
    • Goal: faculty position where she can do “clinical research on stroke patients”
  • 61. Profile - Suzy Q
    • Excelled as a resident in ultrasound rotation
    • “Loves to teach”
    • Spent a year as an ultrasound fellow
    • Goal: faculty position where she can do “ultrasound research and education”
  • 62. 1 year out – Suzy B
    • Serves as departmental liaison to institutional stroke care committee
    • Develops grand rounds talk on stroke
    • Drafts departmental policy on triage of stroke patients
    • Asked to serve as co-investigator on neurology investigator’s grant
      • Develops mentoring relationship
    • Writes chapter on stroke for EM study guide
  • 63. 1 year out – Suzy Q
    • Sets up ultrasound rotation for EM residents doing individual teaching 2-3 days a week
    • Gives two core lectures: DKA and Epistaxis
    • Publishes case report of unusual presentation of Lyme disease
    • Appointed to patient safety committee
  • 64. 3 years out – Suzy B
    • Submits grant proposal to develop novel stroke curriculum for ED providers
    • Continues to work on neurology grant
    • Performs secondary analysis of stroke database and publishes first-authored manuscript
    • Invited to give stroke talk at national meeting
  • 65. 3 years out- Suzy Q
    • Continues to teach US rotation for EM residents (25 hours/week)
    • Continues as patient safety committee member
    • Develops US study protocol
    • Abandons project due to barriers from radiology and IRB
  • 66. 6 years out – Suzy B
    • Receives funding for second grant proposal on ED management of stroke
    • Publishes first-authored paper on novel stroke curriculum
    • Appears as fourth author on premier stroke paper from neurology grant
    • Serves on national task force for prehospital stroke care
    • Told by chair, “you’re on the right track for promotion.”
  • 67. 6 years out – Suzy Q
    • Teaching US rotation but asks for additional support to lessen hours
    • Presents abstract on US teaching experience
    • Struggles with writing manuscript
    • Chair concerned about lack of publications/scholarly writing
    • Feels overwhelmed and unsure of continuing in academic EM
  • 68. Lessons learned
    • Suzy B
      • Pursued interest
      • Passionate about topic
      • Found mentor
      • Focused
      • Built experience stepwise
      • Wrote/spoke about her work
    • Suzy Q
      • Pursued interest
      • Passionate about topic
      • Responsible for development of program at early stage
      • No mentor
      • No documentation of her work
  • 69. Merging academic activities
    • Dovetail administrative, teaching, and research activities
    • All or most should be related
      • Especially during the first few years
    • Consider “apprentice” positions
    • Become known for something
    • Develop expertise
  • 70. Need for a Mentor
    • Important predictor of success
      • Availability during critical period (fellowship – first years as faculty)
    • Especially true when there is little formal research training
    • Quality of mentor and mentor-trainee relationship is especially critical when applying for training grant support
  • 71. Where do I find a mentor?
    • In your own backyard
      • Department or Division
    • Within your institution
      • Related discipline/research
    • Other local institutions
    • Long distance mentors
      • National organizations/meetings
      • Committee work
  • 72. Role Model
    • Identify
      • Who’s doing what you’d like to do?
      • Who has values that you admire?
      • Who has a lifestyle that you admire?
    • Pick their brains
      • Suggestions for success
      • Things they would have done differently
    • Hang out with them
      • Let them introduce you to people
  • 73. Long term goals
  • 74. Importance of Long Term Goals
    • 1, 3 and 5 year plans
    • Career plan
    • Similar to short term goals… but with goals for each year
    • Each year’s goals should be a step toward achieving the long term goal
    • Take time to revise along the way
    • Use as guide for annual chair evaluations
  • 75. The myth of work-life balance
  • 76. The reality…
  • 77. The Balance Wheel