Article review: Career in Academics

What should I do after finishing residency training? What, there's no more training?!

Traditionally, graduates enter one of four traditional areas -- academia, community practice, industry, and the military. With the increased financial and research pressures of academic medicine, a study reviewed why physicians pursue a career in academia.

Specifically, the authors conducted a literature search of the term "career academic medicine". Articles published during 1986-2006 were included. From the 480 relevant articles, there were 41 identified, which were highly relevant. The following themes were noted in the literature:

Opinion and editorial pieces
One editorial commented on the decline of the academic physician pool and that efforts should focus on medical students, who should be encouraged to pursue academia.

Issues and obstacles
There are many obstacles that residents face when considering a career in academia. Issues include:
  • Competition for decreasing pool of funding sources
  • Long patient care hours
  • Heavy administrative responsibilities
  • Busy teaching schedules
  • Lower salary
  • Medical school and residency debt payments
  • Uncertainty for success
  • Number of years of training necessary to join academia
  • Lack of effective mentoring and role modeling
  • Undesirable location and practice environment
  • Challenging work-life balance especially for women in academia
Financial considerations
Because of the general lower pay of academic faculty compared to community and private practices, personal debt may negatively incentive residents from academia.

Role models and mentoring
There are not enough great role models for students and residents interested in pursuing academic medicine. Without strong mentors, especially for women and under-represented minorities, it is a leap-of-faith for undifferentiated residents to choose a career in academics.

Academic physicians as teachers and/or researchers
Gone are the days of the "triple-threat" academic physician, who excels in patient care, teaching, and research. Now there are two academic models: clinician-educator and clinician-scientist. The clinician-educator has a niche in teaching and scholarship. The clinician-scientist has a niche in research.

Publication and research activities
Exposure to research experiences during medical school is associated with medical students pursuing academia as a career choice. Exposure to research during residency is also worthwhile to help foster continued interest in research and publications.

As a broad generalization, two studies suggest that men and women select an academic career for different reasons. Female physicians chose academia for the "perceived quality of life, earnings potential, and organizational reward". Being recognized nationally and being perceived as a leader are less important than for the male physicians. Both genders, however, value the intellectual challenges in academia.

Career development/choice
Students from research-intensive medical schools and those with advanced degrees tend to pursue an academic career more than other students. Those with mentors comment that mentors played an important role in their career decision to enter academics.

Intellectual stimulation is a major factor in a physician's decision to pursue a career in academia. Generating and translating new knowledge is an extremely attractive draw for many physicians (including myself!). Future research will have to to determine exactly how individual and generational values differ for the Baby Boomers, Generation X, and Generation Y physicians and how they affect the decision to pursue an academic career.

The authors propose a call to action to the Association of American Medical Colleges (AAMC) and Society of Directors of Research in Medical Education (SDRME) to build a structured approach towards understanding who enters academic medicine and why.

For me, I kind of fell into academia. I attended Harbor-UCLA for EM residency, which is one of the powerhouses of EM academia. My role models were doing academics, and I just assumed that I was going to do it as well. I felt that I easily fit into the clinician-educator model, because of my interest in teaching. Boy, am I lucky to have had such strong role models.

Question to the reader:

Why did or didn't you pursue a life in academia?

Borges NJ, Navarro AM, Grover A, & Hoban JD (2010). How, when, and why do physicians choose careers in academic medicine? A literature review. Academic medicine : journal of the Association of American Medical Colleges, 85 (4), 680-6 PMID: 20354389
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