An Academic Career:Is It Right For You?
Peter Sokolove, MDPeter Sokolove, MDSusan Stern, MDSusan Stern, MDJill Baren, MDJill Baren, MD
2008 SAEM Annual Meeting2008 SAEM Annual MeetingWashington D.C.Washington D.C.
May 30, 2008May 30, 2008
Overview
Why academics?Why academics? Various settings Various settings How to prepareHow to prepare Fellowship trainingFellowship training Marketplace issuesMarketplace issues ResourcesResources
Academics
Pursuit of “scholarship”Pursuit of “scholarship” Expanding knowledgeExpanding knowledge Passing on knowledgePassing on knowledge
Why Choose Academics?
Career diversityCareer diversity Pursuit of knowledge / researchPursuit of knowledge / research Expertise developmentExpertise development Love of teachingLove of teaching Advance specialtyAdvance specialty ColleaguesColleagues
Why Choose Academics?
““Cutting edge” practiceCutting edge” practice Teaching hospital resourcesTeaching hospital resources Interesting casesInteresting cases Longevity / pace / intensityLongevity / pace / intensity Schedule controlSchedule control SabbaticalSabbatical
Downside of Academics
More total hoursMore total hours Generally less moneyGenerally less money Less “hands on” practiceLess “hands on” practice Pressure to producePressure to produce
Academic Career Building Blocks
Research Teaching
AdministrationPatient Care
“Traditional” Academics
Multiple academic tracksMultiple academic tracks Institutional variationInstitutional variation Research track -- various subgroupsResearch track -- various subgroups Clinical trackClinical track Clinician educator trackClinician educator track
Research Roles
Research DirectorResearch Director
Clinical Trials DirectorClinical Trials Director
Resident Research AdvisorResident Research Advisor
Research Assistants Program DirectorResearch Assistants Program Director
Educational Roles
Residency DirectorResidency Director
Associate Residency DirectorAssociate Residency Director
Medical Student DirectorMedical Student Director
Medical School -- IOR, Assistant DeanMedical School -- IOR, Assistant Dean
Rotating Residents DirectorRotating Residents Director
Fellowship DirectorFellowship Director
CME DirectorCME Director
Specialty Roles
Chest Pain ER DirectorChest Pain ER Director
Toxicology / PCC DirectorToxicology / PCC Director
HBO Chamber DirectorHBO Chamber Director
Ultrasound DirectorUltrasound Director
Administrative Roles
Chair / ChiefChair / Chief
Vice-Chair / Associate ChiefVice-Chair / Associate Chief
EMS DirectorEMS Director
Clinical Operations DirectorClinical Operations Director
Pediatric ED DirectorPediatric ED Director
CQI / Risk Management DirectorCQI / Risk Management Director
Billing DirectorBilling Director
Promotion and Tenure Progressive ranksProgressive ranks TimelinesTimelines Criteria track-dependentCriteria track-dependent
PublicationsPublications Grant fundingGrant funding Regional/National recognitionRegional/National recognition Teaching evaluationsTeaching evaluations Clinical productivityClinical productivity
Area of focusArea of focus TenureTenure
Clinical Teaching Spectrum
EMR primary siteEMR primary site EMR secondary siteEMR secondary site EMR rotation siteEMR rotation site Non-EM residency siteNon-EM residency site Medical studentsMedical students FNP, PA, RN, EMTFNP, PA, RN, EMT
Community Based Positions
EMR secondary / tertiary training siteEMR secondary / tertiary training site Clinical faculty appointmentClinical faculty appointment Lifestyle and reimbursementLifestyle and reimbursement Bedside teaching predominatesBedside teaching predominates
Limited timeLimited time Conferences, CMEConferences, CME
Research more difficultResearch more difficult Grants, time, support, collaborationGrants, time, support, collaboration Can participate in clinical trialsCan participate in clinical trials
Preparing for Academics
MentorsMentors Relationships / networkingRelationships / networking Join SAEMJoin SAEM Residency research projectResidency research project Teaching opportunitiesTeaching opportunities Chief resident yearChief resident year FellowshipFellowship
EM Fellowships
Administration Injury ControlCardiovascular Emergencies Medical and Occupational ToxicologyClinical Forensic Medicine Medical EducationClinical Pharmacology Medical InformaticsDisaster Medicine Neurologic/NeurovascularDisaster and Mass Gathering Pediatric Emergency Medicine
Medicine Research PolicyEMS ResearchEnvironmental Health Sports MedicineFaculty Development ToxicologyGeriatric EM Trauma/Critical CareHyperbaric Medicine UltrasoundInternational EM Wilderness Medicine & EMS
Medical Toxicology
ED clinical timeED clinical time Poison Control CentersPoison Control Centers Consultation servicesConsultation services Inpatient servicesInpatient services Teaching / researchTeaching / research
Pediatric EM
Children’s hospitalsChildren’s hospitals Pediatric and adult patientsPediatric and adult patients Teaching / researchTeaching / research
Sports Medicine
Sports medicine clinicSports medicine clinic Team physicianTeam physician
High schoolHigh school CollegeCollege ProfessionalProfessional OlympicOlympic
ED clinical shiftsED clinical shifts Teaching / researchTeaching / research
Undersea & Hyperbaric Medicine
Decompression chambersDecompression chambers Worldwide locationsWorldwide locations ED clinical shiftsED clinical shifts Teaching / researchTeaching / research
Job Search
Where?Where? AEM, Annals of EMAEM, Annals of EM SAEM, EMRA newsletters / websitesSAEM, EMRA newsletters / websites EM meetingsEM meetings
When?When? Begin fall / winterBegin fall / winter
How?How? Networking / personal contactsNetworking / personal contacts Send CV and letterSend CV and letter
Job Search -- FAQ
Does 3 vs. 4 year program matter?Does 3 vs. 4 year program matter? Need post-residency clinical experience?Need post-residency clinical experience? Will residency geography limit me?Will residency geography limit me? What if I’m not yet sure what I want?What if I’m not yet sure what I want?
Marketplace Forces
Marketplace Forces2004-2005 EM Faculty Salary Survey2004-2005 EM Faculty Salary Survey Mean salary $190KMean salary $190K Mean 1st year $154KMean 1st year $154K Geographic variationGeographic variation
Midwest $192KMidwest $192K Northeast $193KNortheast $193K South $183KSouth $183K West $196KWest $196K
Kristal SL, et al., Kristal SL, et al., Acad Emerg MedAcad Emerg Med 2006. 2006.
Evaluating Academic Positions
Know what’s expected of youKnow what’s expected of you Clinical commitmentClinical commitment Administrative dutiesAdministrative duties ResourcesResources
researchresearch administrativeadministrative
Mentorship availabilityMentorship availability ChairChair
Final Thoughts
Ocean of opportunitiesOcean of opportunities Do what you loveDo what you love Mentorship key to successMentorship key to success Doors aren’t closedDoors aren’t closed Teach and leadTeach and lead
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
Why Choose Academic EM?
• Opportunity to advance and shape the Opportunity to advance and shape the future of our specialtyfuture of our specialty
• Chance to effect and improve the care of Chance to effect and improve the care of many more patients many more patients Research leads to development of new Research leads to development of new
diagnostic techniques, treatments, and diagnostic techniques, treatments, and policiespolicies
Education of medical students and residentsEducation of medical students and residents• Opportunity to become expert in a given Opportunity to become expert in a given
areaarea
Why Choose Academic EM?
• Opportunity to help develop and mentor Opportunity to help develop and mentor othersothers
• Opportunity to meet and work with a variety of people
• Variety, intellectual stimulationVariety, intellectual stimulation• Greater control of your own timeGreater control of your own time• May open other doors for youMay open other doors for you• Career longevityCareer longevity• Research and academics is FUN!!!!!Research and academics is FUN!!!!!
General Considerations When Deciding on An Academic Career Path:
• What are your long-term career goals?What are your long-term career goals?• What is your vision of the ideal What is your vision of the ideal
emergency medicine faculty position?emergency medicine faculty position?• Obviously very personal considerations Obviously very personal considerations
and decisions.and decisions.
Talk to a wide range of faculty about their career decisions and pathway!!!!!!
Educate yourself!!!!!!!!
Specific Considerations When Deciding on An Academic Career Path:
• What EXCITES you? What is your PASSION? What EXCITES you? What is your PASSION? Besides patient care, what do you absolutely Besides patient care, what do you absolutely LOVE to do? What ENERGIZES you? LOVE to do? What ENERGIZES you?
TEACHINGTEACHING
RESEARCHRESEARCH
WRITINGWRITING
ADMINISTRATIVE OR COMMITTEE WORKADMINISTRATIVE OR COMMITTEE WORK
• Is there one topic that you LOVE to read, think, Is there one topic that you LOVE to read, think, and talk about most?and talk about most?
• What things do you NOT like to do (research, What things do you NOT like to do (research, writing, administrative tasks, managing people)?writing, administrative tasks, managing people)?
Specific Considerations When Deciding on An Academic Career Path:
• How do you want to spend your work week?How do you want to spend your work week?
• What percentage of your time do you want to What percentage of your time do you want to devote to the various aspects of your job devote to the various aspects of your job (direct patient care, medical student or (direct patient care, medical student or resident education, administrative tasks, resident education, administrative tasks, research, writing, committee work)? research, writing, committee work)?
• How do you see yourself 10 years from now: How do you see yourself 10 years from now: as an educator, a researcher, an as an educator, a researcher, an administrator, a department chair, a Dean, or administrator, a department chair, a Dean, or even on Capitol Hill?even on Capitol Hill?
Research or Discovery in Academic Emergency Medicine
There are an infinite number of relevant areas of study…..
• clinical researchclinical research• basic science researchbasic science research• education researcheducation research• policy or social science research/workpolicy or social science research/work• clinical operationsclinical operations
There is opportunity and room for you, whatever your passion may be!!!!!!
Research or Discovery in Academic Emergency Medicine
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
Some degree of research (or other form of scholarly activity) will be required in almost any academic position.
Research or Discovery in Academic Emergency Medicine
There are an infinite number of relevant areas of study…..
• clinical researchclinical research• basic science researchbasic science research• education researcheducation research• policy or social science research/workpolicy or social science research/work• clinical operationsclinical operations
There is opportunity and room for you, whatever your passion may be!!!!!!
Post-Graduate Training????
• Do you need post-graduate training?Do you need post-graduate training?• Why would you want to subject Why would you want to subject
yourself to yet more training?yourself to yet more training?• What are the benefits of such What are the benefits of such
training?training?• And what are the opportunities for And what are the opportunities for
such training?such training?
Post-Graduate Training OpportunitiesACGME AccreditedACGME Accredited
Pediatric Emergency MedicinePediatric Emergency MedicineCritical Care MedicineCritical Care MedicineToxicologyToxicologySports MedicineSports MedicineHyperbaric MedicineHyperbaric MedicinePalliative CarePalliative Care
Non – ACGME AccreditedResearch (clinical or basic science)Robert Woods Johnson Clinical Scholars ProgramAdministrativeEMSUltrasoundInternational Emergency MedicineMedical Education – M.Ed. MESPOJOC ProgramsMBA, MHAMPH, MPP, MSci PhD
What are the Advantages of Post-Graduate Training? • Medical school and residency DO NOT Medical school and residency DO NOT
adequately prepare you for an academic adequately prepare you for an academic careercareer
• Post-graduate training facilitates Post-graduate training facilitates becoming an expert in your chosen becoming an expert in your chosen academic disciplineacademic discipline
• Post-graduate training enhances Post-graduate training enhances career career satisfactionsatisfaction and your and your chances of academic chances of academic successsuccess
What are the Advantages of Post-Graduate Training? • Post-graduate training facilitates the Post-graduate training facilitates the
establishment of mentoring and other establishment of mentoring and other important collaborative relationships.important collaborative relationships.
• Fellowship training is the only Fellowship training is the only mechanism by which you will be granted mechanism by which you will be granted adequateadequate protected time to develop the protected time to develop the academic skills required in the discipline academic skills required in the discipline of your choosing!of your choosing!
Preparedness of Graduating Residents for an Academic Career
Survey of EM residency directors:Survey of EM residency directors:
only 29% of EM program directors only 29% of EM program directors felt that their EM graduates were felt that their EM graduates were prepared for an academic career prepared for an academic career
that that required original research. required original research.
Stern, et al. Acad Emerg. 6: 262-270, 1999.
Preparedness of Graduating Residents for an Academic Career Sanders AB, et al. Ann Emerg Med 1994; 23: 81-87.
• Survey of practicing emergency Survey of practicing emergency physiciansphysicians
• Obstacles to research productivity:Obstacles to research productivity: Insufficent research trainingInsufficent research training Finding knowledgeable collaboratorsFinding knowledgeable collaborators
Effects of Post-Graduate Training on Career Satisfaction and SuccessTaylor 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.
Effects of Post-Graduate Training on Career Satisfaction and SuccessAnderson 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.
• Surveyed full-time IM faculty in 123 U.S. medical schools
• Post-graduate research training significantly enhanced the likelihood of success in an academic career.
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.
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
Advantages of Post-Graduate Training: Establishment of mentoring and other collaborative relationships
Correlation between establishment of a mentoring relationship and: Correlation between establishment of a mentoring relationship and: 1) academic success1) academic success
2) career satisfaction2) career satisfaction
Palepu A et al. Academic Medicine 1998; 73: 318-323.Palepu A et al. Academic Medicine 1998; 73: 318-323.• Survey of 3013 full-time faculty at 24 U.S. medical schoolsSurvey of 3013 full-time faculty at 24 U.S. medical schools• Faculty with mentors (versus those without):Faculty with mentors (versus those without):
rated their research preparation and skills higher rated their research preparation and skills higher rated adequacy of professional support from their rated adequacy of professional support from their
institutions for teaching, research, and administrative institutions for teaching, research, and administrative activities higheractivities higher
higher career-satisfaction scoreshigher career-satisfaction scores greater likelihood of being awarded research grantsgreater likelihood of being awarded research grants
“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.
What Specifically Will a Mentor Do for You?• Assist in setting and achieving your goalsAssist in setting and achieving your goals• Provide feedback regarding performanceProvide feedback regarding performance• Help build your confidence/ moral supportHelp build your confidence/ moral support• Read and critique your manuscripts, grants, Read and critique your manuscripts, grants,
proposals, and other academic projectsproposals, and other academic projects• Get you involved in committee workGet you involved in committee work• Introduce you to leaders in your field of Introduce you to leaders in your field of
interestinterest• Keep you on trackKeep you on track• Protect you Protect you
Your mentor is your ADVOCATE!!!!!
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!!!!!!
Advantages & Disadvantages of Post-Graduate Training
Advantages Disadvantages
Mastery of knowledge and skills in chosen area of study
Brief further delay in reaching max salary potential
Chances of success
Career satisfaction
Guaranteed protected time
Makes you more competitive for the ideal job positions
Greater control of your job structure and your time
Facilitate the development of mentoring relationships and other collaborations
Academic Career Pearls & Pitfalls
Goodness of fitGoodness of fit MentorshipMentorship Career focusCareer focus Long term planningLong term planning BalanceBalance
Goodness of Fit
4 components of academic medicine4 components of academic medicine ResearchResearch TeachingTeaching ServiceService Clinical careClinical care
What are your priorities?What are your priorities? Individual vs. institutional valuesIndividual vs. institutional values
Harmonious or at odds?Harmonious or at odds?
What characterizes the institution?
Little fish in a big pond?Little fish in a big pond? ““Up and out” systemUp and out” system What’s rewarded?What’s rewarded? What would happen if I What would happen if I
leave?leave? Everyone is replaceableEveryone is replaceable
Are there real Are there real opportunities for opportunities for advancement?advancement?
Ask not what I can do for the institution, but what the institution
can do for me!
Career focus: “A tale of two Suzys”
Two recent EM residency graduates Two recent EM residency graduates pursue a career in academic emergency pursue a career in academic emergency medicine….medicine….
Profile - Suzy B
Developed a clinical interest in stroke as a residentDeveloped a clinical interest in stroke as a resident Resident member of department QI committee to Resident member of department QI committee to
improve stroke careimprove stroke care Helped neurology investigator enroll stroke Helped neurology investigator enroll stroke
patients in clinical trials while on elective “stroke” patients in clinical trials while on elective “stroke” rotationrotation
Goal: faculty position where she can do “clinical Goal: faculty position where she can do “clinical research on stroke patients”research on stroke patients”
Profile - Suzy Q
Excelled as a resident in ultrasound rotationExcelled as a resident in ultrasound rotation ““Loves to teach”Loves to teach” Spent a year as an ultrasound fellowSpent a year as an ultrasound fellow Goal: faculty position where she can do Goal: faculty position where she can do
“ultrasound research and education”“ultrasound research and education”
1 year out – Suzy B
Serves as departmental liaison to institutional stroke Serves as departmental liaison to institutional stroke care committeecare committee
Develops grand rounds talk on strokeDevelops grand rounds talk on stroke Drafts departmental policy on triage of stroke Drafts departmental policy on triage of stroke
patientspatients Asked to serve as co-investigator on neurology Asked to serve as co-investigator on neurology
investigator’s grantinvestigator’s grant Develops mentoring relationshipDevelops mentoring relationship
Writes chapter on stroke for EM study guideWrites chapter on stroke for EM study guide
1 year out – Suzy Q
Sets up ultrasound rotation for EM residents Sets up ultrasound rotation for EM residents doing individual teaching 2-3 days a weekdoing individual teaching 2-3 days a week
Gives two core lectures: DKA and EpistaxisGives two core lectures: DKA and Epistaxis Publishes case report of unusual Publishes case report of unusual
presentation of Lyme diseasepresentation of Lyme disease Appointed to patient safety committeeAppointed to patient safety committee
3 years out – Suzy B
Submits grant proposal to develop novel Submits grant proposal to develop novel stroke curriculum for ED providersstroke curriculum for ED providers
Continues to work on neurology grant Continues to work on neurology grant Performs secondary analysis of stroke Performs secondary analysis of stroke
database and publishes first-authored database and publishes first-authored manuscriptmanuscript
Invited to give stroke talk at national Invited to give stroke talk at national meetingmeeting
3 years out- Suzy Q
Continues to teach US rotation for EM Continues to teach US rotation for EM residents (25 hours/week)residents (25 hours/week)
Continues as patient safety committee Continues as patient safety committee membermember
Develops US study protocolDevelops US study protocol Abandons project due to barriers from Abandons project due to barriers from
radiology and IRBradiology and IRB
6 years out – Suzy B
Receives funding for second grant proposal on ED Receives funding for second grant proposal on ED management of strokemanagement of stroke
Publishes first-authored paper on novel stroke Publishes first-authored paper on novel stroke curriculumcurriculum
Appears as fourth author on premier stroke paper Appears as fourth author on premier stroke paper from neurology grantfrom neurology grant
Serves on national task force for prehospital stroke Serves on national task force for prehospital stroke carecare
Told by chair, “you’re on the right track for Told by chair, “you’re on the right track for promotion.”promotion.”
6 years out – Suzy Q
Teaching US rotation but asks for Teaching US rotation but asks for additional support to lessen hoursadditional support to lessen hours
Presents abstract on US teaching experiencePresents abstract on US teaching experience Struggles with writing manuscriptStruggles with writing manuscript Chair concerned about lack of Chair concerned about lack of
publications/scholarly writingpublications/scholarly writing Feels overwhelmed and unsure of Feels overwhelmed and unsure of
continuing in academic EMcontinuing in academic EM
Lessons learned
Suzy BSuzy B Pursued interestPursued interest Passionate about topicPassionate about topic Found mentorFound mentor Focused Focused Built experience Built experience
stepwisestepwise Wrote/spoke about her Wrote/spoke about her
workwork
Suzy QSuzy Q Pursued interestPursued interest Passionate about topicPassionate about topic Responsible for Responsible for
development of development of program at early stageprogram at early stage
No mentorNo mentor No documentation of No documentation of
her workher work
Merging academic activities
Dovetail administrative, teaching, and Dovetail administrative, teaching, and research activitiesresearch activities
All or most should be relatedAll or most should be related Especially during the first few yearsEspecially during the first few years
Consider “apprentice” positionsConsider “apprentice” positions Become known for somethingBecome known for something Develop expertiseDevelop expertise
Need for a Mentor
Important predictor of successImportant predictor of success Availability during critical period (fellowship – Availability during critical period (fellowship –
first years as faculty)first years as faculty) Especially true when there is little formal Especially true when there is little formal
research trainingresearch training Quality of mentor and mentor-trainee Quality of mentor and mentor-trainee
relationship is especially critical when relationship is especially critical when applying for training grant supportapplying for training grant support
Where do I find a mentor?
In your own backyard In your own backyard Department or DivisionDepartment or Division
Within your institutionWithin your institution Related discipline/research Related discipline/research
Other local institutionsOther local institutions Long distance mentorsLong distance mentors
National organizations/meetingsNational organizations/meetings Committee workCommittee work
Role Model
Identify Identify Who’s doing what you’d like to do?Who’s doing what you’d like to do? Who has values that you admire?Who has values that you admire? Who has a lifestyle that you admire?Who has a lifestyle that you admire?
Pick their brainsPick their brains Suggestions for successSuggestions for success Things they would have done differentlyThings they would have done differently
Hang out with themHang out with them Let them introduce you to peopleLet them introduce you to people
Long term goals
Importance of Long Term Goals
1, 3 and 5 year plans1, 3 and 5 year plans Career planCareer plan Similar to short term goals… but with goals for Similar to short term goals… but with goals for
each yeareach year Each year’s goals should be a step toward Each year’s goals should be a step toward
achieving the long term goalachieving the long term goal Take time to revise along the wayTake time to revise along the way Use as guide for annual chair evaluationsUse as guide for annual chair evaluations
The myth of work-life balance
The reality…
The Balance Wheel