David Shepard, MD
2010-04-27
Hematology/Oncology Fellow at the
University of Michigan
During the two to four years generally
needed to complete a demanding hematology or hematology/oncology fellowship,
trainees are expected to partake in academic endeavors that will position them
for success in their specific career path — be it academia, community practice,
industry, or any combination of the three. This decision, like many before it
in medical education, may be based on limited knowledge or exposure to a
particular practice environment or area of study.
For those of us who believe we are fit
to carve out a niche for ourselves in the competitive world of academic medicine,
we must first decide what it is about academic medicine that we find
attractive. If drawn to laboratory research or clinical investigations at an
institution where there is high-quality mentorship available, a young
investigator may decide to pursue a career as a clinician-scientist or clinical
investigator with relative ease. Academic medical centers support new
discoveries using the strength of laboratory/clinical research programs and
attainment of grant support to claim their place among the nation’s elite
institutions. In addition to research, the mission statements of the esteemed
centers reflect a commitment to patient care and medical education. At last
year’s ASH Trainee Day, which took place during the annual meeting, Dr. Kenneth
Kaushansky, chair of the Department of Internal Medicine at University of
California, San Diego (UCSD), discussed a career pathway in academic medicine that
merges these latter two critical elements: the clinician-educator track.
Trainees who strive to provide world-class patient care and are devoted to the
tutelage of their junior colleagues may be well suited for the
clinician-educator pathways in academia.
As clinician-educators in academic
medical centers, physicians will devote their time to caring for patients in
both inpatient and outpatient settings and supervising medical students and
residents.1 Depending on the institution, a clinician-educator may split his or
her time evenly between patient treatment and education or alternately up to 80
to 90 percent of his or her time devoted to patient management.2 His or her
salary will generally come from revenue generated by services rendered, without
emphasis on grant support. Students, residents, and faculty members often
recognize clinician-educators as outstanding physicians and role models.3
According to two Association of
American Medical Colleges (AAMC) reports, there are ample opportunities for
clinicians to pursue academic appointments in these tracks. Dr. George Richard,
director, Careers in Medicine Program for AAMC, and Michelle Sullivan,
Vanderbilt University School of Medicine, presented research on faculty career
options for the AAMC on November 4, 2008. They collected data online from 75
U.S. allopathic medical schools and found that 26 schools outlined at least one
specific education-based track; three schools had two clinical-educator tracks.
Common titles included academic educator, teaching scholar, and clinician-teacher.
Of the 29 tracks discovered, 11 were eligible for tenure. The majority of U.S.
medical schools will have clinically based tracks with educational components despite
there not being a direct emphasis on education. According to a 2005 AAMC
report,4 100 American medical colleges have such tracks. There are ample
opportunities to pursue this career track, but there is significant variation among
institutions regarding eligibility for appointment to clinical-educator tracks
and even more variation, with some controversy, regarding promotion of
clinical-educators. Several health-care organizations have data regarding physician
career tracks available online. According to Dr. Kaushansky, UCSD has a
Clinical Professor of Medicine track for physicians who desire to be largely
committed to patient care and education, while still being involved in
scholarly activity. At the time of appointment, candidates are expected to have
completed a recognized training program and display excellence in basic
clinical skills as evidenced by recommendation letters from program directors
and colleagues. A scholarly plan is required that may include such efforts as
participation in collaborative research and publication of case reports, book
chapters, reviews, and articles for lay audiences. Candidates will participate
in training house staff and students through clinical activity. Assuming completion
of the fourth-year appraisal, advancement to associate professor requires
independent clinical excellence with distinction in teaching house staff, as
documented in teaching evaluations and letters. At the associate professor
level, scholarly activity, as listed previously, with documented continued
productivity and presentations at national/local meetings, including CME, is
expected. At this level, service to the university is also required through
hospital/institutional committee membership. With continued momentum in the areas
mentioned, full professorship is attainable. As a second example, Duke
University has a clinician-teacher track in which 75 percent or more of a candidate’s
time is spent on clinical undertakings.5 Although physicians are to be judged
most heavily on clinical activity, participation in the academic community is
considered in the promotion process. Teaching is obviously required and
evaluated, and research and scholarly publications that enhance the candidate’s
regional/ national reputation as a master clinician are encouraged, but are
considered as secondary measures of performance. Promotion from assistant to
associate professor is primarily based upon clinical excellence and attaining a
regional or national reputation with a wide referral base. The rank of
professor is awarded to those who have become nationally or internationally
renowned for clinical excellence.
These examples of clinician-teacher
tracks represent two similar but varied approaches to the clinical-educator pathway
in medicine. This pathway is a viable option for those that love to teach and
embrace patient care with a desire to excel. The current state of affairs would
generally require willingness to accept a non-tenured position and an
understanding that, despite a heavy clinical and teaching load, if a program
stipulates a need for a national reputation in order to gain full
professorship, a significant number of publications and presentations may be
necessary. The days of the academic physician as a triple threat are coming to
a close. As our colleagues in the laboratories continue to break ground at the
molecular level, there will be an increasing need for exceptional clinicians to
employ state-of-the-art patient management strategies and educate the next generation
of physicians.
- Levinson W, Branch WT Jr, Kroenke K. Clinician-educators in academic medical
centers: a two-part challenge. Ann Intern Med. 1998;129:59-64.
- Sheffield
JV, Wipf JE, Buchwald D. Work activities of clinician-educators.
J
Gen Intern Med. 1998;13:406-9.
- Levinson
W, Rubenstein A. Mission
critical — integrating clinician-educators into academic medical centers. N Engl J Med. 1999;34:840-43
- Fleming VM, Schindler N, Martin GJ, et al. Separate
and equitable promotion tracks for clinician-educators. JAMA.
2005;294:1101-4.
- “Track
IV — Clinician–Teacher.” Duke University
School of Medicine. 13 March 2009.
24 March 2010.
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