An Academic Career: Is It Right For You

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An Academic CareerIs It Right For You?

• Peter Sokolove, MD
• Susan Stern, MD
• Jill Baren, MD
• 2008 SAEM Annual Meeting
• Washington D.C.
• May 30, 2008

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Overview

• Why academics?
• Various settings
• How to prepare
• Fellowship training
• Marketplace issues
• Resources

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Academics

• Pursuit of scholarship
• Expanding knowledge
• Passing on knowledge

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Why Choose Academics?

• Career diversity
• Pursuit of knowledge / research
• Expertise development
• Love of teaching
• Advance specialty
• Colleagues

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Why Choose Academics?

• Cutting edge practice
• Teaching hospital resources
• Interesting cases
• Longevity / pace / intensity
• Schedule control
• Sabbatical

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Downside of Academics

• More total hours
• Generally less money
• Less hands on practice
• Pressure to produce

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Academic Career Building Blocks
Research
Teaching
Administration
Patient Care
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Traditional Academics

• Multiple academic tracks
• Institutional variation
• Research track -- various subgroups
• Clinical track
• Clinician educator track

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Research Roles

• Research Director
• Clinical Trials Director
• Resident Research Advisor
• Research Assistants Program Director

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Educational Roles

• Residency Director
• Associate Residency Director
• Medical Student Director
• Medical School -- IOR, Assistant Dean
• Rotating Residents Director
• Fellowship Director
• CME Director

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Specialty Roles

• Chest Pain ER Director
• Toxicology / PCC Director
• HBO Chamber Director
• Ultrasound Director

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Administrative Roles

• Chair / Chief
• Vice-Chair / Associate Chief
• EMS Director
• Clinical Operations Director
• Pediatric ED Director
• CQI / Risk Management Director
• Billing Director

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Promotion and Tenure

• Progressive ranks
• Timelines
• Criteria track-dependent
• Publications
• Grant funding
• Regional/National recognition
• Teaching evaluations
• Clinical productivity
• Area of focus
• Tenure

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Clinical Teaching Spectrum

• EMR primary site
• EMR secondary site
• EMR rotation site
• Non-EM residency site
• Medical students
• FNP, PA, RN, EMT

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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

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Preparing for Academics

• Mentors
• Relationships / networking
• Join SAEM
• Residency research project
• Teaching opportunities
• Chief resident year
• Fellowship

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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

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Medical Toxicology

• ED clinical time
• Poison Control Centers
• Consultation services
• Inpatient services
• Teaching / research

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Pediatric EM

• Childrens hospitals
• Pediatric and adult patients
• Teaching / research

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Sports Medicine

• Sports medicine clinic
• Team physician
• High school
• College
• Professional
• Olympic
• ED clinical shifts
• Teaching / research

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Undersea Hyperbaric Medicine

• Decompression chambers
• Worldwide locations
• ED clinical shifts
• Teaching / research

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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

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Job Search -- FAQ

• Does 3 vs. 4 year program matter?
• Need post-residency clinical experience?
• Will residency geography limit me?
• What if Im not yet sure what I want?

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Marketplace Forces
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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.

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Evaluating Academic Positions

• Know whats expected of you
• Clinical commitment
• Administrative duties
• Resources
• research
• administrative
• Mentorship availability
• Chair

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Final Thoughts

• Ocean of opportunities
• Do what you love
• Mentorship key to success
• Doors arent closed
• Teach and lead

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Wide Spectrum of Opportunities in Academic
Emergency Medicine
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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

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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!!!!!

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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!!!!!!!!
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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)?

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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?

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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!!!!!!
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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.
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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!!!!!!
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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?

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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
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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

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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!

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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.
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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

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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.

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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.
• 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.

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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.

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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

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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

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• Mentorship in the first years is critical for
  launching a productive career. Learning the
  informal network that supports productivitythe
  inner workings of professional associations and
  who the productive people areis critical.
  Blackburn RT. Cur Iss Higher Education 1981 52
  369-377.

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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!!!!!
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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!!!!!!
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Advantages Disadvantages of Post-Graduate
Training
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Academic Career Pearls Pitfalls

• Goodness of fit
• Mentorship
• Career focus
• Long term planning
• Balance

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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?

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What characterizes the institution?

• Little fish in a big pond?
• Up and out system
• Whats rewarded?
• What would happen if I leave?
• Everyone is replaceable
• Are there real opportunities for advancement?

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Ask not what I can do for the institution, but
what the institution can do for me!
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Career focus A tale of two Suzys

• Two recent EM residency graduates pursue a career
  in academic emergency medicine.

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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

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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

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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
  investigators grant
• Develops mentoring relationship
• Writes chapter on stroke for EM study guide

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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

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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

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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

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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, youre on the right track for
  promotion.

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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/scholar
  ly writing
• Feels overwhelmed and unsure of continuing in
  academic EM

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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

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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

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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

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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

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Role Model

• Identify
• Whos doing what youd 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

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Long term goals
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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 years 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

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The myth of work-life balance
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The reality
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The Balance Wheel