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