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.
