Climbing The Academic Medicine Mountain—Lesson 1. Getting on the Right Path

Collision of two of my projects has left me with a mission to enlighten you about academic medicine. Academic medicine is medicine which is practiced in the setting of a medical school or a post-graduate (after medical school) residency training program. Definition: Residency training refers to the 3-7 years after medical school when the doctor is apprenticed to learn how to put the medical school knowledge into practice in a certain field in medicine. The word “residency” comes from a time when the doctor actually lived in the hospital as “house staff.” This way they could be close to the patient and learn all about medical care as a first line apprentice. With the new work rules limiting residents to 80 hour work weeks, the term is obsolete but still hangs on.

The academic physician has an interest not only in caring for patients, often the sickest and who require a university hospital based setting, but also in research, teaching and programmatic development through service to the medical school and university.

Sounds like a huge commitment? Well, it is. And climbing the academic ladder is difficult. It is made more difficult when you don’t know the path, the obstacles, and there isn’t a good guide or two. And that is where I come in.

My first encounter this week with academic mountain climbing came when I started writing the chapter of my memoirs about my personal experience. Was I really that energetic (and crazy) to get up at 4 a.m. almost daily to write research papers or lectures? How many presentations does it take until I will really get the slides right in the days when they were celluloid, melted, warped, and there was no PowerPoint? Does it have to be that way? Clearly I was that crazy and even more clearly, it doesn’t have to be that way.

The second sign that I was meant to tackle this topic came when I received a wonderful comment on the blog that Dana and I write for NPR’s Science Friday, “Like Mother, Like Doctor”.This particular post was written almost a year ago, and yet Bradley commented just today that it had everything he was looking for and how helpful we had been. Wow, Dana and I had made a real difference to someone in cyberspace! My Pavlovian response was, “Let’s do it again.”

The academic medicine mountain is a steep climb, and I think the view from the top is worth the climb. But there are lots of difficult passages. And sometimes it is tiring. But if you just keep putting one foot in front of another, you can make it. You just need to get started on the right path, get the lay of the land, and then make sure you don’t give up when you are met with the inevitable setbacks.

So why aren’t more women climbing the academic medicine mountain? Many, many reasons are given for the dearth of women in the system, especially at the top. In the next several posts I will share with you the most common barriers and then tell you what you can do to overcome these to get and stay on the right path leading to a successful career in academic medicine.

Reason # 1. You need flexibility. Academic medical centers are very hierarchical and are therefore very rigid. Like the term for training, residency, their old habits die hard, or usually not at all. The most rigid requirement is the element of time. You have to get to a certain place in about 6 years. Yes, 6 years to prove that you are a good teacher, researcher and team player in the academic world.

In the past, when patient care was not as complex and residents did a lot more work than they do now, there was more time to ponder the research question, contemplate the theme for a dynamite lecture, and attend committee meetings at 4 pm because the OR always finished at 3:30 pm (it now routinely goes until 5 pm.) So where does the time come from to do all that and take care of patients—the source of clinical material for the academic “clinical classroom?” If you have nothing else to think about or do, it might not be as difficult, but the present generation of medical students and young doctors has a different point of view.

Stay tuned for the next post where I discuss overcoming the time clock and the dinosaur-like approach to academic medicine mountain climbing. Key word: flexibility.