And then there were none: the consequences of academia losing clinically excellent physicians

Understanding academic rank among PAs practicing in academic medical centers

OBJECTIVE

To evaluate the attitudes and prevalence of academic/clinical rank among practicing physician associates/assistants (PAs) in different specialties and geographic locations.

METHODS

We surveyed PAs in clinical practice with a bias toward hospital/academic-based clinicians. The survey was a modified instrument to evaluate perceptions, attitudes, barriers, and prevalence of academic rank.

RESULTS

Overall, 65% of respondents indicated academic/clinical rank opportunities were of interest, but 60.8% noted that they were not eligible to hold rank in their institutions. Nearly 55% indicated a desire to hold rank, but 81.9% of respondents did not hold rank. The survey response rate was 22.9%. A lack of departmental emphasis was a common barrier to rank.

CONCLUSIONS

Clinically practicing PAs clearly have a desire or interest in academic/clinical rank, but barriers persist. Further development of opportunities to hold academic/clinical rank with mentorship may improve PA careers and propel professional advancement and parity.

"Pulling the Parachute": A Qualitative Study of Burnout's Influence on Emergency Medicine Resident Career Choices

OBJECTIVES

About half of all resident physicians report symptoms of burnout. Burnout negatively influences multiple aspects of their education and training. How burnout may impact residents' career choices remains unclear. The authors explored the role burnout played in residents' career decisions.

METHODS

This was a qualitative study among a sample of 29 emergency medicine residents from four institutions. Qualitative data were generated through four semistructured focus groups. The authors employed a constructivist approach to thematic analysis. Transcripts were coded and organized into major themes.

RESULTS

Five major themes connecting burnout with residents' career choices emerged: 1) residents' current burnout and the prevention of future burnout figured prominently in their career considerations, 2) residents aimed to mitigate sources of burnout through their career choices, 3) residents' view of clinical work as a burden and a burnout contributor spurred the pursuit of other interests, 4) faculty advice and role modeling in relation to burnout shaped residents' career perspectives, and 5) residents weighed long-term burnout concerns with short-term financial needs.

CONCLUSION

Burnout played an important role in multiple aspects of residents' career considerations. Educators, program directors, and organization leaders can focus on identified target areas to address burnout's influence on residents' career decisions.

Women and the Decision to Leave, Linger, or Lean In: Predictors of Intent to Leave and Aspirations to Leadership and Advancement in Academic Medicine

BACKGROUND

The Association of American Medical Colleges reports continued low rates of female faculty as professors and in leadership positions. While attrition and discrimination have both been proposed as explanations, recent literature has suggested that women's professional motivations, ingrained behavior, and perceptions of organizational support may also play a role.

METHODS

The authors employed a series of scales informed by the turnover theory (which predicts intent to leave an organization), previously validated and used in business and engineering studies, but rarely used in academic medicine. The authors proposed and tested a multiple regression model to assess predictors (role strain, work-life balance, and organizational climate) for three outcome variables: seeking promotion, seeking leadership, and intent to leave.

RESULTS

Survey results from 614 faculty members indicated that gender significantly influenced both promotion and leadership seeking, but not intent to leave. Perceived work-family conflict was negatively correlated with leadership seeking for women, but not for men. Positive views of organizational support and commitment were associated with promotion seeking and persistence for all participants. Role strain was positively correlated with desire for promotion and leadership, as well as with intent to leave.

CONCLUSIONS

Female faculty may not be leaning in to promotion and leadership roles because of increased role conflict, work-life concerns, and organizational factors; this seems to be more of a factor for female clinical rather than research faculty. Work-family conflict affects male and female faculty differently and should be addressed in efforts to retain faculty and to remove barriers for female faculty seeking leadership opportunities.

Time well spent: the association between time and effort allocation and intent to leave among clinical faculty

PURPOSE

To explore the relationship between clinical faculty members' time/effort in four mission areas, their assessment of the distribution of that time/effort, and their intent to leave the institution and academic medicine.

METHOD

Faculty from 14 U.S. medical schools participated in the 2011-2012 Faculty Forward Engagement Survey. The authors conducted multivariate logistic regression analyses to evaluate relationships between clinical faculty members' self-reported time/effort in each mission area, assessment of time/effort, and intent to leave the institution and academic medicine.

RESULTS

Of the 13,722 clinical faculty surveyed, 8,349 (60.8%) responded. Respondents reported an average of 54.5% time/effort in patient care. The authors found no relationship between time/effort in patient care and intent to leave one's institution. Respondents who described spending "far too much/too much" time in patient care were more likely to report intent to leave their institution (odds ratio 2.12, P<.001). Those who assessed their time/effort in all mission areas as "about right" were less likely to report intent to leave their institution (64/1,135; 5.6%) than those who reported "far too little/too little" or "far too much/too much" time/effort in one or more mission areas (535/3,671; 14.6%; P<.001).

CONCLUSIONS

Although the authors found no relationship between reported time/effort in patient care and intent to leave, the perception of "far too much/too much" time/effort spent in that mission area was correlated with intent to leave the institution. Efforts to align time/effort spent in each mission area with faculty expectations may improve retention.

Scholarship in academic surgery: history, challenges, and ideas for the future

The role of academic surgery is changing. Traditional roles of the triple threat researcher, clinician and teacher, were formulated by Osler and improved upon by Boyle in the 1990s. These include application and integration of research to clinical problems. However, new pressures exist on the academic surgeon. Financial pressures rising costs of health care and decreased research funding all need to be addressed. In addition, retention and advancement of faculty is more difficult with increased emphasis of clinical practice in academic medicine. The future of academic medicine will require personal optimization as a multifaceted academician, businessman, and administrator, as well as rethinking how academic medicine may function in the future.

A qualitative study of work-life choices in academic internal medicine

The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career advancement. Semi-structured interviews were conducted with a purposeful sample of 18 residents and 34 faculty members representing male and female physicians at different career stages. Using thematic analysis, three themes emerged: (1) the love of being a physician ("Raison d'être"), (2) family obligations ("2nd Shift"), and (3) balancing work demands with non-work life ("Negotiating Academic Medicine"). Female researchers and educators reported more strategies for multiple role planning and management than female practitioners. Interventions aimed at enhancing academic internists' planning and self-efficacy for multiple role management should be investigated as a potential means for increasing participation and facilitate advancement.

Perspective: Recognizing and rewarding clinical scholarship

Faculty members in medical schools and academic medical centers are in a constant process of generating new knowledge. The cornerstone of academia--and academic medicine--is scholarship. Traditionally, tenure and/or academic promotion in the professorial ranks is awarded to those who meet institutional criteria in the missions of research, teaching, and service, including patient care. In the academic review process, priority is often placed on a record of demonstrated, consistent success in traditional laboratory research, also known as the scholarship of discovery. More recently, there has been greater recognition of other forms of scholarship: education, application, and integration. These forms of scholarship, although less recognized, also result in the generation of new knowledge. In an attempt to understand the breadth and scope of clinical scholarship, the authors searched the extant literature in academic medicine for a definition of clinical scholarship and expanded the search to disciplines outside of medicine. They found that succinct, discrete definitions of clinical scholarship have been published in other disciplines, but not in academic medicine. After reviewing definitions of clinical scholarship from other disciplines, adapting definitions of educational scholarship in academic medicine, and including qualities unique to clinical scholarship, the authors developed a framework for understanding clinical scholarship in academic medicine as a means for opening a dialogue within the academic medical community. This dialogue hopefully will lead to formulating a succinct, discrete definition of clinical scholarship that will allow greater recognition and reward for clinical scholars in the promotion and tenure process.