Published in the July 2008 issue of Today’s Hospitalist
Just as hospital medicine, as the new kid on the block, is struggling to carve out a niche for itself in the hallowed halls of academic medicine, young academic hospitalists are grappling with how to achieve tenure and promotions in an environment that hasn’t entirely accepted their upstart profession yet.
“Hospital medicine is a young field, and not too many hospitalists have made it through the ranks to full professor,” said Scott Flanders, MD. Dr. Flanders is associate professor at the University of Michigan in Ann Arbor. He is also director of the hospitalist program there and president-elect of the Society of Hospital Medicine (SHM).
Not only are there a dearth of mentors for young hospitalists eager to get promoted, Dr. Flanders said, but there is often no clear roadmap for how physicians can get there on their own. To help remedy that, he joined several other successful academic hospitalists and internists at a session at the SHM annual meeting this spring. Panel members shared their thoughts on how to get ahead as an academic hospitalist.
Become a celebrity
The good news, said panelist Sankey Williams, MD, professor of medicine at Philadelphia’s University of Pennsylvania and chief of the division of general internal medicine, is that “lots of academics get promoted every year.”
But he was quick to add that there are plenty of pitfalls that can sink the careers of promising academics, including missteps in navigating the order of authors on research papers or not making sure mentors and collaborators are on the same page. Young hospitalists also have to figure out how to manage research staff, win enough grant money, write enough papers, and say “no” to projects that will not advance their chances of promotion and tenure.
The inability to say “no,” Dr. Williams explained, is “the most common problem I see with junior faculty. They love to teach, they love to take care of patients. And then they get swamped.”
Instead of being accommodating, panel members said the key to getting ahead is getting known outside your hospital. Young academics should strive to “be a local superstar with a regional reputation,” Dr. Flanders said. “Develop your own clinical niche, something that you know better than anybody else, so people come to you with opportunities to speak to others.” Just being a good doctor, he added, is not enough.
Why? Because whenever you come up before any promotions committee, “everybody who knows you gets up and leaves the room,” explained Dr. Williams. “The people left are those who don’t know what you do, so they look at what your colleagues have to say about you. They are looking for evidence that your colleagues value what you do.”
So how do you get yourself known? For one, Dr. Flanders advised, write up your clinical cases. In addition, document and disseminate your quality improvement interventions, link up with established researchers, write abstracts for meetings, review articles for journals, join national and regional medical societies, and give presentations at other hospitals.
Academic hospitalists have plenty of opportunities, he pointed out, to give lectures to rehab docs and family practice groups, for instance, and give grand rounds at community hospitals in their region.
Success as a researcher
What about one of the traditional tenure tracks in academics: success as a clinician-investigator? Panelists at the presentation said that to find success via this route, hospitalists need to scrutinize first job offers and accept only those that include the resources and colleagues they need to build a successful research career.
“The expectation is that after about three years, you will have obtained the majority of your salary from external funding,” said David Meltzer, MD, associate professor of medicine, economics and public policy at the University of Chicago. To make that happen, he added, you need strong training and mentorship from the beginning; time to focus on your research; and access to adequate office space, administrative support, biostatistical expertise and other resources.
And while you’ll want to start writing papers and grants right away, you also need to invest time at the beginning of your career to “build human capital and gain knowledge,” Dr. Meltzer said, “not just spending all your time getting out the next grant or paper tomorrow.”
You also need to figure out “the rules” at your particular medical center, Dr. Meltzer added, but those frequently aren’t as explicit as you might like. Making matters more complicated, the rules of engagement for researchers constantly evolve, depending on the culture of your institution and who is deciding on promotions.
“At some places,” he said, “you will hear that what matters is quantity of papers. At others, it is defined as quality of papers, meaning original research, the reputation of the journal or your place in the list of authors.”
What is crucial, Dr. Meltzer noted, is to figure out what is unique about your work. “It will be harder to get funded if you look just like others doing the same thing,” he explained.
Teaching and administrative success
Hospitalists in clinician-educator or clinician-administrator jobs are not expected to produce as many papers or bring in as many grants as clinician-investigators.
But panelists said that to be retained and promoted, physicians on these tracks are still expected to demonstrate excellence in everything from teaching and clinical skills to scholarly work.
To prove teaching excellence, hospitalists need to make sure evaluations are routinely collected from trainees. “Not all institutions have an easy way to do that,” Dr. Flanders pointed out, “so you need to create a way.”
He advised young faculty members to keep an educational portfolio to showcase their accomplishments. “When you are going up for promotion,” Dr. Flanders said, “people are going to want to know what you have done about teaching innovation and curricular development.” Just as important as developing a new curriculum, he explained, is “implementing it and measuring its impact on trainees.”
In terms of publication, it’s a rare institution that will tell you directly how many papers you need for tenure or retention. Nonetheless, Dr. Williams said, that number is usually available.
“Most institutions have information about how many people came up for promotion and how many publications each person had,” he explained.
“That’s the number, and I encourage you to get it.”
And as for the sticky wicket of authorship on scientific papers, Dr. Meltzer advised hospitalists to iron out these issues in advance. Then, if any doubts pop up about authorship, he said, “err on the side of inclusiveness.”
Deborah Gesensway is a freelance writer reporting on U.S. health care from Toronto, Canada.