Clinical Academic Careers
Dr Varun Sethi
The decision to ‘become a doctor’ has many reasons, some conscious and many that work quietly beneath the obvious, taking us towards what we are passionate about. After surviving medical school, when we finally become doctors, closely witnessing birth and death, little do we realize that this in only the threshold of a lifetime of decisions. The economic, emotional and intellectual arguments, a product of an inner desire and a projected expectation, work like a chisel shaping a career trajectory that can seem realistic only retrospectively.
Through the drama of night shifts, emergency decisions and ward rounds, the next decision takes shape, and for the daring amongst us, we realize that we want to treat, and we also want to search. The charms of academia infatuate us and we find ourselves chasing a new dream - to be a clinical academic. That’s when we know that a MD is not enough. We need the PhD.
The journey to the MD, Phd is never easy. At times its more structured and coherent; at other times its about joining dots. The structure of integrated MD-PhD programs in the west (US/ UK for example), and a culture that supports this choice is very encouraging to the young doctor, smitten with the whiff of scholarly argument. However in many other countries, the pursuit of clinical academia is varied, less defined and probably existing without a label.
Are you passionate about searching for patterns and clues amongst painstakingly collected data? Are you excited by the mystery of solving a clinical puzzle and reaching a diagnosis? If you answered yes to any of these questions, chances are you would be suited for a career in clinical academia. The word academia has a scholarly connotation implying an elitist interest in intellectual curiosity, contrasting against the reality and practical focus emphasized in what is clinical and immediate. A career managing a marriage of such two very different temperaments is challenging to say the least. This duality is captured well in a quote adapted from Hermann Hesse’ Narcisssus and Goldmund, “It is not our purpose to become each other; it is to recognize each other, to learn to see and honor the other: each the other's opposite and complement.” Becoming a clinical academic is a slow process that requires patience, perseverance, and the ability to adapt to change.
Many visiting fellows at the NIH have pursued the MD-PhD route. For some this has been as part of an MD-PhD dual degree program and for others this has been the sequential pursuit of separate programs, often across different countries, educational boards, and medical licensing authorities. While academic skill sets and degrees often translate across borders, the eligibility to practice medicine in the United States requires passing local medical licensure examinations. Living in global times implies a future with a possibility of our careers re-routing to our home countries, or possible detours into other international laboratories compatible with our interests and area of expertise. On the one hand we have the advantage of working in an era that allows us the opportunity to travel and learn, but, for a clinical academic, this often implies the need to re-qualify via the local medical licensing authority, giving a new set of examinations, each time a professional move so demands.
Examples of medical licensure exams necessitated by career moves include the PLAB in the UK; in the US this is achieved by an ECFMG certification which requires taking the USMLE Steps (I, 2CS and 2CK). Efficient financial and time planning are essential, and it is also critical to understand limitations with respect to visa and immigration rules. For those of us who will return to our home country, the challenges could be creating a clinical academic environment. In India for example, it is very easy to get compartmentalized as being a clinician or an academic, medical college faculty positions being the rare exception. With an MD and a PhD, it would be very hard and unfair to have to give up either route.
Transitioning into non-clinical research and teaching positions is an option that is increasingly being pursued by individuals with an MD-PhD, including careers in science writing, science policy and industry. The NIH has a host of activities that allow you to test the waters and judge for yourself if such a career transition is something that would work for you. A good step is to talk to people who have made a particular transition, possibly by arranging informational interviews and become involved with clubs such as the science policy discussion group. The option of a detail in a desired discipline also allows a first hand experience of what the change would be like and if this fits in with your individual, personal, and professional goals.
The paradox of having a choice of career options is the stress of determining what will work for you. Whatever be the path following your postdoctoral training, an efficient and informed plan will go a long way to ensuring success. For most of us this choice comes at a time in our lives when the responsibilities of balancing children, and family, with our careers presents an additional challenge. Therefore, it is important to investigate, question, and rationalize the best options open to you. As quoted in a paper on Resonant Leadership, “For those bold enough to lead us in this age of uncertainty, the challenges are immense” (Boyatis R and Mckee A, 2005).
From a global perspective, it is very important, that the clinical academic community revisit education policies so as to permit a more smooth transition of professionals in the pursuit of academic clinical research. It is well known that collaborations across countries go a long way in furthering the advancement of science. The practice of medicine should not be prevented from exploiting such an opportunity. In times of need, doctors across borders are allowed to travel on humanitarian grounds. As estimated by numbers across universities across the globe, recruitment of academic staff in medical schools suggests that academic medicine is in need e.g. In the UK, 171 vacancies at professor, senior lecturer, and lecturer grades were reported, in a recent survey of medical clinical academics staffing(Fitzpatrick et al 2014). Global efforts to encourage, promote, and finance clinical academic careers across borders is the need of the hour. A greater stress on the MD-PhD education format, internationally, will also help bridge the gap between the need and availability of clinical academics.