Clinical Pediatrics

7 downloads 2840 Views 107KB Size Report
Page 1 .... cents, I try to make my lectures entertaining by using media creatively. I have lectured ... an offer to start my own division of adoles- cent medicine at a ...
Clinical Pediatrics http://cpj.sagepub.com/

Ten Things I Love and Hate About Academia Victor C. Strasburger CLIN PEDIATR 2010 49: 723 DOI: 10.1177/0009922809360929 The online version of this article can be found at: http://cpj.sagepub.com/content/49/8/723

Published by: http://www.sagepublications.com

Additional services and information for Clinical Pediatrics can be found at: Email Alerts: http://cpj.sagepub.com/cgi/alerts Subscriptions: http://cpj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://cpj.sagepub.com/content/49/8/723.refs.html

Downloaded from cpj.sagepub.com by SAGE Pub on August 1, 2010

Commentaries Clinical Pediatrics 49(8) 723­–726 © The Author(s) 2010 Reprints and permission: http://www. sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922809360929 http://clp.sagepub.com

Ten Things I Love and Hate About Academia Victor C. Strasburger, MD1 In honor of my 30th year in academia, I thought I might look back and consider some of the advantages and disadvantages of choosing such a career, just in case some poor medical student or pediatric resident is still undecided. Because I will undoubtedly be accused of being (a) egocentric, (b) short-sighted, (c) selfish, (d) oafish, or (e) all of the above, I will begin with some of the positive aspects: 10. I don’t have to drag myself out of bed in the morning to go to work. I look forward to each day because each day is different for me. That might not be true if I were in practice, seeing patients all day. On any given day, I could be doing one of several different clinics (general adolescent medicine, inpatient treatment unit, continuity), attending a meeting of the university’s Academic Freedom & Tenure Committee, teaching the medical students or residents, tutoring in the second-year curriculum, reviewing a paper for one of the 20 journals I review for, working on an issue of Adolescent Medicine: State of the Art reviews (a journal I founded 20 years ago), writing a policy statement on media for the American Academy of Pediatrics, or working on a manuscript like this one. Whoever said “variety is the spice of life” must have been thinking about academia, at least for me.   9. I have to keep up. It is one of the most “intellectually honest” jobs I know of. My medical students and residents constantly challenge me, so I have to try to stay ahead of them in reading the latest studies and knowing exactly what I’m doing and—more important—being able to explain it to them.   8. I enjoy seeing patients, but I’d be the first to admit that I couldn’t do it all day every day. Clinical medicine invigorates me—I like people, I like the fact that “patients don’t read the textbooks” (as I always say) and therefore often present in unusual ways—but it is also tiring. Teaching and writing keep me fresh. They also remind me constantly of how much

I don’t know and still have to learn. To paraphrase Erich Segal, being in academia means never having to say I know it all.   7. Benjamin Disraeli once wrote, “The best way to become acquainted with a subject is to write a book about it.”1 Academia has gotten an unfair reputation as being “publish or perish.” Some of us like to write! I was an English major in college and did a lot of creative writing (some people would say I’m still making things up even now). Being in academia gives me the time to write and the freedom to write about what I think is important. No one has ever told me, “You write too much.” On the other hand, I have gotten some fairly vicious reviews, particularly early on in my career.   6. Teaching residents and medical students is like having children of your own (which I have as well). It is extraordinarily satisfying to hear from former residents or students about how I’ve influenced or changed the way that they practice. I can only see “x” number of adolescent patients in my career. But if I can teach 1000 students and residents how to see teenagers, I can reach 1000x more patients.   5. I enjoy lecturing. Because I frequently lecture about effects of media on children and adolescents, I try to make my lectures entertaining by using media creatively. I have lectured in 45 of 50 states (Idaho, Mississippi, Alabama, Oklahoma, and North Dakota—I’m still waiting for your invitations!) and on 5 different continents. Sometimes I get paid; sometimes I don’t. But I don’t do it for the money—I do it because (a) I believe it’s important; (b) people invite me, and I consider it to be part of the Hippocratic Oath (“educate your 1

University of New Mexico, Albuquerque, NM, USA

Corresponding Author: Victor C. Strasburger, MSC10 5590, 1 University of New Mexico, Albuquerque, NM 87131 Email: [email protected]

Downloaded from cpj.sagepub.com by SAGE Pub on August 1, 2010

724

Clinical Pediatrics 49(8)

brethren”); and (c) I enjoy speaking in front of audiences.2   4. I enjoy my colleagues. I have entrusted the medical care of my 2 children to several of them. They are excellent, caring physicians; and it is a privilege to practice with them. We don’t always get along (see item 4 in the next section), but I never have to worry about the care my patients are getting if I make a referral to one of them.   3. I like being a salaried physician and not having to worry about how many patients I’ve seen today or how much time I spend with a patient. The business side of private practice always appealed to my father more than to me. But there is a downside to this as well (see item 3 in the next section).   2. I love to teach. I didn’t choose an academic career—it chose me. When I finished my fellowship in adolescent medicine, I planned to work at an inner city clinic in Boston part-time and write novels. Instead, I received an offer to start my own division of adolescent medicine at a community hospital in Bridgeport, where I discovered how much I enjoyed teaching and writing. Teaching young medical students and residents is an honor and a privilege—one that I will never undervalue.   1. And the number 1 best thing about an academic career: You get to manage your own time and schedule. You set your own agenda. When I was a resident and did a 2-month stint in a private practice in Great Falls, Montana, I learned very quickly that I was completely at the mercy of the front desk schedulers and the nurses. I was given 3 exam rooms and was literally pointed in the direction of the next patient each time. Occasionally, I would have to sprint over to the hospital next-door for a C-section; and on returning, my 3 exam rooms would be filled with disgruntled parents. As an academic, I schedule my own time; and it is an incredible luxury. If “time is money,” then perhaps this makes up for the fact that my salary can’t compete with my former residents who have been in practice for only 2 years. Unfortunately, there seem to be an increasing number of irritations, distractions, and just plain disadvantages of an academic career these days.3

10. As a resident, I was lucky if my attending physician showed up on the ward for more than 2 to 3 hours a week. As a ward attending myself, I’ve spent many days and evenings examining patients, writing detailed notes (no more “Seen and agree” or you won’t get paid), and teaching the residents. The duties and responsibilities of an academic physician have been steadily ratcheted up during the past 30 years.   9. Academic physicians seem to be getting less and less respect these days. To date, I’ve written 12 books and more than 150 journal articles and book chapters. At our medical school, we have a distinguished professor designation; and a few years ago, I asked my Chair to nominate me. The criteria for a distinguished professorship are (a) scholarly work or research and (b) national and international reputation. My Chair’s response: “You don’t attend enough faculty meetings.” Sometimes, I feel like the Rodney Dangerfield of academia. Meanwhile, everyone in academia is subject to the anonymous feedback of medical students and residents who are sometimes way off-base. I suspect that most of us have received feedback comments at one time or another that if we were to use those same words and phrases to describe a medical student or resident, we’d be in deep trouble. Yes, because of the power differential, students and residents need to be able to comment on their professors anonymously; but they also need to be taught how to do that professionally and constructively. Destructive comments by students or residents need to be redacted before being passed on to faculty.   8. In academia, there are really only 2 positive reinforcements: salary and promotion. Salaries are strictly regulated, and promotion can only occur twice before you’re at the top of the heap. Very few academics ever get notes from their Chairs or Deans congratulating them on publishing a paper, completing a study, getting a grant, and so on. Perhaps this explains why academics sometimes remind me of cut-throat pre-meds: There are so few scraps of meat to go around, there seems to be nearly constant in-fighting and backstabbing. I’ve had colleagues who would probably sell me out for spare parts.   7. If you stay in academia long enough, you will be promoted eventually.4 Hence, the system

Downloaded from cpj.sagepub.com by SAGE Pub on August 1, 2010

725

Strasburger is flawed. The standards are frequently bent to accommodate someone who has not published or performed well but is “well liked” or has simply survived long enough. I’ve seen full professors with tenure who have published less than assistant professors. But woe to anyone who criticizes “the system” of promotion—that’s un-American and will not be tolerated by your higher-ups.   6. Few people in academia have the support that they need. Currently, I have one tenth of a secretary. When I began in academia 30 years ago, I had a full-time secretary. No business would make the demands on professors— teaching, writing, applying for grants, doing committee work—and not give them the resources necessary to do the job.   5. There seems to be increasing pressure on academic physicians to account for their time, to justify their salaries and their very existence! My medical school not only tracks relative value units (RVUs)—which are virtually meaningless in adolescent medicine—but also has a Faculty Activity Database that we have to update every 6 months, plus quarterly meetings with our Chair about our division and quarterly meetings with our administrators about finances. We’re about a hair’s breadth away from having to punch time cards. One of the reasons I went into academia was because I am extremely independent and capable of working without much oversight. My shoulders are beginning to ache from people looking over them.   4. I do a dozen to 2 dozen national and international talks per year. But I don’t really enjoy traveling or being away from home. Who in his right mind enjoys traveling these days? Yet, if you asked my colleagues, they would probably tell you that when I’m traveling, I’m probably really at the beach or playing golf or going to the movies. Giving lectures is work— hard work! I don’t just grab a jump-drive and hop on a plane—I carefully tailor my presentation to my audience, and I’m constantly updating my slides and videos depending on new research and new developments. Yet I feel as if my efforts go completely unappreciated by my colleagues.2 As if to confirm this, I am rarely asked to speak in my own department or medical school despite receiving excellent feedback when I do.

  3. Given the freedom I have to work at my own pace and develop my own schedule, I don’t expect to be paid what people in private practice are paid. But a resident 2 years out of residency can make more than I make after 30 years of practice. The salary standards set by the Associate of Administrators in Academic Pediatrics (AAAP) and the Association of American Medical Colleges (AAMC) are frustratingly low compared with private practice salaries. An adolescent medicine professor at the 50th percentile makes $166,000 a year according to the AAAP, less than a general pediatrician in academia ($181,000) and far less than a physician in practice for more than 3 years ($175,000-$271,000, according to the June, 2006 Allied Physicians survey). Is what we do that much less important?   2. Administrators are rapidly becoming the bane of my existence. Instead of making my job easier—which I naively thought is what they are supposed to be doing—they seem to come up with more and more paperwork, hoops to jump through, and mandatory meetings to attend. I find it amusing that to hire a new faculty person, you must write a novel’s worth of justification. But to hire a new administrator or dean, you “just do it.” We’ve got assistant, associate, and vice deans popping up all over the place.   1. And the number 1 worst thing about an academic career: The person who hires you (ie, your Chairman) will not be around after 5 to 10 years, so you may find yourself working for someone completely different. And if you stay in the same place long enough, you may find yourself working for several someones whom you may not be entirely happy with. By now, you’re probably asking, “Would I do it again?” And the answer is a definite yes—although, here’s the surprise: I would probably choose pediatric dermatology over adolescent medicine. Why? Because no one asks if a dermatologist is really necessary, there are no political “turf” battles, and most clinicians readily acknowledge that they don’t know enough dermatology. With adolescent medicine, if the Residency Review Committee didn’t mandate a month-long rotation, I’m not entirely sure we’d even exist; everyone thinks they know how to see and treat teenagers; and we overlap with too many subspecialties.5 In all of pediatric academia, adolescent medicine is probably the

Downloaded from cpj.sagepub.com by SAGE Pub on August 1, 2010

726

Clinical Pediatrics 49(8)

toughest subspecialty to pursue. So my hat goes off to all my adolescent medicine colleagues in academia— keep on truckin’! Declaration of Conflicting Interests The author declared no conflicts of interest with respect to the authorship and/or publication of this article. Funding The author received no financial support for the research and/or authorship of this article.

References 1. http://www.quotationspage.com/quotes/Benjamin_Disraeli 2. Strasburger VC. Have jump drive, will travel. Clin Pediatr. 2009;48:799-800. 3. Strasburger VC. Momma, don’t let your babies grow up to be academics! Clin Pediatr. 2000;39:167-168. 4. Strasburger VC. Thoughts on being promoted. Clin Pediatr. 1999;38:413-414. 5. Strasburger VC. W(h)ither adolescent medicine? Time to fish or cut bait. Clin Pediatr. 2008;47:228-230.

Downloaded from cpj.sagepub.com by SAGE Pub on August 1, 2010