April 23rd, 2014

The Challenges of Early Career Cardiologists in Academic Medicine


In a recent JACC paper co-authored by CardioExchange Editors John Ryan and Andy Kates, the challenges facing early career cardiologists in academic medicine are discussed. Ryan and Kates delve further into what these issues are and why addressing them is important.

John Ryan: The physician-scientist serves an important role by bringing advances in research into the clinical arena. To be trained in this role takes time, resources, and mentorship, features which are embedded in most academic cardiology fellowships. However, there is a legitimate concern that once fellowship is over and we take on junior faculty positions, the ability to protect one’s time and continue to develop becomes a major challenge. The challenges have evolved from cuts in research support and decreases in reimbursements from clinical activities. Whereas in the past, early career academic cardiologists were able to have more protected time in the absence of large NIH funding, this is no longer the case with providers spending more and more of their academic time on large volume inpatient and outpatient clinical service. Additionally, with funding lines being at historically low levels, it is difficult for MDs to compete against PhD candidates for the same funding sources – and in many regards PhD researchers are oftentimes at an advantage because of their dedicated research careers with no competing clinical interest.  Our survey of early career members within the ACC found that cardiologists were very concerned about their future within the academic sphere and added that financial disincentives and RVU tracking were driving early career cardiologists away from academic medicine. Solutions to address this are admittedly difficult to set in stone, but probably involve developing novel partnerships between university systems and clinical entities to provide stability during early career years.

Andy Kates: Academic cardiologists are a heterogeneous group of professionals, including physician-scientists, clinician-educators, clinician- educator administrators and pure clinicians. Some of the challenges that the clinician-educator and clinician-educator-administrator must deal with are related to the changing face of education. There are new, formal education requirements. For instance, the Next Accreditation System has fundamentally changed how we assess fellows. There are new ideas in curriculum development as well. Skills required to address these and other issues are rarely taught in fellowship. There are limitations to onsite mentoring and training and lack of access to professional education programs. Administrative time needs to be carved out for the early career professional who is seeking to establish a concomitant clinical practice. For fellows who chose the clinician-educator track, formal training in education, curriculum development, and educational assessment is needed. More challenging still is that for many of these early career professionals, these activities are rarely reimbursed. This may represent a significant challenge for the early career professional that is judged based primarily on RVUs. Lastly, traditional measures such as grant support and impact journal publications (with this exception) do not necessarily apply to this group as much so other markers of success must be considered when an evaluation for promotion is in order.

What do you feel are the challenges facing academic cardiologists? How can these be addressed?

3 Responses to “The Challenges of Early Career Cardiologists in Academic Medicine”

  1. I completely agree. I have been interested in establishing a mentoring academy consisting of semi or retired academically affiliated cardiologists with recognized teaching ability to help with this problem at little cost to their departments. However since this proposal does not generate income directly there seems to be little interest.

  2. Regina Druz, MD says:

    I agree with the points made by the authors. However, one needs to consider the following: are the cardiologists working in a university or medical school affiliated hospital truly can be called the ” academic” cardiologists? The academia denotes research and grant support, and these are often at odds with clinical, RVU generating activities. If the incoming junior faculty do not have training or support in their department needed to secure grants to supplement income lost from decrease in clinical productivity, then such an environment should not be called ” academic”. Instead, it should be called a salaried hospital position. It is important for fellows to undergo additional years of training beyond the standards of cardiac fellowship of they want to compete for grants and academic opportunities. Otherwise, they will be trapped in what appears to be an ” academic” position without any opportunity for actually realizing themselves in academic pursuits!

  3. Gervasio Antonio Lamas, MD says:

    As an established academic cardiologist with about a 60% clinical profile that has remained constant over decades, I can look back and tell you that some version of the same problems existed in the 80’s. Moreover, it is easy to become discouraged, move into private practice (or now 100% clinical employment), make more money straight off the blocks, and have a pretty nice life- no shame in that. If you want academics then you will trade $$ and weekends for career choice, at least for a time- no question. So how much is academia worth to you? Only you can answer this.

    How do you become successful in this academic jungle? You need a guide. More clearly – if you do not have a strong mentor, you will flounder. And picking a mentor is tough. Just look for someone having a career you would like – that’s the start. The rest is chemistry and having the mentor take ownership of your success – that is tougher. My mentor was Marc Pfeffer – still a close friend. Without him, my career would have been quite different.