Steven Block, MD

Carl Bose, MD

 

Life is a little like the game of "Chutes and Ladders" -- you are always climbing another ladder and finding yourself close to the first rung of the next one. You only hope that along the way the chutes that you eventually hit are the short and gentle ones. It is possible to limit the ups and downs depending on one's tolerance of risk and sense of entrepreneurism.

While for many who are seeking their first appointment out of fellowship, the notion of the first "real job" as a neonatologist may seem to be an end in itself, the reality is that this is just one more beginning. We call this chapter "getting ahead" because it looks beyond the selection of the practice venue to the skills and tools needed to develop a successful career. This section is not intended to provide a guarantee of success, but to guide the reader to ask of a prospective employer the questions that will give assurance that the practice is interested in the personal and professional development of its members.

The initial keys to success are clinical competency and finding the right match with a practice. There is a mutual commitment between the practice and its members to assure that the relationship is nurtured and the skills maintained. It is therefore critical to understand how people get along and that there is a commitment by the practice to continued education and maintenance of certification. These issues are handled elsewhere.

Getting ahead has different implications depending on the practice venue. However there are certain generalizations that may apply to all situations. A capable practice leader, whether s/he is the department chair of an academic department, the CEO of a multispecialty group, or the leader of a group of private practitioners, should have the interest of all members of the practice in mind. There is a "psychological contract" (Kraines) between the leader and the practice member which extends beyond the written performance contract signed at the time of employment. This unwritten contract is a set of tacit understandings and agreements that if violated lead to mutual dissatisfaction and potential failure of the relationship. The relationship between employee and employer is bidirectional and rests upon a series of subtle negotiations that are at the center of human relationships.

No short chapter can cover the spectrum of academic environments in detail. The following will look at some of the characteristics of the current academic environment for neonatologists and reflect on some of the potential topics of conversation that may help the job-seeker get a feeling for the "fit" that is needed for potential success and satisfaction.​

 

University-based academic venues

In academic medical centers there is a long tradition of advancement along the promotion pathway of the particular institution. It has long been said that once you have seen one medical school, you have seen one medical school. It is true that there are many different approaches to advancement in academia. However knowing the right questions to ask will give the applicant the understanding s/he needs to know whether this is the right environment for her/him. Scholarship, Tenure, and Career Development are strongly related concepts in the pathway to academic success.

 

Scholarship

Scholarship is the criterion that is rewarded in promotion programs within academia. Historically scholarship had been limited in scope to the product of research. It is reflected in the old concept of "publish or perish". In the last decade or so the changing environment of healthcare, and associated education and research, has led to a reappraisal of the definition of scholarship. The seminal work of Ernest Boyer [Boyer, E. (1990) Scholarship Reconsidered: Priorities for the professoriate. Princeton: Carnegie Foundation for the Advancement of Teaching] expanded the definition to include four general categories.

1. The "scholarship of discovery" is the traditional research-based scholarship mentioned above. Most medical schools have relatively clear criteria for promotion along this pathway, including:

  • the publication of peer-reviewed research,
  • a history of obtaining extramural funding for the research, and
  • participation in the review of articles for publication and grants.

The various ranks require a graded degree of accomplishment with an emerging degree of scholarship for the rank of assistant professor and established scholarship with substantial numbers of publications and an emerging track record of independent funding for the rank of associate professor. For the rank of professor many institutions require the most complete evidence of scholarship and an acknowledgement that the faculty member has a reputation on the national stage.

2. The "scholarship of application" is the scholarship that surrounds the application of known information to the "real world". In the case of neonatology this could be application of evidence-based medicine to the clinical environment. It becomes scholarship when the application of the information is evaluated in a rigorous fashion and the results of the application are shared with colleagues in a peer-reviewed fashion. Increasingly, academic publications are becoming based on critical analysis of clinical applications from the Vermont-Oxford Collaborative, the NICHD Network, the CPQCC, Pediatrix Medical Group, the Canadian Neonatal Network, and other similar collaboratives. Similar to the scholarship of discovery, increasing academic ranks require an increasing level of sophistication and recognition of the scholarship.

3. The "scholarship of integration" is that work that draws together many sources of information, evaluates the combined evidence and draws conclusions from the combined information. This work is then disseminated in a peer-reviewed fashion for use by peers and colleagues. Meta-analyses, Cochrane reviews, review articles and text books are examples of this form of scholarly work. Again, the degree of scholarship required for promotion increases with the rank sought.

4. The "scholarship of teaching" reflects excellence in teaching, but expands the scholarship to include an evaluative process that allows for external evaluation. Application of adult-learning principles to teaching, certification, and continuous professional development in addition to educational research and innovation may be included under the scholarship of teaching. . The barrier for promotion will again be lower for the lower ranks and very high for the rank of professor.

In all of these groups, which admittedly have indistinct borders, there is the common thread that the work, to be considered scholarship, must be subject to peer review and must be publicly disseminated in some form. These are has referred to as the "three Ps", namely "Public, Peer reviewed and having a Platform for future expansion and development". Many medical schools have accepted these general rules, but each school applies them differently and weighs the forms of scholarship differently.

Some medical schools also recognize administrative leadership as a pathway to promotion. As with other pathways to promotion (research, teaching, and clinical activities), there are often scholarship requirements attached to this pathway, which could involve related academic work in the fields of health administration, business, public health, or public administration.

 

Categories of Scholarship

  • Discovery
  • Application
  • Integration
  • Education
  • Administration
    ​

Combining the 4 career paths in academia (research, education, clinical service, and administration) with adaptations of the categories of scholarship:

  • Research (scholarship) types:
    • Laboratory research
    • Clinical research
    • Translational research
    • Epidemiology
    • Health services research
  • Career paths in education:
    • Educator
    • Developer of educational techniques
    • Educational planner and disseminator
    • Evaluator of education
  • Clinical service:
    • Service provider
    • Developer of innovative careovement​
  • Administration:
    • Program administrator
    • Developer of new programs and systems of care
    • Leader in quality improvement
 

It is important to inquire about the academic interests and the rules regarding advancement at the institutions of interest to you. If your interests and abilities are recognized and rewarded, fitting in and ultimate success are potentiated; if not, you will run the risk of slow personal and professional development because institutional culture change occurs rather slowly. The choice of an academic venue for practice should be exciting and rewarding. It is well documented that financial compensation alone does not provide for job satisfaction. Recognition of ones accomplishments in the promotions process is an important affirmation of the value that the school places on the faculty.

 

Tenure and Personal Career Development

 

Tenure

Tenure is a separate means of rewarding university faculty members. In general tenure implies a permanent commitment of the university or medical school to the employment of the faculty member. Definitions of tenure and the financial obligations of the particular school to tenured faculty members are diverse and generally unique to the school. Candidates for faculty positions at any school should be careful to explore the definition and application of tenure rules, including understanding whether the position for which they are applying is eligible for tenure. Many medical schools have tenure track and non-tenure track positions for clinicians. Often, the tenure track positions have a time line or "tenure clock" associated with them. The tenure clock may be 7 to 10 years, during which the faculty member must achieve tenure or change to a non-tenure track or leave the institution. It is important during the interview process to understand the rules of engagement for the job you are being recruited into and what the expectations are for promotion and tenure.

Characteristics of tenure and non-tenure tracks are listed below.

 

Tenure Track

  • Probationary period
  • "Up or out" (or change tracks)
  • Promotion based on defined criteria 
    • Always requires publication
    • Usually requires extramural funding
    • Criteria institution specific​
  • Promotion usually accompanied by tenure

 

Non-Tenure Track

  • Research vs. clinical or clinician-educator
  • Fixed term appointment
  • Salary range variable
  • Guidelines for promotion variable
  • Lower expectations for "academic productivity"
  • Becoming more common

 

Personal Career Development

In addition to understanding the meaning of scholarship and promotion at the prospective medical school at which you are about to become a new faculty member, you should reflect upon your personal skills and goals. Try to understand in advance how you will develop your career and be promoted. Career development is ultimately the faculty member's responsibility, but without the support and advice of those in the neonatology group, department of pediatrics, and the school as whole you will be less likely to succeed. Thus it is important to know up front what funds, time, collegial support (mentoring), and (if applicable) laboratory space are available for the faculty member to get started in the chosen pathway. It is especially important for the candidate to ask what time commitment will be given her/him to achieve the scholarship that will be rewarded with promotion and advancement in the institution. The candidate should obtain clarity on these issues during the interview process and negotiation phase.

 

Mentorship

No matter which definition of scholarship you have chosen to follow as you develop your career, it is hard to "go it alone". Trail-blazers have almost always preceded the new academic neonatologist, even if the pathway that is chosen is not identical to any that has been traveled before. Section heads and department chairs are generally charged with the development of new faculty and have an interest in the new hire's success. There are informal and formal mentorship programs at many medical schools that are designed to create and sustain momentum toward successful career development. As a new member of a group the neonatologist should ask about formal mentorship programs. If they exist they often have several senior colleagues with an interest in your field and who have a track record of personal success. These formal programs often have 2 or more members of a committee who are expected to meet with the young neonatologist at regular intervals to hear progress reports, brainstorm new projects and programs and set deadlines for productivity. Informal mentorship often requires the new faulty member to seek out collaboration with a colleague who is familiar with his/her field of interest. Collaborative efforts often grow out of these relationships that are beneficial to the careers of both partners. While the description of mentorship outlined here is most well-established among researchers, the principles are increasingly applied to the expanded definitions of scholarship. This is especially important for those interested in developing an academic career in the "non-traditional" arenas of scholarship.​

Academic practices have responsibilities in the areas of clinical care, teaching, and administration similar to mixed academic/private, hospital-based, or private practices, with the added priorities associated with the scholarship commitments discussed above. It is imperative that the discussion with a potential practice explore the time required to meet these needs. The combination of activities in academic practice yields a system involving unique personal and professional rewards and challenges similar across the practice types.

 

Personal rewards in academia

  • Self Gratification
  • Financial
  • Supportive of a life style
  • Personally rewarding ◦patient care
    • educating
    • committees
    • extracurriculars

 

Professional rewards of academia

  • Promotion
  • Recognition by peers
  • Request for professional services
  • Professionally rewarding ◦successful grants
    • research
    • publications
    • other activities

 

Challenge to academic and private professional life

  • Balancing personal and professional rewards
  • Responding to requests for participation in unrewarding activities
  • Balancing the demands of profession and family

In some locales, the academic practice has expanded its coverage to include less sick newborns (Level II care), well infants (Level I care), or outpatient care (specialized follow-up, developmental clinic, etc). The practice may cover one or several hospital sites of varied clinical intensity. Review of the practice's schedule sheet and call coverage can be a good place to start the discussion regarding time allocations among the clinical, educational, and research requirements for faculty members. As residents' and fellows' schedules are limited by the 80-hour rule and other educational commitments, the burden for rounds—direct care and oversight of advanced-practice nurses or physician assistants, parent communication, call coverage, and accommodation for colleagues' time away from the practice present real-world challenges. No one practice has THE solution for these issues, but any practice should be able to relate its current response to its present needs and to envision some adaptations needed in upcoming years. Once these ideas have been explored, a discussion of how the practice sees its new members (you!) fit in, function, and succeed can give another view on the concept of "fit".

 

Getting Ahead in Private Practice Neonatology »​

 

 

Last Updated

04/14/2022

Source

American Academy of Pediatrics