After completing her bachelor’s degree, Louisa Holaday took a job as a compliance officer in the biological sciences division of the University of Chicago. Her job was to review research protocols submitted by physician-scientists and their research teams—and it sparked her desire not only to go to medical school, but to eventually incorporate research into her career.
“I realized that academic medicine had some great opportunities for doing work that was rewarding on an individual level, but also for being able to take that knowledge and make a bigger impact by doing research,” says Holaday, MD, who is now a third-year resident at Montefiore Medical Center in the Bronx in New York City.
In recent years, concern over the looming physician shortage has dominated headlines. But an equally pressing concern has been the declining numbers of physicians who choose a career in academic medicine--as researchers, educators, or medical school administrators.
That’s of tremendous concern to the academic medicine community, says Ross McKinney Jr., MD, AAMC chief scientific officer, who notes that supporting the next generation of physician-researchers and -educators is critical not only for the future of medical education, but for patient care and research.
“Because they care for patients, physician-researchers and physician-educators understand what patient care means, what patients need, and from that understanding comes motivation and research ideas,” he says.
“There is always a need to encourage medical students and residents to serve as future faculty, researchers, and educators.”
John P. Sanchez, MD
Rutgers New Jersey Medical School
In 2013, an NIH study published in Perspectives on Medical Education found that medical students are more likely to pursue careers in academic medicine if they participate in research or are influenced by a mentor during their education. Several academic medical centers have designed programs to do just that.
“There is always a need to encourage medical students and residents to serve as future faculty, researchers, and educators,” says John P. Sanchez, MD, assistant dean for diversity and inclusion at Rutgers New Jersey Medical School.
At the University of Arizona (UA) College of Medicine - Phoenix, educators were troubled by what they viewed as a lack of awareness among students about the nuts and bolts of careers in academic medicine.
Many students had misconceptions about academia—for instance, that academic physicians spent all their time in the lab and that salary, space, and positions were not negotiable. “They were not really prepared to think about having a career in academic medicine as they went through to their residency where some of the training is more hands-on,” says Kenneth Knox, MD, associate dean of faculty affairs and development at the UA College of Medicine - Phoenix. “That’s a lost time, where we don’t necessarily get to keep them in the fold.”
To remedy the problem, university leaders designed a credit-bearing course in 2014 for fourth-year students called A Career in Academic Medicine: Institutional Commitment Towards Early Awareness for the Future Physician. The course outlines the steps to an academic medicine career, options available within an academic setting, and tips for landing an initial academic appointment.
“The early awareness makes them think about decisions as they get through residency and fellowship that can best align them into the proper career choice that fits with their personality and goals and choice of lifestyle,” says Guadalupe Federico-Martinez, PhD, assistant dean for faculty affairs and development at the UA College of Medicine - Phoenix.
Faculty members are currently tracking students after they complete the curriculum to determine how well the course shapes their career outcomes. The first class of students to complete the course are just starting their fellowships, Federico-Martinez says.
Connecting students with mentors
For Holaday, mentors played a big part throughout her education by guiding her direction and sharpening her passion. “It’s absolutely invaluable to have mentors who are doing work that is inspiring to you and can help in terms of: what’s the path and how you get from here to there,” she says. “And [it’s important] to have people who will champion you and put you in positions where you’ll get more exposure and more experience.”
Faculty at the Florida International University Herbert Wertheim College of Medicine also recognized the value of mentorships in helping steer students toward a career in academic medicine. The medical school’s pipeline program—the Florida Science Training and Research Fellowship—connects undergraduate college students with program staff who follow them through medical school matriculation. Students are also assigned a research faculty mentor for an eight-week summer program at the university.
“The students have often extended their relationships with the mentors well past the eight weeks by either continuing to do research once the semester resumes or just having the opportunity to [have a relationship] from afar,” says Cheryl Brewster, EdD, associate dean of diversity at Florida International University.
“The early awareness makes them think about decisions in different ways as they get through residency and fellowship that can best align them into the proper career choice.”
Guadalupe Federico-Martinez, PhD
University of Arizona College of Medicine - Phoenix
The program also enlists social workers to help students discuss and overcome any barriers standing in the way. “We try to find out what exactly they are interested in,” Brewster says. “After the first year with us, they’ve been exposed to so many things related to being an MD, some say, ‘I really love research and that’s the route I want to pursue.’ We tailor the program to meet their needs.”
The program’s first cohort will be graduating in 2019, and Brewster anticipates another matriculation in the fall of 2019. “Mentoring students is very important—finding that connection. Students need to be able to identify with faculty and other physicians or health care providers for inspiration. They need to see what the possibilities are.”
Creating a more diverse academic medicine workforce
Meanwhile, Building the Next Generation of Academic Physicians (BNGAP), a novel initiative that includes more than 20 medical schools, is increasing the number of diverse medical students who pursue careers in academic medicine.
BNGAP conducts research and develops strategies to diversify the academic medicine workforce. Data show that only about 30% of faculty positions at academic medical institutions are held by women and minorities such as African Americans, Latinos, Alaskan Natives, and American Indians represent only 7% of faculty at U.S. medical schools.
Research by BNGAP and partnering associations found that many diverse medical students and residents felt they had no basic knowledge about academic medicine career options, nor had they received enough exposure to such career opportunities during training.
“What we found is that once we started talking to medical students about academia, they were excited. They felt like it was the first time anyone had presented this career opportunity to them,” says Sanchez, who is also BNGAP’s board president. “But overall, irrespective of race, gender, and sexual orientation, everyone reported that they felt that this wasn’t integrated into their medical school curriculum and that there was not transparency on how to enter into this.”
Based on the research, BNGAP leaders developed a 10-module curriculum centering on academic medicine career opportunities, which since 2015 has been implemented in 23 medical schools across the United States and Puerto Rico, Sanchez says. The modules have also been published within MedEdPORTAL.
“It's been an amazing journey for us to speak with the students, hear their concerns and translate that into a curriculum,” Sanchez says. “Our hope is that within the next two years, we will hit all of the medical schools.”