From Launch to Leadership: Successfully Navigating an Academic Career Path

Editor’s note: The opinions expressed in this editorial do not necessarily reflect the opinions of the AAMC or its members. Navigating an academic career path, from launch to leadership, is often an ongoing focus for members of the academic medicine community at all career stages. Getting established and translating one’s excellence in education, science, clinical care, and community mission areas to academic promotion are crucial steps for early- to mid-career faculty. Converting experience and contributions into expanded, responsible leadership roles in the field is a next-stage challenge. Understanding approaches that enable successful navigation along this path is a theme of several articles in this issue of Academic Medicine. One such approach is the Lasker Clinical Research Scholar Program1 of the National Institutes of Health (NIH), which was initiated in 2011 and represents a tremendous investment by the federal government in building clinical and translational investigation skills. Between 2011 and 2023, the Lasker Scholar program trained 39 scholars, including 1 dentist–scientist, 2 nurse–scientists, and 36 physician–scientists. Remarkably, the Scholars receive up to 10 years of research support from the NIH. Dearolf et al1 documented the academic productivity of most of the Lasker Scholars (n = 29) and a matched group of early-stage investigators (n = 121), finding that the Scholars had better outcomes with respect to publication numbers, weighted citations in the literature, and measures of clinical impact. The majority of the Scholars in the study identified funding stability, quality collaborators, a productive lab, and supportive peers, mentors, and work environment as facilitators of their development as independent investigators, while the disruption of the COVID-19 pandemic and administrative hurdles were seen as hindrances. Several of the Scholars have become researchers in the NIH intramural program. To strengthen career development of clinician educators, Martin et al2 describe the value of “academic catalyst” working groups—collaborations that can be as simple as informal email listservs organized around a common idea or as elaborate as service on a formal committee in a professional society. These working groups create openings for growth, learning, mentorship, and contribution beyond the local institutional setting, all of which are valuable for faculty development and for building toward academic promotion. The authors note the potential of working groups as communities of practice that are purposeful and goal oriented and that deliver valuable “wins” for the field and for group members. Examples of academic catalyst working groups that they include are related to a committee of the Society of Hospital Medicine and a hospitalist email listserv of Veterans Affairs, both of which facilitated academic publications by group members. In reading Martin et al’s article, I was reminded of my own early experiences collaborating with other trainees whom I met at national meetings of, for example, the Association of Academic Psychiatry, the Academy of Consultation-Liaison Psychiatry, and the Group for the Advancement of Psychiatry. Together we performed a series of studies on medical student health attitudes and needs, barriers to care, and the inspirational role of personal health experiences in becoming a physician and in caring for patients.3–13 The field of physician well-being was in its infancy. Very little attention had been given to the special issues of physicians-in-training when seeking health care, such as the dual role as learner and patient for medical students or the triple role as learner, employee, and patient for residents and fellows, the availability and adequacy of insurance, the problems of overwork and stigma, the role of “curbsiding” to obtain care informally, and patterns of deferring necessary care. Through our collaboration, we developed and piloted new survey instruments; figured out how to work with our IRBs, ensure confidentiality, and obtain informed consent; partnered with mentors and statisticians; agonized over analyses and manuscripts; and worked through authorship equity concerns. We overcame challenges, including the fact that we had few resources and our studies were self-funded. As an example of our “shoestring” approach, we “compensated” volunteers for their participation in our project by stapling bags of chocolate candy (which we paid for ourselves) to the paper surveys that we put into volunteers’ medical school mailboxes or distributed at student gatherings. We learned together, and we learned a lot. Ultimately, our group published several articles, including one of my first publications in Academic Medicine.3 Many of us went on to have substantial NIH-funded research portfolios. Over the years, members of the collaborative group have written letters of promotion for one another and have partnered on other research, including follow-on studies in undergraduate and graduate medical education and in clinical medicine. This early collaboration helped build the curricula vitae of quite a few of us as we moved forward in our faculty positions and was indeed a catalyst for academic advancement. Improving the academic promotion success of faculty through the creation of an institutional standardized approach—including targeted communications, the establishment of an “intent to apply” process, and templates and guides accessible to all faculty, as well as required coaching for all faculty—is described in the Innovation Report by Hill et al.14 Numbers of promotion applications and outcomes were assessed before and after this new approach was implemented. The findings are encouraging, with clear improvement in the numbers of faculty seeking promotion, including non-majority-identifying individuals applying at a rate more in keeping with their proportions on the faculty, as well as individuals seeking the rank of professor. Moreover, the faculty appear to have been better prepared, as the proportion of faculty successfully attaining promotion rose to 99% from the 90% who were successful before implementation of the institutional promotion support process and the requirement that all faculty engage in coaching. Perspectives on the transition to significant leadership roles by faculty with demonstrated excellence in science or education are given in 2 major Research Reports appearing in this issue of the journal. As part of a longitudinal NIH-funded study, Greene et al15 performed in-depth interviews with 60 clinician–scientists who had received NIH K08 or N23 Career Development Awards between 2006 and 2009 to explore their views of “pursuing, attaining, or rejecting” leadership roles. Themes in the interviews related to feeling unprepared for leadership roles that entail, for example, administrative, financial, accreditation, and related duties perceived to be far from the responsibilities of building research teams and laboratories. Mentors and sponsors were seen as helpful to individuals moving into leadership roles, and the potential for positive impact and influence was seen as a benefit of making that transition. That said, many interviewed did not see themselves in leadership roles and saw many downsides to leadership, including time-consuming administrative work that would take them away from their involvement in science. For those of us who love leadership and who feel honored to serve in leadership roles in academic medicine, the opportunity to bring people together with a common purpose is enormously fulfilling. Shouldering responsibility and learning to manage administrative, financial, and other tasks are all part of the challenge and the fun. It may be that clinician–scientists do not have sufficient exposure to positive role models who enjoy and derive great meaning from their leadership activities. In the second Research Report, 12 leaders who serve as designated education officers (DEOs) in Veterans Health Administration medical centers were interviewed by Bidwell et al16 about their work and challenges. The authors found that the DEOs had 4 areas of responsibility: fiscal, administrative, affiliate partnership, and education duties. They identified a number of competences necessary to perform their roles, such as program development, strategic planning, managing those above and those below in the organizational “chain of command,” negotiation, communication, and others. Importantly, the DEOs talked about how educational program oversight is different from other education, teaching, or mentorship roles and requires an expanded and distinct skill set. Based on the findings in these studies, Greene et al15 and Bidwell et al16 emphasized the need for additional training and professional development for mid-career and senior faculty who can, should, or do make the transition to expanded and high-responsibility leadership roles in academic medicine. Creating opportunities for structured experience and exposure to the positive aspects of leadership are clearly important. Training and professional development are needed to ensure preparedness and effectiveness in leadership roles that are built on, but are distinct from, excellence in fundamental mission areas of academic medicine, such as science or education. Such efforts also may dismantle the invisible barriers that prevent meritorious and capable faculty from seeking and flourishing in leadership roles, as noted in the report by Greene et al15 and others,17,18 such as narrow conceptualizations of who leaders should be, what leaders do, or how leaders should be identified. The Association of American Medical Colleges offers virtual and in-person leadership training,19 which has been valuable to me in my career and to many of my mentees who have gone on to assume significant leadership roles in our field. Navigating an academic career path entails developing a foundation of expertise, skills, and a body of work in the mission areas of academic medicine and then, with this foundation, finding ways to contribute to the betterment of human health. It is both correct and equitable that faculty earn academic promotion based on their foundational merit and on their contributions that have value and impact. But it is also clear that intentional approaches by collaborative groups, programs, and institutions can help faculty to build a strong foundation that enables and strengthens their contributions. No one is born knowing how to play the violin, as I often say, and it takes time, a love of learning, progressive challenges, and real dedication to become quite good at it. And not every violinist—not even every very talented violinist—will choose to take the path to become the conductor of an orchestra. The parallels to academic medicine are clear. It is understandable that taking a next step into leadership will not be the best choice for everyone who enters the field. Still, creating opportunities for earlier career faculty to be exposed to a range of leadership roles may illuminate an unexpected path forward for faculty from a variety of disciplines and backgrounds who are navigating their careers. Offering leadership training will allow talented individuals to develop the distinct competences that will be needed in roles of influence and consequence as we look to the future.