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Rheumatology fellows' perception on training and careers in academiaThe American College of Rheumatology Fellow Research and Academic Training Survey.

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Arthritis & Rheumatism (Arthritis Care & Research)
Vol. 61, No. 2, February 15, 2009, pp 266 –273
DOI 10.1002/art.24212
© 2009, American College of Rheumatology
ORIGINAL ARTICLE
Rheumatology Fellows’ Perception on Training
and Careers in Academia: The American College
of Rheumatology Fellow Research and Academic
Training Survey
THE YOUNG INVESTIGATOR SUBCOMMITTEE OF THE AMERICAN COLLEGE OF RHEUMATOLOGY
COMMITTEE ON RESEARCH
Objective. To examine the perceptions of rheumatology fellows regarding their research training, mentoring, and interest
in a career in academia.
Methods. We solicited by e-mail 386 fellows in the American College of Rheumatology 2005–2006 fellow database to take
an anonymous Internet-based survey addressing the topics of research training, mentoring, and interest in an academic
career.
Results. We received 176 responses (50% response rate after excluding invalid contacts) to the survey. During their
training, 58% of fellows reported an interest in academia and 21% in research. There was great satisfaction with
mentoring. However, there were concerns about academic salaries, with 50% of respondents stating a preference for a
higher paying community position. Furthermore, there were substantial concerns about the difficulty of generating funds
to cover salaries. In addition, several respondents viewed an academic career as incompatible with starting a family.
Compared with male fellows, female fellows were more likely to want a career in academics, were less concerned about
academic salaries, and were more concerned about funding and family life.
Conclusion. Despite an interest in academia and satisfaction with current mentoring, several barriers to academia were
identified among rheumatology fellows. The concern that academia and family life are incompatible needs further
attention. University deans should consider reevaluating promotion programs to make allowances for family and
parenting demands. Rheumatology division chairs should better promote the nonfinancial rewards of a career in
academia. Programs such as the National Institutes of Health Loan Repayment Program should be strongly advertised to
interested applicants with financial concerns.
INTRODUCTION
The decline in the number of physician researchers across
medicine has been well documented. Nearly 30 years ago,
the clinician investigator was described as “an endangered
species” by then National Institutes of Health (NIH) director James Wyngaarden (1). Ten years ago, Leon Rosenberg,
Professor of Microbiology at Princeton and a well-published authority on academic medicine, deemed physician
Dr. Mandl’s work was supported by the NIH (grant K23AR050607) and an Arthritis Investigator/Clinical Investigator Award from the National and New York State Arthritis
Foundation. Dr. Cron’s work was supported in part by the
Nickolett Family Awards Program for Juvenile Rheumatoid
Arthritis Research, the Foerderer Fund for Excellence, and
the Arthritis Foundation, Alabama Chapter Endowed Chair
in Pediatric Rheumatology. Dr. Lacaille is the Nancy and
Peter Paul Saunders Scholar and holds an Investigator
Award from the Arthritis Society of Canada. Dr.
266
scientists to be “endangered and essential,” suggesting a
collaborative national effort through the creation of a
“broad-based national panel of leaders” to develop recommendations (2).
The number of physicians choosing a career in research
has declined from 23,268 in 1985 (4.6% of the physician
work force) to 14,340 in 2003 (1.8% of the work force) (3).
The physician-scientist work force is also aging, with
⬃50% of NIH award recipients age ⱖ50 years (3). MeanDeane’s work was supported by the National Institute of
Arthritis and Musculoskeletal and Skin Diseases, NIH
(grant K23-AR051461). Dr. Franchin’s work was supported
by the NIH (grant F32-AI058520-01) and a Career Development Award from the SLE Lupus Foundation.
Members of the Young Investigator Subcommittee of the
American College of Rheumatology Committee on Research
are as follows: John FitzGerald, MD, PhD: David Geffen
School of Medicine, University of California, Los Angeles;
Lisa A. Mandl, MD, MPH: Cornell Weill Medical College,
ACR Fellows’ Research and Academic Training Survey
while, success for first-time physician R01 applicants has
been falling (4).
In response to these concerns, career development
awards have been expanded and the NIH Loan Repayment
Program was created in 2001. However, additional factors
such as the current difficult funding climate at the NIH and
private foundations and the associated faculty insecurity
may inhibit correction of recent trends. Examining the
concerns from the standpoint of fellows may provide insight into genuine barriers to pursuing an academic career.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) recently examined the success
of their training grant (T32, F32, K01, K08) recipients
between 1993 and 1997 (5). Ten years after the initial
training award, 17% of 271 T32 recipients had obtained
R01 funding, 78% had published within the last 10 years,
and 50% within the past 2 years. Among 58 K08 award
recipients, 55% had obtained R01 funding, 98% had published within the last 10 years, and 85% within the last 2
years. Therefore, the K08 mechanism was successful for
⬃50% of its recipients.
One of the working group’s final assessments was that
“the most significant impediment to attracting and retaining qualified individuals for careers in NIAMS-related
fields is the (accurate) perception that this is a high-risk
career path. All NIAMS-supported trainees eventually face
the increasing daunting challenge of achieving and maintaining independent R01 support” (5). In addition to recommending efforts to increase funding for training and
R01 grants, the working group recommended reinforcing
the value of grant writing and management, and the value
of mentorship.
Rheumatology as a field is not exempt from these concerns. The American College of Rheumatology (ACR) recently examined these issues in its 2005 work force study
of US rheumatologists (6). This study projected a shortage
of clinical rheumatologists by 2025, attributable to the
increasing prevalence of musculoskeletal disease in the
aging US population and a lack of projected growth in the
supply of rheumatologists. The study went on to examine
the health of academic rheumatologists, reporting that the
and Hospital for Special Surgery, New York, New York;
Randy Q. Cron, MD, PhD: University of Alabama at Birmingham School of Medicine; Diane Lacaille, MD, MHSc:
University of British Columbia and Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; Kevin
Deane, MD: University of Colorado, Boulder; Giovanni
Franchin, MD: Columbia University, New York, New York;
S. Sam Lim, MD, MPH: Emory University, Atlanta, Georgia;
Christy C. Park, MD, (Chair): Northwestern University Feinberg School of Medicine, Chicago, Illinois and University of
Tennessee Graduate School of Medicine, Knoxville.
The American College of Rheumatology is an independent, professional, medical, and scientific society which
does not guarantee, warrant, or endorse any commercial
product or service.
Address correspondence to John FitzGerald, MD, PhD,
University of California, Los Angeles Rehab Center 32-59,
1000 Veteran Avenue, Los Angeles, CA 90095-1670. E-mail:
jfitzgerald@mednet.ucla.edu.
Submitted for publication May 15, 2008; accepted in revised form October 16, 2008.
267
time to independent research status averaged 7– 8 years
after faculty appointment, with 35% of academic respondents reporting more than 9 years required to establish
independent status. The proportion of rheumatologists receiving independent grant support (defined by an R01
award) declined from 41% to 22%.
Of those respondents who left academics within the last
5 years, the reasons cited for leaving included lack of
support (50%), interest in higher paying jobs (50%), difficulty funding research (32%), shorter work hours (27%),
and inadequate mentoring (13%). The majority of those
leaving academics (61%) entered private practice.
In response to this information, the ACR and the ACR
Research and Education Foundation have committed to
expanding support of rheumatology training programs
through awards, recruitment initiatives for medical students and residents, and increased number of young investigator awards to “preserve our current academic programs” (7). The ACR Committee on Research also created
and charged the Young Investigator Subcommittee to explore how the ACR could best serve the needs of its
younger research members. To address these concerns, the
subcommittee developed a survey to assess the 2005–2006
rheumatology fellows’ interests in pursuing a career in
academics and research, and perceived barriers to a career
in academics. The results of this study are reported herein.
PARTICIPANTS AND METHODS
Participants. The Young Investigator Subcommittee designed the domains and questions for the survey (for a
copy of the survey see supplemental Appendix A, available in the online version of this article at http://www3.
interscience.wiley.com/journal/77005015/home), which
was then developed by the ACR staff for Web-based implementation. All rheumatology fellows in the ACR fellows’ database were solicited by e-mail in May 2006 to
complete the online survey. Two reminder solicitations
were sent in the subsequent 2 months. Participants completing the survey entered a drawing for a free registration
to the 2006 ACR Annual Scientific Meeting and free textbooks (adult or pediatric) as incentive to complete the
survey. Responses to the survey were collected without
personal identifiable data. Because the subcommittee had
interest in disseminating results of the survey, the University of California, Los Angeles Office for Protection of
Research Subjects reviewed the protocol and designated
the project exempt from further Institutional Review Board
review.
Data collection and analysis. Primary measures. The
primary goal of the survey was to assess fellows’ interests
in academic medicine, their perceptions of the quality of
their mentoring, and perceived barriers to a career in academic medicine, including concerns about funding, salary
compensation, and family life.
Other variables. Respondents were asked to describe
their type of rheumatology program (adult, pediatric, or
combined adult/pediatric programs), their year in fellowship, sex, age, race, and ethnicity. Respondents were asked
268
Young Investigator Subcommittee of the American College of Rheumatology Committee on Research
Figure 1. Response pattern from the Web survey. ACR ⫽ American College of Rheumatology; IP ⫽ Internet provider.
to describe their fellowship program’s hospital affiliation
(university, veteran, other government, or private) and the
number of fellows enrolled in the program.
Statistical analysis. The mean, median, and percent
responses were calculated. Bivariate analyses were performed using Student’s t-test, Wilcoxon’s pairwise comparisons, chi-square test, or Fisher’s exact tests as indicated. Analyses were weighted to adjust for potential
duplicate survey responses. Owing to the structure of the
Web-based survey, missing responses to individual questions were uncommon. Those records with missing responses were dropped from the related analysis. All analyses were conducted using SAS statistical software (8).
Survey response. The ACR maintains a database for US
and Canadian fellows for the purpose of communicating
with rheumatology fellows. During the 2005–2006 academic year, fellows’ names and program year (e.g., first
year, second year, or later) were available in the database
for 363 US fellows and 46 Canadian fellows (n ⫽ 409
fellows). For the same year, the Accreditation Council for
Graduate Medical Education recorded 380 US rheumatology fellows at 108 programs, suggesting the ACR database
was fairly complete (9).
For the 409 fellows in the database, there were 355 valid
e-mail addresses. Through 3 separate e-mail solicitations
toward the end of the academic year, we received a total of
185 responses from 128 unique user Internet provider (IP)
addresses. Six responses had little to no data (with less
than 1 minute spent at the Web site by the user) and were
dropped from the database.
Since many fellows may have completed these surveys
at work on shared computers, it is not surprising that we
received duplicate user IP addresses. Upon examining the
69 responses that did not have a unique IP address, we
used self-reported age, sex, race/ethnicity, program type,
and year of training to identify potential duplicate responses. We found 4 sets of duplicate user IP addresses
with indistinguishable self-reported descriptors for a total
of 10 responses. (Figure 1). We then looked at self-reported
research project titles and other fields. For 1 of the 4 sets,
the research project titles and other text fields were so
disparate that we determined these to be 4 unique individual responses. For 2 of the remaining sets (2 responses
each), the research titles or start-stop times completing the
webform indicated that they were duplicate responses.
There was 1 remaining set (2 responses) with an identical
user IP address and descriptors that we could not determine were unique, and therefore identified them as potential duplicates. This resulted in a final analytic sample of
173 unique respondents with 3 sets of likely duplicate
respondents (6 responses). For all analyses, the potential
duplicate responses were weighted by 50%, resulting in a
final weighted analytic sample of 176 fellows (50% response rate of those with valid e-mail addresses). From the
analytic sample, fellows spent a median of 10 minutes
completing the survey (25th, 75th percentiles 8, 14 minutes, respectively).
ACR Fellows’ Research and Academic Training Survey
Table 1. Descriptors of the 2005–2006 American College
of Rheumatology fellowship database
survey respondents*
Respondents
(n ⴝ 176)
Age, mean ⫾ SD years
Women
Race/ethnicity
White (non-Hispanic)
Asian/Indian
Hispanic
African American
Program type
Adult
Pediatric
Combined
Program year
First
Second
Third
Hospital affiliation
University
Veterans
Other government
Private
Fellowship program size, median
(25th, 75th percentiles)
33.3 ⫾ 3.8
56
57
36
4
2
81
14
4
44
43
13
90
47
23
15
4 (3, 6)
* Values are the percentage unless otherwise indicated.
RESULTS
Sample description. Respondents had a mean ⫾ SD age
of 33.3 ⫾ 3.8 years, 56% were women, and 57% identified
themselves as white (non-Hispanic), 36% Asian, 4% Hispanic, 2% African American, and 2% other (Table 1). The
majority of fellows were in adult rheumatology training
programs (81%) with a similar number of first-year and
second-year respondents (44% and 43%, respectively),
and 13% of respondents were in their third year or later.
Most fellows were affiliated with university hospitals
(90%), followed by programs that had affiliations with
veterans (47%), other government (23%), and private hospitals (15%). The total tallies to ⬎100%, since respondents
could check all that apply. Median fellowship program
size was 4 fellows (25th, 75th percentiles 3, 6, respectively).
Self-reported characteristics of research training.
When asked about the numbers of months available for
research, fellows reported a median 1 month of research
during their first year (25th, 75th percentiles 0, 2 months,
respectively), and a median 8 research months during their
second year (25th, 75th percentiles 3, 11 months, respectively). Fellows identifying an interest in academics or
research reported significantly more second-year research
months than fellows with a nonacademic interest (10 versus 4.5; P ⫽ 0.0009), as did fellows with interest in research versus fellows with interest in patient care (10
versus 6.5; P ⫽ 0.0004).
Fellows were further asked to describe how much of
269
their week was protected for research during their typical
research month. An equal number of fellows, ⬃1 in 6,
described their protected time for research as either ⬍60%
or ⬎90% during their research month. First-year fellows
reported having much less protected time than secondyear fellows. Again, fellows reporting an interest in academics or research described a greater amount of protected
time than their counterparts (P ⫽ 0.02 and 0.03, respectively). During their research month, 59% of all fellows
reported taking call and described their clinical workload
as moderately busy.
In addition to protected time, the fellows were queried
about available formal research training. Two-thirds of
fellows reported that their institution had specific research
training programs. Of those reporting structured training
programs, the described programs included research symposiums or classes (78%), Masters programs in research
(86%), or Doctoral programs (48%). However, 37% of
these respondents reported that they would need to find
funding if they wanted to take advantage of these programs. In a separate question, only 54% of fellows reported being aware of any grant-writing classes.
Fellow research and mentoring. Eighty-five percent of
fellows stated that they had a research project and all but
1 fellow identified a research project mentor. Fellows favorably described their research mentors, with 90% describing them as role models with high ratings regarding
their mentor’s reputation and track record with prior mentees. Mentor involvement included providing the project
(57%), helping design the fellow’s own project (65%),
providing funding (33%), guaranteeing to provide future
funds (11%), or being instrumental in obtaining funds
(28%). More than 50% of fellows reported being either
very or extremely satisfied with both the availability and
quality of their mentoring to date (52% and 53%, respectively). However, 59% of the fellows were unaware of any
formal research mentoring programs at their institution.
One of the fellows responded with the following qualitative comment: “At my particular institution, we could not
ask for better mentoring. It was the strong role modeling
that led me to decide to take an academic position despite
the loss of income, increased work load, and stress that are
inherent to academia.”
Self-reported interest in research or academia. Fellows
were asked to identify their principal career interest; 36
fellows (21% of respondents) identified research and 137
fellows identified patient care (3 missing responses) (Table
2). Of the 36 fellows expressing a primary interest in
research, 21 fellows expressed an interest in basic science,
21 for non–industry-based clinical or translational research, 3 for clinical trials, and 3 for health service research. The total sums to ⬎36 because fellows could identify multiple areas of interest. There were no differences in
research interest by sex or year of fellowship. As anticipated due to the structure of pediatric fellowships, fellows
enrolled in pediatric training programs were more likely to
express interest in research than were adult rheumatology
fellows (P ⫽ 0.03). All pediatric rheumatology fellowships
270
Young Investigator Subcommittee of the American College of Rheumatology Committee on Research
Table 2. Percentages of fellows responding agree or strongly agree to the following statements by stated career preference*
Interest in research
Interest in academics
Sex
Entire
sample
Patient care Research Nonacademic Academic
Men
Women
(n ⴝ 173)† (n ⴝ 137) (n ⴝ 36)
(n ⴝ 73)
(n ⴝ 100) (n ⴝ 75) (n ⴝ 97)
Research is stated as principal career interest.
I would like to pursue a career in academia.
Potential barriers to academics
Financial
If I wanted to pursue a career in
academics, I would be able to get a
position.
Obtaining funding is or will be difficult.
I am concerned about a lack of strong
divisional and/or institutional
support.
I would rather seek a higher paying job
than an academic position can offer.
Personal
Academic hours interfere too much with
home life.
Mentoring
I have had inadequate mentoring to date.
Baseline interest
I have never desired an academic
position.¶
Research is very important to me.
36 (21)‡
100 (58)‡
N/A
49
N/A
92§
4
N/A
32§
N/A
19
50
23
65§
62
62
58
45
73§
64
62
78
43
76
41
86
48
73
44
82
42
70
35
84§
49
48
55
22§
62
38§
58
40§
25
26
22
30
22
21
29
22
22
23
19
24
18
26
28
34
6§
64
4§
33
25
53
41
100§
29
71§
51
56
* N/A ⫽ not applicable.
† Three missing responses for most of these fields. Range 2–7 for missing responses.
‡ Number (percentage).
§ P ⬍ 0.05 between subgroups (e.g., patient care versus research respondents).
¶ Includes neutral responses.
are a minimum of 3 years, with greater time devoted to
research.
One hundred (58%) fellows stated that they wanted a
career in academics, whereas 73 preferred nonacademic
careers (3 missing responses). Fellows’ interest in academics was strongly correlated with their stated interest in
research (P ⬍ 0.0001), with 92% of fellows expressing an
interest in research stating that they wanted a career in
academics. By comparison, fellows expressing primary interest in patient care were evenly divided between academic and nonacademic careers (49% versus 51%). A
greater proportion of women versus men (65% versus
50%; P ⬍ 0.05) stated they were interested in academia.
Barriers to academia. We examined several potential
barriers to a career in academics, including concerns about
funding, mentoring, salary, work hour concerns, and baseline interest in academics and research. In addition to the
single-item Likert questions (for a copy of the questionnaire see supplemental Appendix A, available in the online version of this article at http://www3.interscience.
wiley.com/journal/77005015/home), qualitative responses
were also solicited. A total of 39 qualitative responses
(22.5% of respondents) were obtained and broken down
into the following categories by frequency of comment:
concerns about funding (17), concerns about salary (12),
comments on training (9), comments about mentoring (9),
and concerns about family life (6). Representative com-
ments are included below to supplement the quantitative
responses from the survey.
Baseline interest in academia, research, and perception
of mentoring. Neither lack of baseline interest in academics, interest in research, nor inadequate mentoring was
cited as a barrier to academics (Table 2). More than threequarters (78%) of fellows reported being satisfied with
their mentoring to date. However, several respondents emphasized the importance of early mentoring: “The critical
point is that mentoring is crucial for fellows at the beginning of their training,” and “We need time to think and
plan and meet with potential mentors early in the first year
of fellowship. We need help coming up with meaningful
projects that can [be] finished during fellowship.”
Financial concerns. Although two-thirds of fellows
(62%) believed that positions would be available to them if
they were interested in pursuing a career in academia,
nearly half of the fellows (43%) expressed concerns about
the potential lack of strong divisional or institutional support. Funding was the primary concern about pursuing an
academic career, with 78% of fellows stating obtaining
funding for their salary would be difficult (Table 2). When
specifically asked about the availability of funds for a
university position and the effort needed to obtain those
funds, only 9% of fellows responded that funding was
readily available for a research position, whereas 33% of
ACR Fellows’ Research and Academic Training Survey
271
Figure 2. Proportion of respondents describing the ratio of academic salary (for research and
clinical positions) to community salary.
fellows reported funding available for a university clinical
position. Two-thirds of fellows reported that with large
effort on their part, funding for a research or clinical position would be available. Some of the written comments
received follow here: “From personal observation of junior
faculty, funding for clinical research and even translational research is extremely difficult,” “While young researcher funding sources are available competitively, I am
concerned about the overall funding environment through
the NIH, etc.,” and “Academics seems like a fairly scary
proposition. Unsecured funding is getting more and more
difficult to obtain.” Funding concerns were more prevalent
among female fellows than male fellows (84% versus 70%;
P ⬍ 0.05).
Almost half of respondents (48%) stated that they would
rather pursue a higher paying job than an academic position would pay, with male respondents more likely than
female respondents (58% versus 40%; P ⬍ 0.05) to express
interest in a higher paying job (Table 2). Fellows were
separately asked how they thought an academic research
or clinical salary compares with a community salary. More
than half of the respondents reported that a research salary
would pay ⬍60% of a community salary. Fellows had the
impression that pay for clinical positions was better than
research positions but still sharply below community incomes (Figure 2). These perceptions accurately reflect the
results of self-reported incomes from the ACR work force
study (10). Again, the following written comments were
reported: “Until the academic centers can come up with
salaries that can be competitive, it is my opinion that the
academic rheumatologist will become a dinosaur,” and
“My student loans exceed $225,000, simple mathematics
drive the need for a higher paying position with a guaranteed income.”
Personal or family concerns. In today’s society, economic pressures and division of labor for parenting among
2 working parents is impacting the more traditional academic working model. Twenty-five percent of residents
stated that they thought academic hours would interfere
with home life (Table 2). There were several strongly
worded written comments describing the potential diffi-
culties of balancing family and academia: “Medical training to date has taken a toll on my family; they deserve
more of my time. This (more than money) is my primary
motivating factor in making a long-term career decision”
(male respondent), and “As a woman who wants to have a
family, I think that it’s difficult to be on a strict tenuretrack position without having the ability to put promotional evaluation on hold for one year [per] new child.”
DISCUSSION
Results from this survey provide several interesting insights. In contrast to our a priori concerns about the adequacy of mentoring, fellows reported being satisfied with
their mentoring. This was an encouraging finding, although this was a self-reported assessment and fellows in
training may not be the best judges of whether their mentoring is adequate. During fellowship, academic mentoring
is focused on learning skills and obtaining early funding.
Later, mentorship must include attention to career development, academic culture, long-term strategies for independence, and continued funding.
Despite current challenges, fellows still express interest
in academia. Training programs have an excellent opportunity during the fellow’s training to either favorably impress or discourage fellows about the potential rewards
from a career in academia, depending on how faculty
portray their job satisfaction.
Fellow respondents have identified several important
potential barriers to academia. With medical school debt
averaging $129,943 (11) in 2006 and 85% of students carrying more than $100,000 of debt at graduation (3), it is not
surprising that debt obligation was cited as a barrier to
academia. However, the NIH Loan Repayment Program
(http://www.lrp.nih.gov) offers an excellent means to
largely reduce this potential barrier. The program repays
the applicant’s educational debt (minus a small participant obligation) at the rate of 25% annually, up to a maximum of $35,000 per year for work in 1 of 5 areas (clinical
research, pediatric research, health disparities research,
clinical research for individuals from disadvantaged backgrounds, and contraception and infertility).
272
Young Investigator Subcommittee of the American College of Rheumatology Committee on Research
In 2007, the NIH Loan Repayment Program granted
1,646 awards totaling almost $74 million in payments.
Success rates for new and renewal applicants were 42%
and 72%, respectively (12). The NIH does not collect data
on applicants by specialty; however, rheumatology fellows
or recent graduates would be primarily applying to
NIAMS. In 2007, NIAMS ranked twelfth out of the 21
institutes for a number of awards (42 awards), eleventh for
total dollars awarded ($1.8 million), and fifth as a proportion of Loan Repayment Program dollars per total appropriations by institute.
Despite medical school debt and an accurate perception
of lower remuneration for academic positions, respondents expressed tolerance about lower salaries but significant anxiety about securing funds to cover these salaries.
Female fellows more frequently expressed these concerns,
perhaps a reflection of their increased interest in academia. The concerns expressed in this survey echo the
issues identified in the recent ACR work force survey (10).
Specifically, problems funding research and higher pay
ranked as the 2 highest reasons for leaving academia. A
preference for providing community clinical care was the
least cited reason for leaving academia.
As the time interval between postgraduate work and
K-award, as well as the interval between K-award and
R-award are increasing, young faculty need to find other
means of salary support or programs will have to provide
a greater share of young faculties’ salaries. The increased
funding pressure will inherently lead to attrition. The cost
of interrupting research support to an established laboratory can be enormous. With NIH paylines at ⬃10% of all
submitted grant proposals, a new investigator who misses
this cutoff after a few attempts faces the demise of a potentially promising career (13). Although this survey did
not directly address the psychological stressors associated
with the requirement to obtain research funding in academia, this is of particular concern in the current financial
state of the NIH.
Concerns about starting family life and a career in academia ranked as the second-highest concern among respondents. Although 65% of women and 50% of men in
our survey would like to pursue a career in academia, 29%
of women and 21% of men stated that “academic hours
interfere too much with home life.”
Attributable to the demands of medical education and
training, the decision to start a family often occurs about
the same time that an academic career is starting. Academic demands and family obligations compete for a finite
number of hours. The most intense academic demands are
made at the same time that parents need flexibility to care
for their young children.
The traditional academic tenure–track timeline does little to address the realities of family life. With greater
numbers of women entering rheumatology and the observation that some will opt to work part time, the projected
rheumatology clinical work force shortage may be even
worse for academia unless academic work schedules can
become more flexible. With co-parenting becoming the
model of family care, these concerns are not limited to
female rheumatologists and are likely to be more prevalent
in rheumatology today than they were in preceding de-
cades, unless universities respond to demographic and
cultural changes.
Along these lines, many institutions have begun to address these issues by giving candidates an additional year
before promotion evaluation for each new child. It is vital
to make academic institutions aware of these trends so that
such family accommodations can be incorporated more
universally.
The demands of private practice, in comparison with
academia, should not be underestimated by young rheumatologists. Some private practices have minimum billing
requirements or inflexible vacation and on-call schedules
for their most junior partners. Industry jobs may require
significant travel and can also have tight time demands.
These realities should be weighed against the perceived
challenges of academics.
Since academic careers are often not as lucrative as
private practice, rheumatology along with other similarly
structured divisions should stimulate their departments,
universities, and hospitals to help make their positions
more attractive to candidates, for example, by supporting
subsidized on-site day care, job sharing, or flexible job
hours. To retain the best and brightest physicians as investigators and teachers, it is vital to address the practical
needs of parents of young children.
Based on the results of this survey, approximately half of
rheumatology fellows are interested in academic medicine
and the majority is satisfied with their mentoring. However, major perceived barriers to a career in academic
medicine include concerns about funding and family life.
These findings do not bode well for the pipeline of
young academicians. There is clear data that funding is
harder to obtain, and it takes longer to develop research
independence. Meanwhile, greater pressures are being
placed on young graduates through greater family demands and higher indebtedness at culmination of training.
Lower remuneration does not appear to be as significant a
problem as does the anxiety about securing long-term
funding for academic salaries. Certain actions may be
taken at the division, department, or university level to
reduce barriers to academia and foster a better perception
about a career in academics. However, encouraging young
rheumatologists to consider academia would be unsound
unless advocacy work can be done at the national level to
bring about improvements in the availability of funding for
researchers and clinician educators.
The Association of Professors of Medicine recently
made recommendations for revitalizing the nation’s physician-scientist work force (3). Those recommendations
included focusing on physician-scientist retention and
mentoring, with emphasis on advancement and retention
of female physician-scientists.
ACKNOWLEDGMENTS
We would like to acknowledge the hard work and support
of the ACR staff who implemented the survey and collected the data, and specifically thank LaTanya Batts, the
ACR representative to the Young Investigator Subcommittee. We also wish to thank Dr. Jane Salmon, our respected
mentor and the ACR Committee on Research liaison rep-
ACR Fellows’ Research and Academic Training Survey
resentative, and Dr. Bevra Hahn for their review and comments on the manuscript, as well as the respondents who
participated in the study.
AUTHOR CONTRIBUTIONS
Dr. FitzGerald had full access to all of the data in the study and
takes responsibility for the integrity of the data and the accuracy
of the data analysis.
Study design. FitzGerald, Mandl, Cron, Lacaille, Deane, Franchin,
Lim, Park.
Acquisition of data. FitzGerald, Mandl, Cron, Lacaille, Deane,
Franchin, Lim, Park.
Analysis and interpretation of data. FitzGerald, Mandl, Cron,
Lacaille, Deane, Franchin, Lim, Park.
Manuscript preparation. FitzGerald, Mandl, Cron, Lacaille,
Deane, Franchin, Lim, Park.
Statistical analysis. FitzGerald.
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