7 things to know before entering academic medicine

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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

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to build their own research program, whether or not they have a mentor.

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As clinicians, we spend a decade or more as trainees learning to take care of patients.

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When we finally start our careers, we want to build research programs, but then we find

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that our years of clinical training did not adequately prepare us to lead our research

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program.

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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

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However, clinicians hold the keys to the greatest research breakthroughs.

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For this reason, the Clinician Researcher podcast exists to give academic clinicians

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the tools to build their own research program, whether or not they have a mentor.

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Now introducing your host, Toyosi Onwuemene.

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Welcome to the Clinician Researcher podcast.

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I'm your host Toyosi Onwuemene, and it is my absolute pleasure to be talking with you today.

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Thank you so much for tuning in.

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I'm excited to bring you today's episode called Seven Things You Should Understand,

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You Should Know, Before You Go Into Academic Medicine.

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Seven Things You Should Know Before You Go Into Academic Medicine.

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This comes from a coaching session that we had yesterday, and I thought I needed to come

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on and share with my audience and to share with those of you who missed the coaching

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session what you really, really should understand about going into academic medicine.

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I have to say that I think people were somewhat shocked, but it was a good shock because it's

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good to know, to have a clear understanding of the lay of the land, because then you're

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able to go in strategically.

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You're not like me, like a dare stuck in the headlights when you start your academic position.

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And just to recall, and for those of you who've been listening to me for some time, you'll

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remember that I started my academic job totally clueless.

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I said, I want to do research.

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I want to do research.

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That's why I'm here in academia.

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And I ended up with a full-time clinical job, totally confused as to how it was that I wanted

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to do research, and I ended up with a 100% clinical position.

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I'm sorry, it was 80%, even though I was seeing patients five days a week.

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It was technically 80%.

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How did that happen to me?

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And so I want to share with you what the challenges are and what some of the drivers are that

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may be driving decisions that are happening outside of your purview so that you can prepare

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yourself to be ready to take on an academic job whenever you choose.

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Or at the end of this episode, you might say, well, academia is probably not for me.

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Thank you.

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And that's okay too, because what you want to do is you want to have a realistic picture

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of how you're going to move forward.

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Okay?

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All right, here we go.

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So first of all, you need to recognize that academic medical centers operate a business.

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Okay?

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I want to say that again.

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Academic medical centers operate as a business.

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Now, I know that you are a wonderful person.

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You are altruistic.

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You really want to take care of patients, and actually you feel like patient care should

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be free.

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And I'm not disagreeing with you there.

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I'm just saying that in this year, right now, 2024, it's not.

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And for that reason, you're going to have to reckon with the fact that you take care

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of patients within a business model.

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And for many physicians, especially my group of coaching clients who don't really care

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very much about money and don't necessarily want money to be front and center of the conversations

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that they're having, especially around patient care, I want you to know that even though

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it's not front and center for you, it is front and center for the people who run the business.

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Academic medical centers are businesses.

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Academic medicine is a business enterprise.

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Okay.

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Why is it important for you to know that?

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Businesses exist only when they profit.

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Okay.

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If a business is only able to meet its operating costs, that means that it is not able to really

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provide the services that it needs to.

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Businesses that operate at a profit are able to keep going.

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For that reason, the security of your job lies in the profit-making ability of your

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business enterprise.

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Okay.

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Again, this is not front and center for you, but when it comes to the powers that be at

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any academic medical center, the administrative team is thinking very seriously about the

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business enterprise.

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And whether you like it or not, you play an important role in the success of the business

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enterprise.

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Now, I'm talking about physicians as a group, right?

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I'm talking about you individually.

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You may not think your contribution is very much, but when it all comes together, you

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play a significant role in the success of the academic medicine business enterprise.

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I would like you, if you would please indulge me, would you just say after me, I play an

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important role in the success of my academic business enterprise.

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Okay.

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Now, I'm saying that to people clearly who are already in academic medicine.

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I am hoping that people who are not yet in academic medicine, at least committed as faculty

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members, are listening to me so that perhaps when you repeat after me, you're saying, I

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am going to play a role in the revenue generating capacity of the business enterprise.

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Okay.

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I forgot what I said the first time, so now I switched it up.

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But you know what I'm saying.

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The money that comes into the institution happens because of the work that you do.

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Thank you for keeping our academic medical centers funded.

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Thank you for doing the work that moves money into the academic medical center.

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You may be like, well, I'm a fellow.

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Yes.

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Thank you so much for the work you do that brings money into the academic medical centers.

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Thank you.

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Okay.

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This is important to recognize that academic medicine is a business.

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Here's a problem with the academic medical enterprise as a business.

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It's that things are shifting and businesses have to be able to pivot to stay afloat.

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So you can't just be like, this was my business model 20 years ago and it's a business model

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that we're still using.

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Businesses have to evolve.

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Okay.

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I'm going to stop at that for number one, which is recognize that academic medicine

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is a business.

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Now I'm going to move on to number two, which is to understand how academic medical centers

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make money.

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Okay.

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So think about all the things I said in number one, but now I want you to recognize how academic

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medical centers make money.

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Now the stuff that's really easy is like, of course, clinical dollars.

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Yes.

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Clinical services.

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Okay.

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And part of the clinical services are physician payments.

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So yes, you as a physician, whether you're in training or a faculty member, you help

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to make clinical revenue for the academic institution, right?

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Because you see patients, you generate bills.

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Ooh, you send patients off to get procedures.

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Okay.

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There are clinical services that may not necessarily require or depend on the physician, but the

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physician is helping to generate these clinical services.

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You send someone off to get PFTs.

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You send someone off to get different studies.

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Gosh, they're all escaping me now.

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You're generating revenue because now the clinical services are able to generate revenue.

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You send people to get lab draws.

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The lab services are generating revenue.

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So clinical services are a huge part of how academic medical centers make money.

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Now are clinical services the only way?

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No.

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Academic medical centers are academic.

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And so they are providing an academic service.

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And so yes, there are students, there are trainees within that academic framework.

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So medical students pay fees.

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So that also is part of the income.

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And also, GME is funded largely by Medicare.

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And so the government funds education as well.

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And so educational dollars are coming into the institution either through fees or through

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payments by the people who are invested in this education, or maybe even the VA as you're

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training some fellows who work at the VA.

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But dollars are coming in to support the education mission.

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Another way that academic medical centers make money is through philanthropy.

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Now philanthropy for some institutions is a big chunk of that, never bigger than clinical

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dollars, but still a significant portion.

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However, there are some institutions that don't really necessarily make a lot of philanthropy

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dollars.

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That's another strategy in which, and that's another way in which money comes into the

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academic medical center.

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And I want to talk about one more way.

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There are a couple of other ways, but I want to talk about one other way.

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One other way is providing operational services to hospitals that are part of the system.

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So if I'm going to use MD Anderson as an example, there's MD Anderson in Houston, which is the

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original MD Anderson, but there are MD Anderson's now all over the country.

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And there is a price, a cost to using the MD Anderson name.

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There is benefit, and there's also a cost to the people who are using the name.

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And that's another way that revenue can be generated.

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So there are a number of ways that academic medical centers generate revenue, but by far,

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the most important, the most critical to an academic medical center's business enterprise

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is clinical dollars.

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And you as a physician are very important part of that revenue generation process.

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Now here's what's happening in the landscape of academic medicine and the landscape of

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medicine in general, is that there are declining reimbursements for the same services.

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And so people are still sick, we're still doing the things that we've been doing to

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them for ages, and we're getting more sophisticated.

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Our treatments are becoming more expensive.

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Everything is becoming more expensive, but guess what's happening in the government circles?

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Reimbursements are declining for government paid services.

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So Medicare is a huge portion of any academic medical center's practice in terms of who

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are the insurance providers that are paying for people to be seen, and over time, less

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and less money is coming in, and we're seeing more and more people come in who are Medicare

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population, the part of Medicare population.

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What does that mean?

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It means with declining reimbursements, you need to do more with less to be able to keep

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the business afloat.

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Remember, number one, academic medical centers are a business and they've got to stay profitable.

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So what happens if you are getting less money for the same services, then the squeeze starts

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to happen, right?

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People are asked to do more, they're asked to do more with less.

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People start to feel the pressure, they feel the pressure of the business, they feel like,

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oh my gosh, I thought I was here to care for patients, I hate this feeling.

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People are calling you all the time, close charts.

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Yes, you are feeling the squeeze because in healthcare generally, everyone is feeling

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the squeeze of declining reimbursements with increasing cost of care.

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It's one thing if the reimbursements are declining and the cost of care is the same, the cost

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of care is increasing and the reimbursements for care continue to decrease.

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Okay, now, why does this matter to you?

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Why does this matter to you?

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Number three is for you to recognize your role in the business, recognize your role

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in the business.

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If academic medical centers are a business that can only profit, that profit to be able

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to stay afloat and their biggest revenue generation is clinical services and you are a provider

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of clinical services, then recognize that you are an important piece of the revenue

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generation framework.

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When it comes to your institution, when it comes to your academic medical center, you

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are a critical piece of the revenue generation framework and the more your specialty brings

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in dollars, the more you are critical.

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Even if your specialty does not bring in a lot of dollars, wow, you still got to be able

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to make that revenue.

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The reality of the pressure you feel to see more patients with less resources is real.

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It is a real thing.

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That is what's happening at academic medical centers across the country.

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It's been a trend that's been shifting over time.

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We're going to continue to feel it more and more and more.

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Okay, I want to share that, you know, for many people, I hear people say, oh, yeah,

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yeah, yeah, I really am just here for, I mean, I really want to take care of patients.

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So it's a win, right?

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It's a win because you take care of patients, you love to care for patients and the academic

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medical center wants you to take care of patients because it's generating some revenue.

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And so it's a win-win.

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But here's the thing though, you didn't come to academic medical center to only see patients,

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right?

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Yesterday, I had the privilege of being with a fantastic group of early career people who

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were really thinking critically about how they contribute to the academic mission.

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And when they talked about the things that they really love about academic medicine,

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they talked about things like, you know, the ability to really think about the patient

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problem and really help somebody.

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They talked about the ability to teach and really pass on to the next generation.

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They talked about the ability to do research and generate new knowledge.

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And they love that academic medicine gives you all these things that you can do.

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And oh my gosh, it was so beautiful listening to them.

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I was like, academic medicine is so beautiful.

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Yeah.

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But here's the challenge now.

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There is increasing pressure to generate clinical revenue with declining reimbursements.

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And so over time, people are going to be asked to do more.

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But over time too, the question is, well, how can we continue to provide care in a way

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that's not so expensive?

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And to some extent, physicians, though they're the most, you know, one of the biggest revenue

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generators in an academic medical center, also tend to cost a lot, right?

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Because the biggest cost to any environment is payroll.

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And to any business environment is payroll.

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You got to pay the people who are working for you.

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And so here's why it now becomes important.

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Number four is understand how your academic pursuits fit within the revenue generation

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model.

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OK.

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So now when I talked about how academic medical centers make money, I talk about the importance

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of GME.

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I talked about, you know, fees from medical schools and things like that.

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But remember, I told you that the most important is clinical.

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OK.

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Now, you come into an academic medical environment and you're like, well, you know, I want to

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see patients, but I don't want that to be all that I do.

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I want to be able to teach and I want to be able to do research.

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And then you've got to say, well, how is what I'm doing making money relative to my ability

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to generate revenue from seeing patients?

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That's an important consideration that while you may not be thinking about the math, somebody's

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thinking about the math.

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And they're looking at you saying, hmm, so this person is able to generate significant

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clinical revenue with their specialized degree.

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And they want instead to forego that revenue generation so they can do some academic stuff.

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OK.

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OK.

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All right.

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OK.

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Let's let's make the math work here.

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Who is going to have to work extra so that this person can be covered in the academic

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pursuits?

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I think it's a well, I'm going to bring in grant funding like, OK, OK, when are you going

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to bring in the grant funding that allows you to contribute to the profitability of

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the of the of the of the enterprise?

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When are you going to do that?

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When you think about it, it takes years, especially for a physician to be able to grow in their

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research skills.

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So in prior episodes, I've talked about the fact that your clinical training, as amazing

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as it is, is really clinical training.

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It's not research training.

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And if you as a physician say, well, I want to do research, it's like great.

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But you have no research skills.

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You don't have a significant amount of research skills.

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So now you're going to forego your clinical dollars to get the skill that, you know, to

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be honest, my PhD researchers already have.

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Right.

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And so when you are a physician saying I want protected time, and I'm on to number five,

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to understand what it means to request protected time.

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So when you as a physician say, I want protected time, it's like, oh, you too.

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How is it going to be funded?

281
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That's the question that people are asking.

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How is it going to be funded?

283
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Who's going to give you money for this protected time?

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Because here I thought you were coming in to use your specialized surgical skills to

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build my organization to help keep us profitable.

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Because hey, payroll every month is as high.

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Of course, certain salary is kind of, it's a little bit higher than we like to pay.

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But you're telling me that you're not going to generate the revenue that pays that salary.

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You want to do what?

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You're like, I won't protect the time because I want to do research.

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Like, okay.

292
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And how are you qualified to lead research?

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Like, well, you know, I did a fellowship, I did a year and a half of research.

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Okay.

295
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So I was asking how, right?

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Do you understand the conversations that are going on around physicians wanting to lead

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research, right?

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So when you say I want to request protected time, you're saying for the next three years

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or more, I want to focus just on the research.

300
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I don't want to generate this clinical revenue that actually really easily funds my position

301
00:18:02,260 --> 00:18:07,580
or actually becoming less easy to fund my position, but it's still funding my position.

302
00:18:07,580 --> 00:18:09,380
I would like to forgo all of that.

303
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And I would like to focus on research and oh, I don't really have research training.

304
00:18:13,660 --> 00:18:16,380
So I'd like to invest my time doing the research training.

305
00:18:16,380 --> 00:18:20,500
I'm not going to be able to bring in any significant research dollars for the first five, six,

306
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seven, maybe 10 years.

307
00:18:22,180 --> 00:18:24,960
I hope that's okay with you.

308
00:18:24,960 --> 00:18:30,340
So I want you to understand the challenge and it's a big deal.

309
00:18:30,340 --> 00:18:33,860
And once upon a time, you know, you could say, well, you know, to be honest, we're making

310
00:18:33,860 --> 00:18:36,220
a lot of money from this clinical revenue.

311
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Let's just use some of that money to fund the academic mission.

312
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And to a great extent, that's still what's happening.

313
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But again, remember I told you that the reimbursements are declining, the cost of care is going up.

314
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And so there is less and less margin for any medical dollars or clinical dollars to fund

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the academic mission.

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00:18:54,660 --> 00:19:00,100
And so the person who comes in and now says, I want protected time, there has to be a good

317
00:19:00,100 --> 00:19:06,940
justification of how this person merits the protected time and is going to use that time

318
00:19:06,940 --> 00:19:08,700
and be successful.

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Because what you're asking your institution to do is to make an investment and they want

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to see a return on that investment.

321
00:19:15,180 --> 00:19:18,620
It's like, okay, okay, we're going to make the investment, right?

322
00:19:18,620 --> 00:19:21,860
Because when you come in and you're like, I want protected time, you're not just asking

323
00:19:21,860 --> 00:19:23,740
for protected time, you're asking for resources.

324
00:19:23,740 --> 00:19:25,740
You're asking for a startup package.

325
00:19:25,740 --> 00:19:28,460
And it's like, okay, I'm going to make this investment.

326
00:19:28,460 --> 00:19:31,860
I'm going to lose out on your clinical dollars because you are in this space where you're

327
00:19:31,860 --> 00:19:36,780
trying to do research and I want to recoup my investment.

328
00:19:36,780 --> 00:19:42,500
When they look over time and clinicians in general who haven't had a lot of research

329
00:19:42,500 --> 00:19:47,460
training are not able to start bringing in significant research dollars very quickly,

330
00:19:47,460 --> 00:19:48,460
right?

331
00:19:48,460 --> 00:19:52,700
It takes you time to grow in skill and you're a masterful person.

332
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You're going to grow in skill, but it'll take you time because it takes time to grow in

333
00:19:56,900 --> 00:19:57,980
skill.

334
00:19:57,980 --> 00:20:01,460
And all this while people are like, we're not seeing those dollars coming in for research

335
00:20:01,460 --> 00:20:02,460
funding.

336
00:20:02,460 --> 00:20:06,020
We're not seeing those dollars coming in for research funding, but what we're seeing is

337
00:20:06,020 --> 00:20:10,340
loss of clinical revenue because you're not in the clinical space.

338
00:20:10,340 --> 00:20:16,780
So I say all that to let you know that there are some real pressures happening in the background.

339
00:20:16,780 --> 00:20:19,820
They may not be going on in your mind, but there are people crunching the numbers who

340
00:20:19,820 --> 00:20:25,600
are saying, where is this funding going to come from for this person who wants to spend

341
00:20:25,600 --> 00:20:28,980
a significant portion of time not generating clinical revenue?

342
00:20:28,980 --> 00:20:31,860
And you might be like, oh, I'm going to teach the fellows.

343
00:20:31,860 --> 00:20:37,120
There's a fixed pot of money that's coming in from GME and that pot of money does not

344
00:20:37,120 --> 00:20:38,820
make up for your clinical dollars.

345
00:20:38,820 --> 00:20:44,020
And so there is a real pressure and a real conflict of interest to support physicians

346
00:20:44,020 --> 00:20:49,180
in leading research programs, especially when they come in and they don't have the training.

347
00:20:49,180 --> 00:20:51,820
So I want it to be very explicit to you.

348
00:20:51,820 --> 00:20:57,980
So you recognize the currents that you are swimming against when you enter into the academic

349
00:20:57,980 --> 00:21:04,440
medical enterprise, or you recognize that it makes less and less sense for a physician

350
00:21:04,440 --> 00:21:10,660
who can generate significant clinical revenue to come in and spend all that time doing something

351
00:21:10,660 --> 00:21:16,860
that's largely unfunded by that person, at least for a fixed period of time.

352
00:21:16,860 --> 00:21:17,860
Okay.

353
00:21:17,860 --> 00:21:22,620
That brings me to number six, because I think all of that before now, to some extent, it's

354
00:21:22,620 --> 00:21:25,580
the good and the bad news because you want to know.

355
00:21:25,580 --> 00:21:27,740
You don't want to be naive like I was.

356
00:21:27,740 --> 00:21:31,140
This is why I'm here, because I don't want you to be like me and I don't want you to

357
00:21:31,140 --> 00:21:35,300
show up and be shocked when people were so shocked yesterday, which is why I was like,

358
00:21:35,300 --> 00:21:38,660
this has got to be an episode that I share with the rest of the community that wasn't

359
00:21:38,660 --> 00:21:39,660
there yesterday.

360
00:21:39,660 --> 00:21:44,980
And with you, my audience who I hope, well, maybe now you already know, or maybe if you

361
00:21:44,980 --> 00:21:52,140
didn't know, you know now, but it's important to recognize the reality of what's happening

362
00:21:52,140 --> 00:21:55,140
in academic medical centers.

363
00:21:55,140 --> 00:21:59,140
So the good news is that now you have this information.

364
00:21:59,140 --> 00:22:00,720
Number six is pertinent to you.

365
00:22:00,720 --> 00:22:03,020
Don't start an academic job until you're ready.

366
00:22:03,020 --> 00:22:04,020
Don't.

367
00:22:04,020 --> 00:22:06,180
Now here's the pressure that a lot of people feel.

368
00:22:06,180 --> 00:22:09,460
They're like, did you understand how much I owe in student loans?

369
00:22:09,460 --> 00:22:11,420
Do you understand how much I owe?

370
00:22:11,420 --> 00:22:12,420
And I get it.

371
00:22:12,420 --> 00:22:15,020
What you're saying is that you're feeling financial pressure.

372
00:22:15,020 --> 00:22:20,020
I want you to think about separating your financial pressure from your academic career.

373
00:22:20,020 --> 00:22:21,020
Separate the two.

374
00:22:21,020 --> 00:22:22,020
What do I mean by that?

375
00:22:22,020 --> 00:22:26,980
I'm saying, well, if your problem is revenue, then go do locums or something.

376
00:22:26,980 --> 00:22:28,800
Go moonlight.

377
00:22:28,800 --> 00:22:33,740
Go do something that generates the revenue for you, but that still leaves you time to

378
00:22:33,740 --> 00:22:36,540
really build an academic portfolio.

379
00:22:36,540 --> 00:22:38,660
Don't say I'm desperate for clinical dollars.

380
00:22:38,660 --> 00:22:40,220
I'm desperate for money.

381
00:22:40,220 --> 00:22:42,500
So I'm just going to take a job and just whatever.

382
00:22:42,500 --> 00:22:47,180
We'll just let whatever will be will be because it doesn't have to be that way.

383
00:22:47,180 --> 00:22:51,020
Again, I'm not saying that you shouldn't take the academic job, but I'm saying that if you

384
00:22:51,020 --> 00:22:55,380
understand the pressures of an academic medical institution, you recognize that if you're

385
00:22:55,380 --> 00:23:00,140
going to come to the table in your negotiations and you're going to say, I want protected

386
00:23:00,140 --> 00:23:06,060
time, you've got to show up as a candidate who is ready for that investment.

387
00:23:06,060 --> 00:23:09,480
You can't be like, well, I'm going to figure it out in three years because institutions

388
00:23:09,480 --> 00:23:11,420
don't have three years for you to figure it out.

389
00:23:11,420 --> 00:23:16,020
And at the end of it, you're kind of like right back where you were at the beginning,

390
00:23:16,020 --> 00:23:21,220
only now they've invested a couple of hundred thousand dollars to figure that out.

391
00:23:21,220 --> 00:23:25,500
So understand that people now are very selective in who they're investing in.

392
00:23:25,500 --> 00:23:27,540
Yes, there's disparities in that process.

393
00:23:27,540 --> 00:23:29,740
There's bias in that process.

394
00:23:29,740 --> 00:23:34,940
But if you're going to be the candidate that shows up at the door saying, I want protected

395
00:23:34,940 --> 00:23:38,540
time because I want to lead a research program, then you got to show up ready.

396
00:23:38,540 --> 00:23:39,740
And what does that mean?

397
00:23:39,740 --> 00:23:42,340
You've got to show up with publications.

398
00:23:42,340 --> 00:23:47,140
And publications now are the currency of academic medicine.

399
00:23:47,140 --> 00:23:50,020
And it's not really publications or the sign really.

400
00:23:50,020 --> 00:23:57,180
They're just the evidence of the value you've created in research or in scholarship in general.

401
00:23:57,180 --> 00:24:00,660
Sometimes people spend three years doing a research project that doesn't result in a

402
00:24:00,660 --> 00:24:01,660
publication.

403
00:24:01,660 --> 00:24:03,820
Does it mean that you didn't learn or that that time was wasted?

404
00:24:03,820 --> 00:24:04,820
It doesn't.

405
00:24:04,820 --> 00:24:07,500
But publications are one way of saying, I did it.

406
00:24:07,500 --> 00:24:08,500
I did it.

407
00:24:08,500 --> 00:24:10,500
And here's the evidence.

408
00:24:10,500 --> 00:24:12,320
And then grant funding too.

409
00:24:12,320 --> 00:24:19,060
It's like, oh, I'm not just coming and saying, hey, give me money or I'm hopeful or wishful

410
00:24:19,060 --> 00:24:21,860
that in the future I'll be able to get grants.

411
00:24:21,860 --> 00:24:25,640
When you come in and you've already had experience applying for grants and maybe even have one

412
00:24:25,640 --> 00:24:28,300
or two grants, you can say, I know how to do this.

413
00:24:28,300 --> 00:24:30,100
I've done this before.

414
00:24:30,100 --> 00:24:33,740
And I'm going to continue to grow in skill, but I already know what it takes.

415
00:24:33,740 --> 00:24:38,700
So what you want to do is you want to come to the table.

416
00:24:38,700 --> 00:24:40,820
You want to come strategically.

417
00:24:40,820 --> 00:24:42,220
So that's number seven.

418
00:24:42,220 --> 00:24:44,580
Prepare yourself strategically.

419
00:24:44,580 --> 00:24:47,180
Don't just show up at the door like I did.

420
00:24:47,180 --> 00:24:52,220
And this is, again, I think I'm so grateful for my younger self and for how naive she

421
00:24:52,220 --> 00:24:58,580
was because here I am now sharing with you so that you don't have to be naive like me.

422
00:24:58,580 --> 00:25:02,780
Don't just show up at the door and say, hey, I want the protected time.

423
00:25:02,780 --> 00:25:06,420
People who are counting the money in the background, they can start laughing.

424
00:25:06,420 --> 00:25:09,820
They're like, ha, ha, ha, ha, ha, ha, ha.

425
00:25:09,820 --> 00:25:10,820
No.

426
00:25:10,820 --> 00:25:16,980
And then the people who really want you to succeed as a researcher or succeed as a scholar,

427
00:25:16,980 --> 00:25:18,760
they want to make a case for you.

428
00:25:18,760 --> 00:25:25,260
But then they are like, well, you know, this person only has a clinical background.

429
00:25:25,260 --> 00:25:28,700
This person has demonstrated prowess in clinical things.

430
00:25:28,700 --> 00:25:31,580
I see no evidence that this person has scholarship.

431
00:25:31,580 --> 00:25:34,260
There's no real track record of scholarship.

432
00:25:34,260 --> 00:25:40,180
How do you ask that person to go make a case for you with the bean counters as to how you're

433
00:25:40,180 --> 00:25:46,820
going to succeed as a scholar if they don't have anything to go by?

434
00:25:46,820 --> 00:25:48,900
And if they ask you like, OK, so what do you want to do?

435
00:25:48,900 --> 00:25:50,940
And you're like, I just want to do research.

436
00:25:50,940 --> 00:25:51,940
What do you want to do?

437
00:25:51,940 --> 00:25:52,940
I just want to do research.

438
00:25:52,940 --> 00:25:53,940
What's your goal?

439
00:25:53,940 --> 00:25:54,940
And you're not specific.

440
00:25:54,940 --> 00:25:56,620
You have no clarity.

441
00:25:56,620 --> 00:26:00,660
You can't show a record of having done the work over time.

442
00:26:00,660 --> 00:26:03,900
It just makes your case not very strong.

443
00:26:03,900 --> 00:26:05,740
And what does a strong case look like?

444
00:26:05,740 --> 00:26:10,700
So now I interview faculty who come through our division and people will just show up

445
00:26:10,700 --> 00:26:12,300
and say, yeah, I want to do research.

446
00:26:12,300 --> 00:26:15,820
OK, how much of your time do you envision doing research?

447
00:26:15,820 --> 00:26:21,180
And somebody who's barely had any research training said, you know, I like research,

448
00:26:21,180 --> 00:26:22,660
but I like patient care.

449
00:26:22,660 --> 00:26:26,860
So I was thinking maybe 25% of my time, maybe 50%.

450
00:26:26,860 --> 00:26:30,220
And those of us who know are like, this person doesn't know.

451
00:26:30,220 --> 00:26:33,420
Because 25% patient care is kind of like 50%.

452
00:26:33,420 --> 00:26:37,060
50% patient care is kind of like 80%.

453
00:26:37,060 --> 00:26:40,260
And 60% to 70% patient care is really like 100%.

454
00:26:40,260 --> 00:26:43,500
Actually, to be honest, 50% is really like 100%.

455
00:26:43,500 --> 00:26:45,500
But I'm trying to be conservative here.

456
00:26:45,500 --> 00:26:46,620
But you understand what I'm saying.

457
00:26:46,620 --> 00:26:51,020
So when someone who's never done any research, who's not had any significant research training

458
00:26:51,020 --> 00:26:55,980
shows up at the door and says, I have a lot to learn, but I'd like to do it in 25% of

459
00:26:55,980 --> 00:26:59,620
my time, we know that that person doesn't understand what they're getting themselves

460
00:26:59,620 --> 00:27:00,620
into.

461
00:27:00,620 --> 00:27:04,140
And clearly, they don't know what it takes to succeed as a researcher, because research

462
00:27:04,140 --> 00:27:05,140
is a full time job.

463
00:27:05,140 --> 00:27:11,980
And when somebody says 75%, that's not even really enough, because you really need 100%

464
00:27:11,980 --> 00:27:15,660
to be able to understand, to really learn, to learn the skills, and then later on, you

465
00:27:15,660 --> 00:27:17,100
can cut back.

466
00:27:17,100 --> 00:27:19,860
But you need a lot upfront.

467
00:27:19,860 --> 00:27:24,540
And so when you are coming to your academic job, and you're asking for that time, be clear

468
00:27:24,540 --> 00:27:25,740
what you need.

469
00:27:25,740 --> 00:27:27,820
Be clear what it's going to give you.

470
00:27:27,820 --> 00:27:32,700
And be very specific as to how you see your career unfolding.

471
00:27:32,700 --> 00:27:37,820
If you are not clear as to how your research career unfolds, you cannot convince anybody

472
00:27:37,820 --> 00:27:38,820
else.

473
00:27:38,820 --> 00:27:43,620
That's what you're going to fall into the pot of people who are going to generate clinical

474
00:27:43,620 --> 00:27:45,700
revenue for the institution.

475
00:27:45,700 --> 00:27:48,260
And it's not a bad thing to generate clinical revenue.

476
00:27:48,260 --> 00:27:50,060
Again, it's a great service.

477
00:27:50,060 --> 00:27:54,420
The institution runs on clinical revenue, but you're not going to achieve your academic

478
00:27:54,420 --> 00:27:55,420
pursuits.

479
00:27:55,420 --> 00:27:59,660
And for many of you, you're coming to academic medicine, not just so you can see patients,

480
00:27:59,660 --> 00:28:04,540
you're coming so you can satisfy that part of you that wants to build the legacy through

481
00:28:04,540 --> 00:28:08,340
education, that wants to contribute through research.

482
00:28:08,340 --> 00:28:10,500
And so if that's what you want to do, then you got to be prepared.

483
00:28:10,500 --> 00:28:11,900
You got to be prepared.

484
00:28:11,900 --> 00:28:13,260
You got to be prepared.

485
00:28:13,260 --> 00:28:14,940
You got to be prepared.

486
00:28:14,940 --> 00:28:15,940
All right.

487
00:28:15,940 --> 00:28:18,180
I hope this has not been bad news.

488
00:28:18,180 --> 00:28:24,340
And even though, even as I say it, I recognize that to some extent, it's an eye-opening conversation,

489
00:28:24,340 --> 00:28:26,460
one that I want to have with as many people as possible.

490
00:28:26,460 --> 00:28:29,660
And for that reason, I want to invite you to please share this episode.

491
00:28:29,660 --> 00:28:34,640
Please, please, please, if you share no other episode on this podcast, I want you to share

492
00:28:34,640 --> 00:28:35,640
this episode.

493
00:28:35,640 --> 00:28:38,060
Because people need to know.

494
00:28:38,060 --> 00:28:43,700
There need to be fewer people showing up wide-eyed and bushy-tailed like a dare stuck in the

495
00:28:43,700 --> 00:28:46,540
headlights like I was saying, I want to do research.

496
00:28:46,540 --> 00:28:48,460
I have no idea exactly what research I want to do.

497
00:28:48,460 --> 00:28:51,100
I have no real significant research training.

498
00:28:51,100 --> 00:28:55,380
And yes, I don't want to do the clinical time that you say I should do.

499
00:28:55,380 --> 00:28:57,700
And in reality, it's not realistic.

500
00:28:57,700 --> 00:29:01,700
But when somebody shows up at the door and they're like, yeah, I've been doing research.

501
00:29:01,700 --> 00:29:05,780
I've published these number of papers and I've been focused in this area.

502
00:29:05,780 --> 00:29:10,260
And in the next three years, I'm going to build this portfolio in this specific area.

503
00:29:10,260 --> 00:29:12,380
And then I'm going to apply for funding.

504
00:29:12,380 --> 00:29:14,820
That's a different experience.

505
00:29:14,820 --> 00:29:16,820
That's someone who's very clear.

506
00:29:16,820 --> 00:29:21,420
That's somebody who I can see this because they're telling it to me in a way that's very

507
00:29:21,420 --> 00:29:22,420
clear.

508
00:29:22,420 --> 00:29:26,140
And so really, this episode is not to bring you bad news.

509
00:29:26,140 --> 00:29:28,340
It's to help you be strategic.

510
00:29:28,340 --> 00:29:31,700
It's to help you prepare to be strategic.

511
00:29:31,700 --> 00:29:34,820
It's to help you prepare to show up and get the job you actually want.

512
00:29:34,820 --> 00:29:40,380
And be able to craft the job that you actually want.

513
00:29:40,380 --> 00:29:42,300
As always, I'm here to help you.

514
00:29:42,300 --> 00:29:43,660
I do coach.

515
00:29:43,660 --> 00:29:50,140
And I would love to help you craft your strategic plan as you move forward into your research

516
00:29:50,140 --> 00:29:51,140
career.

517
00:29:51,140 --> 00:29:55,860
And I will tell you that if you are a fellow or you are still in training, you can come

518
00:29:55,860 --> 00:29:58,580
to my coaching sessions on Mondays.

519
00:29:58,580 --> 00:30:01,620
And they are free to fellows, free to trainees.

520
00:30:01,620 --> 00:30:07,900
And just send me an instant message through or direct message through LinkedIn.

521
00:30:07,900 --> 00:30:12,140
And I will give you information about registering for these sessions.

522
00:30:12,140 --> 00:30:16,740
But I really want to help you because I don't want anybody to end up struggling in the way

523
00:30:16,740 --> 00:30:17,740
that I did.

524
00:30:17,740 --> 00:30:20,580
And maybe struggle is good for you, but people quit.

525
00:30:20,580 --> 00:30:22,780
People quit because it's so hard.

526
00:30:22,780 --> 00:30:26,620
And even when you have everything, all your docs in a row, it's still hard.

527
00:30:26,620 --> 00:30:30,060
And you can make it because you have already made it.

528
00:30:30,060 --> 00:30:32,260
You've shown yourself to be someone who can succeed.

529
00:30:32,260 --> 00:30:33,260
All right.

530
00:30:33,260 --> 00:30:34,260
Let's summarize those seven steps.

531
00:30:34,260 --> 00:30:37,020
Number one, recognize that academic medicine is a business.

532
00:30:37,020 --> 00:30:40,420
Number two, understand how academic medical centers make money.

533
00:30:40,420 --> 00:30:45,740
Number three, recognize your role in the business making, in the money making for the business.

534
00:30:45,740 --> 00:30:50,220
Number four, understand how your academic pursuits fit within the revenue generation

535
00:30:50,220 --> 00:30:51,220
model.

536
00:30:51,220 --> 00:30:55,100
Number five, understand what it means to the business system for you to request protective

537
00:30:55,100 --> 00:30:56,100
time.

538
00:30:56,100 --> 00:30:58,940
Number six, don't start an academic job before you're ready.

539
00:30:58,940 --> 00:31:01,620
And number seven, prepare yourself strategically.

540
00:31:01,620 --> 00:31:03,380
All right.

541
00:31:03,380 --> 00:31:07,860
Next time on this podcast, I'm going to talk about what it means to be prepared strategically.

542
00:31:07,860 --> 00:31:11,340
So I hope you'll join us and share this episode widely.

543
00:31:11,340 --> 00:31:17,140
I look forward to talking with you again next time on the Clinician Researcher Podcast.

544
00:31:17,140 --> 00:31:24,100
Thank you for listening.

545
00:31:24,100 --> 00:31:29,460
Thanks for listening to this episode of the Clinician Researcher Podcast, where academic

546
00:31:29,460 --> 00:31:34,900
clinicians learn the skills to build their own research program, whether or not they

547
00:31:34,900 --> 00:31:36,260
have a mentor.

548
00:31:36,260 --> 00:31:42,360
If you found the information in this episode to be helpful, don't keep it all to yourself.

549
00:31:42,360 --> 00:31:44,100
Someone else needs to hear it.

550
00:31:44,100 --> 00:31:48,140
So take a minute right now and share it.

551
00:31:48,140 --> 00:31:53,620
As you share this episode, you become part of our mission to help launch a new generation

552
00:31:53,620 --> 00:31:59,260
of clinician researchers who make transformative discoveries that change the way we do health

553
00:31:59,260 --> 00:32:27,180
care.