Every year, at events that cause me to reflect on where I’ve been, and what I have left to accomplish, like the ASH annual meeting, I’ve noticed a phenomenon similar to what transpires in macabre murder mysteries: several promising colleagues drop out of sight, vanishing from academic ranks without a trace, as I try to guess where they went – and who will be next to disappear.
We are drawn to academic medicine for multiple reasons, but a large part of our daily existence is caring and healing. Healing is the sine qua non of “physician”: We will go to inexhaustible lengths to take care of our patients, both during the clinic visit and in turning the giant cogs of health care on their behalf. As physicians, we are also highly creative people, with passions that fuel the design of clinical trials, delineate cellular disease mechanisms, craft next-generation assays, and enable us to teach that new knowledge to others. Innovation in medicine, the cornerstone of hematology’s frontier, rests on a physician’s ability to be creative.
On the academic front, we experience a constant battle between caring for patients and nurturing our creativity (and protecting our research time). Both are necessary and interdependent, but both also require a huge investment of time. Each of us struggles to find this balance in our professional careers.
Newly minted junior faculty like myself eventually come to the slow and deliberate realization that we have the power to do anything we want with our careers – including leaving academics if we’re so inclined.
Enter the pharmaceutical industry.
The (Fading?) Appeal of Academia
Those of us who entered academia chose a field where we could heal patients while continuing to learn and advance hematology. We cherished our first academic titles and our first manuscript authorships, along with the promise of grant funding.
But, for many of us, that was not the incentive. How could it be, when many of us will spend at least five to eight years as young faculty, accepting the opportunity cost of often earning below the tenth percentile of our respective profession while facing rising medical student loans? This mounting debt is coupled with the difficulty of finding success at the start of our careers.
The funding climate has been cooling for years; the National Institutes of Health (NIH) funding rate for training grants is discouraging, and the rate of conversion from a Career Development K Series Award to a Research Grant R Series award is dishearteningly low. Private foundation grants are also tough to obtain – ASH efforts notwithstanding. The leadership in many academic centers is cognizant of these barriers and may discourage junior faculty from seeking careers in research at the outset.
Crossing Over to the Pharma Side
As junior faculty, we often have mixed feelings about interacting with industry. Some of us went through training during the “No Free Lunch” hysteria, a natural anti-industry backlash against the preceding era – when blood pressure medication prescriptions paid for physicians and their families to go skiing in Vail, or sit in a box seat at a Yankees game.
We learned our lesson from this era of excess: Our patients shouldn’t be prescribed expensive medications, and we don’t want them to be unwilling accomplices to an unregulated medical free market, especially at a time when medical bills are a leading source of personal bankruptcy.
Industry, obviously, plays an important role in driving hematology innovation. Even under the most optimistic of federal funding circumstances, academic medicine could not undertake the large clinical trials that industry support make possible. And, for individual physicians, a career in the pharmaceutical industry offers the opportunity to apply our creativity by finding innovative answers to difficult research questions.
The Choice Between Academia and Industry
In both the world of academia and the world of pharma, we look forward to using our own findings and ideas to transform patient care and delineate pathology. When we feel our exploratory passions and training are aligned with place and time, we can unleash a dynamo of unstoppable creativity.
Unfortunately, the academic physician is fighting on many fronts.
The pressure to generate revenues from patient care have never been higher for academic centers. That 50 to 80 percent of “protected research time” required for many federal or private young investigator awards and grant applications (including ASH initiatives) is a privilege appreciated by only a few academic physicians. This is also a struggle for division chiefs or department chairs who have to compensate for that part of a physician’s salary within the department as a whole to make sure patients are still being cared for.
With a career in the pharmaceutical industry, on the other hand, young physicians can focus their energies on research and improve patient care indirectly. In addition to the possibility of being assigned to a project that doesn’t match his or her area of interest, though, becoming an industry physician also means losing the opportunity for direct patient observations that can lead to new clinical and therapeutic insights. It also begs the question, when the patient experience is removed, does the basic definition of being a physician – caring for patients – still apply?
So, we find ourselves in an odd tug-of-war with our passions, and one that doesn’t seem to be resolving itself anytime soon. The need for physicians to generate more revenue by seeing patients will not change soon, nor will the research funding environment.
I do not claim vantage or perspective to state that one career path will satisfy any young physician more than the other. The question to ask is whether the physician can align his or her various passions to do the most good – personally and professionally. The bottom line is not about grant funding, salary levels, or reaching 80 percent protected research time; it’s about navigating our careers by following the internal compass each of us has to keep a happy focus and balanced life in our sights.