Career choice in academic medicine
Received: 12 December 2005 Revised: 20 February 2006 Accepted: 21 June 2006 DOI:
Cite this article as: Straus, S.E., Straus, C., Tzanetos, K. et al. J GEN INTERN MED (2006) 21: 1222. doi:10.1111/j.1525-1497.2006.00599.x Abstract To review systematically the evidence about what factors influence the decision to choose or not choose a career in academic medicine. OBJECTIVES: A systematic review of relevant literature from 1990 to May 2005. DESIGN: Searches of The Cochrane Library, Medline (using Ovid and PubMed) from 1990 to May 2005, and EMBASE from 1990 to May 2005 were completed to identify relevant studies that explored the influential factors. Additional articles were identified from searching the bibliographies of retrieved articles. DATA SOURCES: We attempted to identify studies that included residents, fellows, or staff physicians. No restrictions were placed on the study methodologies identified and all articles presenting empirical evidence were retrieved. For cohort, case-control, and cross-sectional studies, minimum inclusion criteria were the presence of defined groups, and the ability to extract relevant data. For surveys that involved case series, minimum inclusion criteria were a description of the population, and the availability of extractable data. Minimum inclusion criteria for qualitative studies were descriptions of the sampling strategy and methods. SELECTION OF STUDIES: The search identified 251 abstracts; 25 articles were included in this review. Completion of an MD with a graduate degree or fellowship program is associated with a career in academic medicine. Of the articles identified in this review, this finding is supported by the highest quality of evidence. Similarly, the completion of research and publication of this research in medical school and residency are associated with a career in academic medicine. The desire to teach, conduct research, and the intellectual stimulation and challenge provided in academia may also persuade people to choose this career path. The influence of a role model or a mentor was reported by physicians to impact their decision making. Trainees’ interest in academic medicine wanes as they progress through their residency. RESULTS: In order to revitalize academic medicine, we must engage trainees and retain their interest throughout their training. Research opportunities for medical students, and fellowships or graduate training can meet this challenge and influence career choice. Initiatives to stimulate and maintain interest in academic medicine should be evaluated in prospective studies across multiple sites. CONCLUSIONS: Key words academic medicine career choice
S.E.S. is supported by a Tier 2 Canada Research Chair and by the St. Michael’s Hospital/University of Toronto Knowledge Translation Program.
International Working Party to Revitalise Academic Medicine
. ICRAM: agenda setting. BMJ. 2004;329:787–9.
International Working Party to Revitalise Academic Medicine
. Academic medicine: the evidence base. BMJ. 2004;329:789–92.
. More in expectation than in hope: a new attitude to training in clinical academic medicine. BMJ. 2000;320:630–3.
Gray J, Armstrong P
. Academic health leadership: looking to the future. Clin Invest Med. 2003;26:315–26.
Council of Heads of Medical Schools. A survey of clinical academic staffing levels in UK medical and dental schools, 2001. Available at: www.chms.ac.uk/chms.pdf.
Simpson DE, Rediske VA, Beecher A, et al.
Understanding the careers of physician educators in family medicine. Acad Med. 2001;76:259–65.
Thomas PA, Diener-West M, Canto MI, et al.
Results of an academic promotion and career path survey of faculty at the Johns Hopkins University School of Medicine. Acad Med. 2004;79:258–64.
Kelley WN, Stross JK
. Faculty tracks and academic success. Ann Intern Med. 1992;116:654–9.
Oinonen MJ, Crowley WF, Moskowitz J, et al.
How do academic health centers value and encourage clinical research. Acad Med. 2001;76:700–6.
Jackson VA, Palepu A, Szalacha L, et al.
Having the right chemistry: a qualitative study of mentoring in academic medicine. Acad Med. 2003;78:328–34.
McGuire LK, Bergen MR, Polan M
. Career advancement for women faculty in a US school of medicine. Acad Med. 2004;79:319–25.
Abelson HT, Bowden RA
. Women and the future of academic pediatrics. J Pediatr. 1990;116:829–33.
Cain JM, Schulkin J, Parisi V, et al.
Effects of perceptions and mentorship on pursuing a career in academic medicine in obstetrics and gynecology. Acad Med. 2001;76:628–34.
Bilbey JH, Fache JS, Burhenne HJ
. Are there predictors for future academic radiologists? A Canadian survey. Can Assoc Radiol J. 1992;43:369–73.
Sanders AB, Fulginiti JV, Witzke DB, Bangs KA
. Characteristics influencing career decisions of academic and nonacademic emergency physicians. Ann Emerg Med. 1994;23:81–7.
. Careers in academic neurology. Ann Neurol. 1996;40:123–7.
Littlewood S, Ypinazar V, Margolis SA, et al.
Early practical experience and the social responsiveness of clinical education: systematic review. BMJ. 2005;331:387–91.
Kalfoglou AL, Sung NW
. What inspires clinical research trainees and keeps them on the path? J Invest Med. 2002;50:408–11.
Gunderman RB, Heitkamp DE, Kipfer HD, et al.
Developing tomorrow’s academic radiologists: a 3-month residency elective in education. Acad Radiol. 2003;10:650–6.
Osborn EH, Ernster VL, Martin JB
. Women’s attitudes toward careers in academic medicine at the University of California, San Francisco. Acad Med. 1992;67:59–62.
Solomon SS, Tom SC, Pichert J, et al. Impact of medical student research in the development of physician-scientists. J Invest Med. 2003;51:149–56.
Lubavin BV, Langdorf MI, Blasko BJ
. The effect of emergency medicine residency format on pursuit of fellowship training and an academic career. Acad Emerg Med. 2004;11:938–43.
Buddeberg Fischer B, Klaghofer R, Abel T, Buddeberg C
. The influence of gender and personality traits on the career planning of Swiss medical students. Swiss Med Wkly. 2003;133:535–40.
Stern SA, Kim HM, Neacy K, et al.
The impact of environmental factors on emergency medicine resident career choice. Acad Emerg Med. 1999;6:262–70.
. A descriptive analysis of National Library of Medicine-funded medical informatics training programs and the career choices of their graduates. Med Decision Making. 1991;11:33–7.
. Impact of the Cancer Education Program on career paths of students. J Cancer Educ. 1991;6:145–51.
Goldacre MJ, Turner G, Lambert TW
. Variation by medical school in career choices of UK graduates of 1999 and 2000. Med Educ. 2004;38:249–58.
Ranta M, Hussain SS, Gardiner Q
. Factors that inform the career choice of medical students: implications for otolaryngology. J Laryngol Otol. 2002;116:839–41.
Erzurum VZ, Obermeyer RJ, Fecher A, et al.
What influences medical students’ choice of surgical careers. Surgery. 2000;128:253–6.
Thornton J, Esposito F
. How important are economic factors in choice of medical specialty? Health Econ. 2003;12:67–73.
Murdoch MM, Kressin N, Fortier L, et al.
Evaluating the psychometric properties of a scale to measure medical students’ career-related values. Acad Med. 2001;76:157–65.
Brotherton SE, Rockey PH, Etzel SI
. US graduate medical education, 2003–2004. JAMA. 2004;292:1032–7.
Cooter R, Erdmann JB, Gonnella JS, et al.
Economic diversity in medical education: the relationship between students’ family income and academic performance, career choice, and student debt. Eval Health Prof. 2004;27:252–64.
Al-Jarallah KF, Moussa MA
. Specialty choices of Kuwaiti medical graduates during the last three decades. J Cont Educ Health Prof. 2003;23:94–100.
Erwin DO, Henry-Tillman RS, Thomas BR
. A qualitative study of the experience of one group of African Americans in pursuit of a career in academic medicine. J Natl Med Assoc 2002 94:802–12.
Medina-Walpole A, Barker WH, Katz PR, et al.
The current state of geriatric medicine: a national survey of fellowship-trained geriatricians, 1990 to 1998. J Am Geriatr Soc. 2002;50:949–55.
Clark JM, Hanel DP
. The contribution of MD-PhD training to academic orthopaedic faculties. J Orthop Res. 2001;19:505–10.
Wallick MM, Cambre KM, Randall HM
. Personality type and medical specialty choice. J LA State Med Soc. 1999;151:463–9.
Cravens DD, Campbell JD, Mehr DR
. Why geriatrics? Academic geriatricians’ perceptions of the positive, attractive aspects of geriatrics. Fam Med. 2000;32:34–41.
Tosi LL, Mankin JF
. Ensuring the success of women in academic orthopaedics. Clin Orthop. 1998;356:254–63.
Ledley FD, Lovejoy FJ Jr. Prospects for academically trained pediatricians in academic medicine. Clin Invest Med. 1992;15:536–7.
Lovejoy FH, Ledley FD, Nathan DG
. Academic careers: choice and activity of graduates of a pediatric residency program 1974–1986. Trans Am Clin Climatol Assoc. 1992;104:180–95; discussion 195–7.
Palepu A, Carr PL, Friedman RH, Ash AS, Moskowitz MA
. Specialty choices, compensation and career satisfaction of underrepresented minority faculty in academic medicine. Acad Med. 2000;75:157–60.
Curtis P, Dickinson P, Steiner J, et al.
Building capacity for research in family medicine: is the blueprint faulty? Fam Med. 2003;35:124–30.
Ahn J, Watt CD, Greeley SA, Bernstein J
. MD-PhD students in a major training program show strong interest in becoming surgeon-scientists. Clin Orthop. 2004;425:258–63.
Coyle YM, Aday LA, Battles JB, Hynan LS
. Measuring and predicting academic generalists’ work satisfaction: implications for retaining faculty. Acad Med. 1999;74:1021–27.
Buckley LM, Sanders K, Shih M, Hampton CL
. Attitudes of clinical faculty about career progress, career success and recognition, and commitment to academic medicine. Arch Intern Med. 2000;160:2625–9.
Campos-Outcalt D, Senf J, Watkins AJ, Bastacky S
. The effects of medical school curricula, faculty role models, and biomedical research support on choice of generalist physician. Acad Med. 1995;70:611–9.
Brodgon BG, Heveron ED, Diamond JJ. Attitudes of American radiologists toward their practices: present and future. Am J Radiol. 1990;154:867–9.
Bland CJ, Meurer LN, Maldonado G
. Determinants of primary care specialty choice: a non-statistical meta-analysis of the literature. Acad Med. 1995;70:620–41.
Friedman CP, Slatt LM
. New results relating the Myers-Briggs Type indicator and medical specialty choice. J Med Educ. 1988;63:325–7.
Moss PH, Lambert TW, Goldacre MJ, Lee P
. Reasons for considering leaving UK medicine: questionnaire study of junior doctors’ comments. BMJ. 2004;329:1263.
Ward AM, Kamien M, Lopez DG
. Medical career choice and practice location: early factors predicting course completion, career choice and practice location. Med Educ. 2004;38:239–48.
Gerrity MS, Pathman DE, Linzer M, et al.
Career satisfaction and clinician-educators: the rewards and challenges of teaching. JGIM. 1997;12(suppl 2):S90-S97.
. Careers in academic medicine. Clin Med. 2004;4:284–5.
Brem H, Amundson E
. Preparing Hopkins medical students for a career in academic medicine. Surgery. 2003;134:414–5.
Todd RF. A guide to planning careers in hematology and oncology. Am Soc Hematol Educ Program 2001:499–506.
. Today’s radiology redient and tomorrow’s academic radiologist. AJR. 2001;177:1277–80.
Rubenstein DS, Blauvelt A, Chen SC, Darling TN
. The future of academic dermatology in the United States: report on the resident retreat for future physician-scientists, June 15–17, 2001. J Am Acad Dermatol. 2002;47:300–3.
Cavalieri TA, Basehore P, Perweiller E, Chopra A
. Training osteopathic geriatric academicians: impact of a model geriatric residency program. J Am Osteopath Assoc. 1999;99:371–6.
. Careers in academic neurology, 1996. Ann Neurol. 1996;40:123–7. Comment in Ann Neurol 1997;41(2):283–4.
. Careers in academic neurology in the decade of the brain. Ann Neurol. 1994;35:753–8.
. How to attract candidates to academic medicine. Clin Invest Med. 1992;15:204–15.
Martin CA, DeMoss KL
. The development of the woman child psychiatry researcher—a review. J Am Acad Child Adolesc Psychiatry. 1991;30:1009–14.
. The impact of medical school loans and the promise of loan repayment on entry into a pediatric academic career. Arch Pediatr Adolesc Med. 2001;155:1296–7.
. Are physician-scientists a vanishing breed? J Natl Cancer Inst. 2001;93:490–1.
Zemlo TR, Garrison HH, Partridge NC, Ley TJ
. The physician-scientist: career issues and challenges at the year 2000. FASEB J. 2000;14:221–30.
. How renowned researchers were initiated into the world of research. Am J Health Behav. 2003;27:564–73.
Pathman DE, Agnew CR
. Querying physicians’ beliefs in career choice studies: the limitations of introspective causal reports. Fam Med. 1993;25:203–7.
Rashid A, Allen J, Styles B, Gray DP
. Careers in academic general practice: problems, constraints, and opportunities. BMJ. 1994;309:1270–2.
Allen I. Factors affecting career choices in medicine. Clin Obstet Gynecol. 1999;13:323–36.
. Careers in academic practice. BMJ. 1995;310:262.
. Survey shows serious shortage of medical academics in the UK. BMJ. 2002;324:446.
. Influences before and during medical on career choices. Med Educ. 2004;38:230–1.
. Medical student indebtedness and the propensity to enter academic medicine. Health Econ. 2003;12:101–12.
Fang D, Meyer RE
. Effect of two Howard Hughes Medical Institute research training programs for medicals students on the likelihood of pursuing research careers. Acad Med. 2003;78:1271–80.
Ledley FD, Lovejoy FH Jr
. Factors influencing the interests, career paths, and research activities of recent graduates from an academic, pediatric residency program. Pediatrics. 1993;92:436–41.
Abelmann WH, Nave BD, Wilkerson L. Generation of physician-scientists manpower: a follow-up study of the first 294 graduates of the Harvard-MIT Program of Health Sciences and Technology. J Invest Med. 1997;45:272–5.
Doherty MJ, Schneider AT, Tirschwell DL
. Will neurology residents with large student loan debts become academicians? Neurology. 2002;58:495–7.
Markert RJ, Part HM, Vetter DK
. Predictors of careers in academic medicine for graduates of a community-based, primary-care-oriented medical school. Acad Med. 1998;73:790–3.
Frieden C, Fox BHJ
. Career choices of graduates from Washington University’s Medical Scientist Training Program. Acad Med. 1991;66:162–4.
McClellan DA, Talalay P
. MD-PhD training at the Johns Hopkins University School of Medicine, 1962–1991. Acad Med. 1992;67:36–41.
Simon SR, Shaneyfelt TM, Collins MM, et al.
Faculty training in general internal medicine: a survey of graduates from a research-intensive fellowship program. Acad Med. 1999;74:1253–5.
. Factors influencing the pursuit of careers in academic medicine: a survey of MD-PhD residents in dermatology programs in the United States. J Invest Dermatol. 1992;98:125–7.
Feng L, Ruzai-Shaprio C
. Factors that influence radiologists’ career choices. Acad Radiol. 2003;10:45–51.
Hillman BJ, Fajardo LL, Witzke DB, et al.
Influences affecting radiologists’ choices of academic or private practice careers. Radiology. 1990;174:561–4.
Neacy K, Stern SA, Kim HM, Dronen SC. Resident perception of academic skills training and impact on academic career choice. Acad Emerg Med. 2000;9:1408–15.
Sanders AB, Fulginiti JV, Witzke DB
. Factors influencing resident career choices in emergency medicine. Ann Emerg Med. 1992;21:47–52.
Goldacre M, Stear S, Richards R, Sidebottom E
. Junior doctors’ views about careers in academic medicine. Med Educ. 1999;33:318–26.
Lee P, Goldacre M. Views of general practitioners in academic posts about careers in academic general practice: a national survey. Educ Primary Care. 2002;13:465–71.
Wood PS, Altmaier EM, Franken Jr EA, et al.
Factors influencing choice of academic or practice careers in radiology. Invest Radiol. 1990;25:675–7.
Rubeck RF, Donnelly MB, Jarecky RM, et al.
Demographic, educational, and psychosocial factors influencing the choices of primary care and academic medical careers. Acad Med. 1995;70:318–20.
Leonard JC, Ellsbury KE
. Gender and interest in academic careers among first- and third-year residents. Acad Med. 1996;71:502–4.
Reiser LW, Sledge WH, Fenton W, Leaf P
. Beginning careers in academic psychiatry for women—“Bermuda Triangle”? Am J Psychiatry. 1993;150:1392–7.
. Perceptions of the academic environment: a national survey. J Am Acad Dermatol. 1991;25:1092–6.
Brown AJ, Swinyard W, Ogle J. Women in academic medicine: a report of focus groups and questionnaires, with conjoint analysis. J Women’s Health (Larchmt). 2003;12:999–1008.
Underwood SM, McIndoe AK
. Influence of changing work patterns on training in anaesthesia: an analysis of activity in a UK teaching hospital from 1996 to 2004. Br J Anaesth. 2005;95:616–21.
Sambunjak D, Straus SE, Marusic A. Impact of mentorship on career development: systematic review. JAMA. (in press).
Awasthi S, Beardmore J, on behalf of the International Campaign to Revitalise Academic Medicine, et al.
Five futures for academic medicine. PLoS Med. 2005;2:606–13.
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