Journal of General Internal Medicine

, Volume 21, Issue 12, pp 1222–1229

Career choice in academic medicine

Systematic review
  • Sharon E. Straus
  • Christine Straus
  • Katina Tzanetos
  • the International Campaign to Revitalise Academic Medicine
Original Articles

Abstract

OBJECTIVES: To review systematically the evidence about what factors influence the decision to choose or not choose a career in academic medicine.

DESIGN: A systematic review of relevant literature from 1990 to May 2005.

DATA SOURCES: 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.

SELECTION OF STUDIES: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Key words

academic medicine career choice 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    International Working Party to Revitalise Academic Medicine. ICRAM: agenda setting. BMJ. 2004;329:787–9.CrossRefGoogle Scholar
  2. 2.
    International Working Party to Revitalise Academic Medicine. Academic medicine: the evidence base. BMJ. 2004;329:789–92.CrossRefGoogle Scholar
  3. 3.
    Savill J. More in expectation than in hope: a new attitude to training in clinical academic medicine. BMJ. 2000;320:630–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Gray J, Armstrong P. Academic health leadership: looking to the future. Clin Invest Med. 2003;26:315–26.PubMedGoogle Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    Simpson DE, Rediske VA, Beecher A, et al. Understanding the careers of physician educators in family medicine. Acad Med. 2001;76:259–65.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    Kelley WN, Stross JK. Faculty tracks and academic success. Ann Intern Med. 1992;116:654–9.PubMedGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedGoogle Scholar
  11. 11.
    McGuire LK, Bergen MR, Polan M. Career advancement for women faculty in a US school of medicine. Acad Med. 2004;79:319–25.PubMedCrossRefGoogle Scholar
  12. 12.
    Abelson HT, Bowden RA. Women and the future of academic pediatrics. J Pediatr. 1990;116:829–33.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Bilbey JH, Fache JS, Burhenne HJ. Are there predictors for future academic radiologists? A Canadian survey. Can Assoc Radiol J. 1992;43:369–73.PubMedGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Spencer SS. Careers in academic neurology. Ann Neurol. 1996;40:123–7.PubMedCrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    Kalfoglou AL, Sung NW. What inspires clinical research trainees and keeps them on the path? J Invest Med. 2002;50:408–11.CrossRefGoogle Scholar
  19. 19.
    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.PubMedCrossRefGoogle Scholar
  20. 20.
    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.PubMedCrossRefGoogle Scholar
  21. 21.
    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.Google Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedGoogle Scholar
  24. 24.
    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.PubMedGoogle Scholar
  25. 25.
    Braude RM. 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.CrossRefGoogle Scholar
  26. 26.
    Huth JF. Impact of the Cancer Education Program on career paths of students. J Cancer Educ. 1991;6:145–51.PubMedCrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar
  29. 29.
    Erzurum VZ, Obermeyer RJ, Fecher A, et al. What influences medical students’ choice of surgical careers. Surgery. 2000;128:253–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Thornton J, Esposito F. How important are economic factors in choice of medical specialty? Health Econ. 2003;12:67–73.PubMedCrossRefGoogle Scholar
  31. 31.
    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.PubMedCrossRefGoogle Scholar
  32. 32.
    Brotherton SE, Rockey PH, Etzel SI. US graduate medical education, 2003–2004. JAMA. 2004;292:1032–7.PubMedCrossRefGoogle Scholar
  33. 33.
    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.PubMedCrossRefGoogle Scholar
  34. 34.
    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.CrossRefGoogle Scholar
  35. 35.
    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.PubMedGoogle Scholar
  36. 36.
    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.PubMedCrossRefGoogle Scholar
  37. 37.
    Clark JM, Hanel DP. The contribution of MD-PhD training to academic orthopaedic faculties. J Orthop Res. 2001;19:505–10.PubMedCrossRefGoogle Scholar
  38. 38.
    Wallick MM, Cambre KM, Randall HM. Personality type and medical specialty choice. J LA State Med Soc. 1999;151:463–9.PubMedGoogle Scholar
  39. 39.
    Cravens DD, Campbell JD, Mehr DR. Why geriatrics? Academic geriatricians’ perceptions of the positive, attractive aspects of geriatrics. Fam Med. 2000;32:34–41.PubMedGoogle Scholar
  40. 40.
    Tosi LL, Mankin JF. Ensuring the success of women in academic orthopaedics. Clin Orthop. 1998;356:254–63.PubMedCrossRefGoogle Scholar
  41. 41.
    Ledley FD, Lovejoy FJ Jr. Prospects for academically trained pediatricians in academic medicine. Clin Invest Med. 1992;15:536–7.Google Scholar
  42. 42.
    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.PubMedGoogle Scholar
  43. 43.
    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.PubMedCrossRefGoogle Scholar
  44. 44.
    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.PubMedGoogle Scholar
  45. 45.
    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.PubMedCrossRefGoogle Scholar
  46. 46.
    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.PubMedCrossRefGoogle Scholar
  47. 47.
    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.PubMedCrossRefGoogle Scholar
  48. 48.
    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.PubMedCrossRefGoogle Scholar
  49. 49.
    Brodgon BG, Heveron ED, Diamond JJ. Attitudes of American radiologists toward their practices: present and future. Am J Radiol. 1990;154:867–9.Google Scholar
  50. 50.
    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.PubMedGoogle Scholar
  51. 51.
    Friedman CP, Slatt LM. New results relating the Myers-Briggs Type indicator and medical specialty choice. J Med Educ. 1988;63:325–7.PubMedGoogle Scholar
  52. 52.
    Moss PH, Lambert TW, Goldacre MJ, Lee P. Reasons for considering leaving UK medicine: questionnaire study of junior doctors’ comments. BMJ. 2004;329:1263.PubMedCrossRefGoogle Scholar
  53. 53.
    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.PubMedCrossRefGoogle Scholar
  54. 54.
    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.PubMedCrossRefGoogle Scholar
  55. 55.
    Devonald MAJ. Careers in academic medicine. Clin Med. 2004;4:284–5.PubMedGoogle Scholar
  56. 56.
    Brem H, Amundson E. Preparing Hopkins medical students for a career in academic medicine. Surgery. 2003;134:414–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Todd RF. A guide to planning careers in hematology and oncology. Am Soc Hematol Educ Program 2001:499–506.Google Scholar
  58. 58.
    Gunderman RB. Today’s radiology redient and tomorrow’s academic radiologist. AJR. 2001;177:1277–80.PubMedGoogle Scholar
  59. 59.
    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.PubMedCrossRefGoogle Scholar
  60. 60.
    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.PubMedGoogle Scholar
  61. 61.
    Spencer SS. Careers in academic neurology, 1996. Ann Neurol. 1996;40:123–7. Comment in Ann Neurol 1997;41(2):283–4.PubMedCrossRefGoogle Scholar
  62. 62.
    Griggs RC. Careers in academic neurology in the decade of the brain. Ann Neurol. 1994;35:753–8.PubMedCrossRefGoogle Scholar
  63. 63.
    Watanabe M. How to attract candidates to academic medicine. Clin Invest Med. 1992;15:204–15.PubMedGoogle Scholar
  64. 64.
    Martin CA, DeMoss KL. The development of the woman child psychiatry researcher—a review. J Am Acad Child Adolesc Psychiatry. 1991;30:1009–14.PubMedCrossRefGoogle Scholar
  65. 65.
    Chesney RW. 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.PubMedGoogle Scholar
  66. 66.
    Reynolds T. Are physician-scientists a vanishing breed? J Natl Cancer Inst. 2001;93:490–1.PubMedCrossRefGoogle Scholar
  67. 67.
    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.PubMedGoogle Scholar
  68. 68.
    Perry CL. How renowned researchers were initiated into the world of research. Am J Health Behav. 2003;27:564–73.PubMedGoogle Scholar
  69. 69.
    Pathman DE, Agnew CR. Querying physicians’ beliefs in career choice studies: the limitations of introspective causal reports. Fam Med. 1993;25:203–7.PubMedGoogle Scholar
  70. 70.
    Rashid A, Allen J, Styles B, Gray DP. Careers in academic general practice: problems, constraints, and opportunities. BMJ. 1994;309:1270–2.PubMedGoogle Scholar
  71. 71.
    Allen I. Factors affecting career choices in medicine. Clin Obstet Gynecol. 1999;13:323–36.Google Scholar
  72. 72.
    Hilton S. Careers in academic practice. BMJ. 1995;310:262.PubMedGoogle Scholar
  73. 73.
    MacDonald R. Survey shows serious shortage of medical academics in the UK. BMJ. 2002;324:446.PubMedCrossRefGoogle Scholar
  74. 74.
    Morrison J. Influences before and during medical on career choices. Med Educ. 2004;38:230–1.PubMedCrossRefGoogle Scholar
  75. 75.
    Fox M. Medical student indebtedness and the propensity to enter academic medicine. Health Econ. 2003;12:101–12.PubMedCrossRefGoogle Scholar
  76. 76.
    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.PubMedCrossRefGoogle Scholar
  77. 77.
    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.PubMedGoogle Scholar
  78. 78.
    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.Google Scholar
  79. 79.
    Doherty MJ, Schneider AT, Tirschwell DL. Will neurology residents with large student loan debts become academicians? Neurology. 2002;58:495–7.PubMedGoogle Scholar
  80. 80.
    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.PubMedCrossRefGoogle Scholar
  81. 81.
    Frieden C, Fox BHJ. Career choices of graduates from Washington University’s Medical Scientist Training Program. Acad Med. 1991;66:162–4.PubMedCrossRefGoogle Scholar
  82. 82.
    McClellan DA, Talalay P. MD-PhD training at the Johns Hopkins University School of Medicine, 1962–1991. Acad Med. 1992;67:36–41.PubMedCrossRefGoogle Scholar
  83. 83.
    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.PubMedCrossRefGoogle Scholar
  84. 84.
    Prystowsky JH. 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.PubMedCrossRefGoogle Scholar
  85. 85.
    Feng L, Ruzai-Shaprio C. Factors that influence radiologists’ career choices. Acad Radiol. 2003;10:45–51.PubMedCrossRefGoogle Scholar
  86. 86.
    Hillman BJ, Fajardo LL, Witzke DB, et al. Influences affecting radiologists’ choices of academic or private practice careers. Radiology. 1990;174:561–4.PubMedGoogle Scholar
  87. 87.
    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.Google Scholar
  88. 88.
    Sanders AB, Fulginiti JV, Witzke DB. Factors influencing resident career choices in emergency medicine. Ann Emerg Med. 1992;21:47–52.PubMedCrossRefGoogle Scholar
  89. 89.
    Goldacre M, Stear S, Richards R, Sidebottom E. Junior doctors’ views about careers in academic medicine. Med Educ. 1999;33:318–26.PubMedCrossRefGoogle Scholar
  90. 90.
    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.Google Scholar
  91. 91.
    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.PubMedGoogle Scholar
  92. 92.
    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.PubMedCrossRefGoogle Scholar
  93. 93.
    Leonard JC, Ellsbury KE. Gender and interest in academic careers among first- and third-year residents. Acad Med. 1996;71:502–4.PubMedCrossRefGoogle Scholar
  94. 94.
    Reiser LW, Sledge WH, Fenton W, Leaf P. Beginning careers in academic psychiatry for women—“Bermuda Triangle”? Am J Psychiatry. 1993;150:1392–7.PubMedGoogle Scholar
  95. 95.
    Bergstrasser PR. Perceptions of the academic environment: a national survey. J Am Acad Dermatol. 1991;25:1092–6.CrossRefGoogle Scholar
  96. 96.
    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.Google Scholar
  97. 97.
    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.PubMedCrossRefGoogle Scholar
  98. 98.
    Sambunjak D, Straus SE, Marusic A. Impact of mentorship on career development: systematic review. JAMA. (in press).Google Scholar
  99. 99.
    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.CrossRefGoogle Scholar

Copyright information

© the Society of General Internal Medicine 2006

Authors and Affiliations

  • Sharon E. Straus
    • 1
    • 2
  • Christine Straus
    • 2
  • Katina Tzanetos
    • 1
  • the International Campaign to Revitalise Academic Medicine
  1. 1.Division of General Internal MedicineUniversity Health NetworkTorontoCanada
  2. 2.Knowledge Translation ProgramUniversity of Toronto/St. Michael’s HospitalTorontoCanada

Personalised recommendations