Psychiatry trainees who pursue academic faculty roles can look forward to a fulfilling and viable career. However, like early-career physicians in all specialties, many young psychiatrists struggle with the decision-making process of selecting their first academic job (1). The process of identifying desirable academic positions is far less structured than the search for a suitable residency program, which leaves some trainees feeling ill-prepared for this important task.
There are also significant developments in medicine that affect today’s psychiatrists entering academic careers. By the 1980s, medical education in the United States became loan-dependent, with rates of medical educational debt well above inflation (2). In 2010, the average debt of a medical school graduate had climbed to $158,000 (3). The consequences of this educational debt burden are substantial and may be one of many factors contributing to the declining percentage of medical graduates seeking academic careers, because of the lower income generally available in academic medicine than in non-academic positions (4, 5).
Academic medical centers and pathways to career advancement in academic medicine have also changed. Over the last two decades, most academic hospitals recruited large numbers of clinician-educators to provide patient care and medical education for trainees (6). The majority of these positions are non-tenured (i.e., fixed-term), and there are at least 36 faculty tracks across medical schools in the United States, with most schools offering 3–4 separate tracks for clinicians and educators (7). The recent movement toward tenure-eligibility within these tracks (7) may reflect a growing appreciation of the importance of these faculty to the mission of the academic center and a need to retain these key individuals in academic medicine. The heterogeneity of available tracks also reflects the high variability of roles in which faculty members may spend their time (2).
The current generation of psychiatrists considering their first academic position therefore approaches this complicated decision through the lens of sizable student debt, an evolving mission of academic medical centers, and a desire for work–life balance and collaborative work (8). One of the defining characteristics of early-career physicians today is the increase in the number of women in medicine, and this is particularly relevant to psychiatry, where over 50% of psychiatry residents are female (9).
There is substantial literature available on the factors associated with selecting academic medical careers. However, there are comparatively few reports that help psychiatry trainees think through their various career choices and navigate the decision-making process for selecting an academic job. Based on a review of the available literature, our discussion with peers, and our own personal experiences in selecting our first academic positions, this article highlights the attributes of a desirable academic position and the decision-making steps to better understand the selection process of an academic psychiatry career.
Physicians who pursue academic careers are driven by the desire for intellectual stimulation, the availability of interaction among colleagues, and the opportunity to help shape the next generation of physicians, as well as multiple individual factors (4, 10, 11). The attributes of a desirable academic position should be compelling enough to offset the financial costs of forgoing private practice or industry opportunities. We focus our discussion on the academic job-search for psychiatrists pursuing a clinician–educator or clinician–researcher track, as these represent the majority of available positions in academic medical centers today. Through our own experiences and discussion with colleagues, we have identified several job attributes that are important for the psychiatrist starting his or her academic career.
Although difficult to clearly define, the psychiatry department’s culture and atmosphere can be as important as its academic prestige. A desirable department is peer-oriented and brings opportunities to interact and collaborate with colleagues who are diverse not only in background and training but also in age and career-stage. Most “Generation Y” trainees prefer peer-oriented and collaborative work (8), with opportunities to form relationships with colleagues. An ideal department is flexible and organized in a way that facilitates interpersonal interactions in both informal and formal settings. To help understand the department’s culture, candidates can request informal group interviews with junior faculty to explore their experiences with their more-senior colleagues, their efforts to influence change in the department, and the department’s track-record of junior-faculty promotion.
The financial stability of the department and healthcare system, as well as the availability of monetary and administrative support for junior faculty members, are important factors to explore. The more desirable positions have sufficient staff and monetary support to help facilitate both their faculty’s academic and clinical responsibilities. Finally, broader institutional respect for psychiatry and its unique roles in medicine, as well as collegiality among the hospital’s departments, can affect a candidate’s decision-making when selecting an academic position.
Job Flexibility and Autonomy
Having the flexibility and autonomy to adjust job responsibilities according to individual strengths and interests over time is usually an important reason that psychiatrists seek careers in academic medicine. Many early-career psychiatrists joining an academic institution assume multiple roles, and it is not always clear to the department or the psychiatrist which of these positions will provide both parties the greatest opportunity to prosper. The most attractive opportunities allow early-career psychiatrists the flexibility to develop a niche and choose which duties they prefer, rather than mandating that all physicians participate in teaching, research, administrative work, and clinical care. Flexibility with work-hours or working part-time may be equally important as priorities change over time. Most early-career psychiatrists of both genders prefer positions that provide the opportunity to balance the fluctuating needs of family and career.
Most physicians in academic medicine report a desire for intellectual stimulation and opportunities to teach and do research as primary motivators in pursuing an academic career (10). There is typically no shortage of opportunities for committee or administrative work, clinical research, or teaching. Lectures and workshops by departmental or institutional colleagues are also plentiful in most academic medical centers. However, these opportunities are only meaningful if the early-career psychiatrist has the time to partake of them. Desirable academic positions offer clearly protected time and scheduling flexibility to foster this. In an era of growing clinical demands on medical faculty, candidates pursuing careers in academic medicine should be explicit about this need for protected time.
In academic psychiatry today, typical early-career positions have heavy clinical responsibilities as faculty members at academic medical centers are increasingly expected to generate sufficient revenue from clinical work to support their salaries (4). This pressure to generate income can lead to reduced time for research and teaching. Salaries largely dependent on clinical productivity can cause dilemmas for early-career psychiatrists with high educational loan debt. Many graduates pursuing academic careers prefer salaried positions with comparatively lower reliance on clinical income productivity, although these are not always available. Desirable positions provide clear descriptions of the clinical work environment, such as call responsibilities, availability of online medical records, clinical resources, and clinical support staff.
Salaries for new junior faculty vary at each academic medical center, based on local cost-of-living and other variables. Most academic settings cannot offer salaries commensurate with private practice or industry opportunities, and, since most new graduates have sizable loans from medical training, neither the applicant nor the hiring institution can ignore these financial disincentives. Trainees seeking their first academic position should be clear how much money they will need to live reasonably comfortably, so that they do not get “seduced” by other factors into taking a job that will not meet their basic living needs. The early-career psychiatrists we interviewed were receptive to call responsibilities that are rewarded with an additional stipend or incentive payment as a way to augment their salary. Candidates should remember that salary is not the only contributor to the amount of money they will have to live on, as benefits (medical, disability, life insurance, retirement contributions, vacation time, etc.), either paid by the employer or mandatory expenses for the individual, are also a component of a person’s working income. Many academic medical centers can provide substantial paid benefit packages that are appealing to candidates, and they should explore and compare the above institutional benefits as well as access to tuition assistance, faculty-development programs, subsidized childcare, and relocation and “sign-on” bonuses (12).
The availability of accessible, effective mentoring is also a requisite aspect of the first academic job. Ideal settings have formal mentorship programs through the medical school department to help guide junior faculty through the maze of academic promotions, research, and education opportunities. Informal mentorship is also important, and a departmental mix of early-, mid-, and later-career academicians is a benefit for gaining perspective and direction on balancing competing roles.
Rarely does the “perfect” academic position exist for the early-career psychiatrist immediately following the completion of training. Although clarity about one’s “dream job” is important, the decision-making process for selecting an academic position begins with the establishment of personal and absolute priorities that any job one seriously considers must meet (see Figure 1) (12, 13). The psychiatry trainee should actively seek mentorship to help him/her define personal and professional priorities before beginning the job search. Since many opportunities are identified through professional contacts, having mentors who can link the candidate to such opportunities may have a direct impact on one’s job search.
FIGURE 1.Decision Tree for Selection of Positions in Academic Psychiatry
For most early-career psychiatrists, personal and family preferences about geographic location and opportunities for spouse or partner are important factors in identifying the location of a suitable academic medical center. After identifying locations and specific positions, candidates undertake an iterative process of comparing each position with their priorities and determining which opportunities meet their needs. For a candidate, going on several job interviews is often helpful in fully clarifying one’s priorities. Even if the candidate desires to remain at his/her training institution, it is important to know what other programs are like, and interviewing at a variety of institutions allows the candidate to compare and contrast employment opportunities (14). Table 1 provides an overview of several key academic medical center, departmental, and position specifics to consider in this process.
TABLE 1.Key Characteristics to Consider When Selecting Academic Jobsaa
| Add to My POL
|Department Characteristics||Position Specifics|
|Academic mission||Adequate time dedicated to each role|
|Academic prestige||Clinical and administrative support|
|Availability of faculty tracks||Clinical productivity expectations|
|Clear promotion guidelines||Job autonomy|
|Department demographics/variety||Job flexibility|
|Department “fit” with personality||Job variety|
|Financial stability||Opportunity for specialty practice|
|Mentorship and role models||Protected time for research|
|Opportunity for collaboration||Protected time for teaching|
|Research infrastructure and support||Research opportunities and expectations|
|Scholarly opportunities and expectations||Salary support|
|Strength of training programs||Teaching opportunities and expectations|
|Visa sponsorship (if applicable)|
After family and geographic considerations, the strengths of the department and the prospects for professional long-term growth often counterbalance and at times outweigh the more immediate issues of salary and benefits. However, when presented with options from equally strong institutions, the job that offers greater flexibility and protected time for nonclinical responsibilities is typically more attractive. When possible, reviewing specific opportunities with mentors and other early-career psychiatrists aids in decision-making.
Since institutions heavily invest in young academic physicians, it is in their interest to create a position and work environment that is attractive to and will help retain talented psychiatrists (13). It is estimated that the average cost of faculty turnover is $110,000–$900,000 per faculty replacement in medical schools (15). Therefore, negotiation to find an agreement that is beneficial to both the candidate and the department is critical for the long-term success of this relationship. Negotiation will be aided if the candidate has clarity about his/her priorities and the offered position’s clinical, teaching, and research expectations, salary and benefits, administrative support, and clinical coverage details before accepting any position.
Early-career psychiatrists today consider an academic position within an environment distinctly different from previous generations. Academic medical centers, medical education, and the provision of healthcare in America have all changed greatly in the past decade. Regardless of gender, physicians today place more emphasis on family and personal preferences than ever before. These differences affect how current early-career psychiatrists approach the decision-making process for their first academic job search.
Further research and programming will be needed to help facilitate psychiatry residents interested in academic careers. Although monetary compensation remains important for many early-career psychiatrists, we believe that embarking on a career in academic medicine can provide meaningful intellectual satisfaction that is priceless.