October 2007
Alfred Peet died on 8/29/2007. For coffee mavens on the West Coast, especially the Bay Area, Peet’s coffee meant a unique handcrafted approach to coffee roasting and brewing. Call it savvy marketing, or boomer yuppie indulgence but I think a lot of people drank Peet’s coffee simply because it was good, because Alfred Peet and his stores stood for a passionate, uncompromising commitment to quality that people admired and aspired to.
You may wonder why I am writing about a coffee purveyor in a column about career development and medicine, but one neglected, yet critical aspect of medical training is the lack of positive role models. Two young women asked me last week why I chose pulmonary/critical care as a sub-specialty. One was a recent college graduate preparing to take her MCATs while the other was a newly minted second year internal medicine resident. Both were concerned about whether a career in pulmonary critical care and sleep (PCC&S) would be “family-friendly.” But I was surprised at the amount of negative feedback they had already gotten during their education thus far and how discouraged they were. All they ever heard was how tough it was to “balance” family and a rigorous sub-specialty like PCC&S. As one woman said to me, “I’m tired of being beaten down before I’ve even started”!
I’m sure she was only thinking of making it through a 3-year fellowship, not an additional 5-8 years of postdoctoral training. But I don’t think that being a physician-scientist-parent is more difficult than say a single mom who works in retail at a minimum wage job with 2 kids under the age of 5. If anything, there are more options available to physicians because of their career choice and higher incomes. What makes the decision to pursue an academic career more difficult for many women is the lack of positive role models.
The lack of role models affects everyone. And by role models, I don’t necessarily mean the famous people admired by all, but who, to a trainee’s eye, may seem remote, unattainable, even irrelevant. I mean the people whom they see and hear about on a regular basis, their attendings and peers. One unstudied consequence of the declining number of physician-scientists is the loss of critical mass needed to create a vibrant culture of success. We hear about debt burden, length of training and other various obstacles to a career in academic medicine. But a far more powerful deterrent to pursuing an academic career may be the gradual erosion of a positive environment where being a physician-scientist is seen as desirable.
Like many in medicine, my decision to train in pulmonary and critical care basically boiled down to the people with whom I trained. I loved the ICU, but it was my attendings that made the difference in my choosing pulmonary over renal or infectious disease. They were anesthesiologists, surgeons and pulmonologists. They were not only smart but they were fun and they loved medicine. It didn’t matter that they were men, they were great doctors and people.
When I got to fellowship, my vague, lofty notion of being a physician-scientist blossomed in an institution where I was surrounded by peers who believed in science as I did. These were people whom I enjoyed being with and I could see the trail being blazed by senior fellows and junior faculty. Sure, we groused about low pay and long hours. We all came in on weekends to run experiments. The cliché “Do what you love and you’ll love what you do” was true. We didn’t have to “think” about science. It was a part of our daily lives. We didn’t focus on the barriers or the sacrifices but on the promise that through science we could begin to understand “why” and “how” and bring that back to the bedside.
Alfred Peet was a coffee roaster and brewer. You might think coffee, so what? But Alfred Peet was not only passionate about coffee, he was also funny, intellectually curious and inspiring. He singlehandedly inspired an entire generation of specialty coffee roasters, including Starbucks. Most of us don’t think of ourselves as role models and even fewer think about “saving academic medicine” when we are simply trying to get our jobs done, but our presence and actions all contribute to creating the collective culture that trainees experience.
Learning about the rewards of an academic career has little to do with classroom didactics but everything to do with the culture of medicine in which trainees are immersed from their first day of internship. We all know that a huge part of becoming a doctor or scientist is the socialization process that occurs 24/7 out on the wards and in the laboratories. Lessons in the classroom remain just that, in the classroom and irrelevant until trainees see them put into practice in the real world during their years of postgraduate training. Trainees consciously and unconsciously absorb behaviors and values as they seek to find a niche and are molded into their future selves. For example, a pregnant fellow or faculty person treated as a burden or something dreaded by her chief sends a far more powerful message to a young woman considering a career in academics than dutiful email notifications of official policy. On the other hand, seeing senior women not merely surviving but flourishing sends an equally powerful “Yes, I can” message to those who follow.
Whether we are master-clinicians, clinician-educators, or physician-scientists, we all can lead by our passion and dedication to what we do. Although we may feel trapped in a seemingly endless cycle of productivity measured by RVUS and RO1s, we must get out and be seen. Not just to show the overarching connection between test tube and patient but also to demonstrate the value of what we do. After all, if we are too busy to teach or go to conferences because teaching is so little valued, what kind of message are we sending to trainees? If we want to inspire a new generation to stay in academics, we need to show them not only how but why.
References:
- Stern, DT and Papadakis, M. The Developing Professional – Becoming a Professional. NEJM 355:1794-1799, 2006.
- Neilson, EG. The role of medical school admissions committees in the decline physician-scientists. JCI 111:767-767, 2003.
