Fellows-in-Training: Chasing the Thrill of Academic Medicine

The anticipation mounts. Months and months of planning, fine-tuning, and reviewing your presentation and it all comes down to those precious 7 minutes: How will it be received? What impact will these data make on clinical medicine?

Having just undergone this experience at the European Society of Cardiology's Annual Congress in Munich for my project on outcomes associated with NSAID usage in the REACH registry, I have now realized the thrill of academic medicine and how invigorating scientific discovery really is! This project, spanning more than 9 months, culminated in the ESC presentation, which may raise awareness in the way NSAIDs are used in patients with stable atherothrombotic disease. My work could lead to an impact on medical practice—it really makes all those months of hard work worth it!

It’s been easy so far. You take the pre-med courses, then medical school, then residency, then fellowship. This is the first time in our lives when the next step isn’t clearly laid out for us. The choice is finally ours, so now what do we do? Job? Private practice? Academics? At University of California, San Francisco, all second-year cardiology fellows write for a grant to secure funding for their third year of research. And, hearing all the second-years stress about it over the past few months really made me reflect on the types of people who pursue academic medicine and their reasons for doing so.

Well, as we all know, academic medicine is fraught with struggles. Not only do we have to spend a million years doing our clinical training, residency, fellowship, and sub-fellowship, but you also have to add in a few extra years here and there for research fellowships, epidemiology courses, and post-doctorate work to become a successful researcher. You're really looking at a lifetime commitment. Yikes!

And, that’s not all. From securing funding for your research projects, to the constant negotiation of trying to "buy" nonclinical time for yourself, to trying to spend your night and weekends not distracted from family time, to keeping up with the latest publications… it just never seems to get easy. So, why do so many people do it?

Well, there are a lot of reasons! For some, the clinical/nonclinical time allows for more flexibility for personal obligations and more variety in their daily routine. For others, it is the rich academic environment, full of collaborations, discussions, and debate among colleagues that provides a more fulfilling intellectual experience. For me, I have realized, it is the thrill of contributing scientific knowledge and advancing the frontier of medicine (in whatever small way) that is leading me down this path. Knowing that I had the opportunity to share my work with the scientific community at an international meeting really does make the whole academic medicine struggle worthwhile.

Just like anything in medicine, you have to really want to do it and you will most likely only succeed if you really feel rewarded by what you are doing. It's not enough to simply walk the academic path because everyone else around you is doing it, or because you feel you are expected to. If you do it for these reasons alone, your chances of failure are undoubtedly high. Now is the time in our careers when we really need to do some soul-searching, think about what motivates us, and be honest with ourselves when we try to answer whether academics is really right for us.

If, after thinking about it critically, you have decided to give academia a whirl, my advice is to keep your eyes on the prize (whatever the prize may be for you) if you want to keep your ship from capsizing in those choppy waters. And, as one mentor once told me, "It's easy to get picked off early." Try not to get discouraged easily because the waters do quiet down eventually. After all that struggle, you are left with a fulfilling, rewarding, and stimulating career that gets you out of bed every morning.

After my presentation, I had at least three people come up to me with business cards and ideas to expand my project by looking at biomarkers or pooled analyses looking at other registries. One was from Israel, one from Germany, and another from China. I couldn’t help but muse on the way in which academic medicine can form connections and collaborations between people and scientists from across the globe, regardless of language or cultural barriers, all coming together to experience that indescribable thrill of discovery. What a rush!

(An aside: There is a great article in this month’s JACC FIT newsletter about how to decide whether academic medicine is right for you. To read it visit: http://bit.ly/QbvLku.)

Payal Kohli, MD, graduated from MIT and received her MD from Harvard Medical School. She completed her internal medicine residency at Brigham and Women’s Hospital in Boston and was a research fellow at the TIMI Study Group. Dr. Kohli began her clinical fellowship in June 2012 at the University of California, San Francisco. To watch an interview with Dr. Kohli about her presentation at ESC 2012, visit youtube.cswnews.org.

Keywords: Fellowships and Scholarships, Registries, China, Private Practice, Biomarkers, Language, Medicine, Germany, Israel, Awareness, Research

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