This post was authored by Payal Kohli, MD, fellow-in-training at the University of California San Francisco.

Lately it has struck me that many of my brightest medical school classmates have left medicine altogether to work in industry, consulting, business or pharmaceuticals.  There appears to be some sort of Darwinian selection.  And even today, I could name at least a dozen who are completing their residency and/or fellowship only to become the next Associate at McKinsey or the next Medical Director at Pfizer or the next Project Manager for device development at Medtronic.  Perhaps many of their decisions are motivated by a desire to make a drastic change in the way medicine is practiced and an inability to feel that it could be easily accomplished within the rigid walls of the ivory tower of academic medicine.

Although academic medicine offers tremendous advantages such as the ability to function within a rich intellectual environment, the chance to indulge in groundbreaking research, and the ability to take care of some of the most complex patients, the administrative and logistical restraints within this environment may limit the creativity of many.  The path is strewn with challenges at each step of the way and the timeline for jumpstarting a career in academic medicine is at least 10-15 years following completion of fellowship.  At many top-level academic institutions, it takes 15-20 years to climb the academic ladder and get promoted from an “Instructor” appointment to full “Professor of Medicine.”  Add that to the 18 years someone has already spent training and you are talking a full lifetime before someone can fully indulge their ideas and creativity with freedom.  For these individuals, these alternative career paths can offer the “express train (without a dozen local stops along the way)” to the top as a way to innovate and discover with more abundant resources and fewer roadblocks.

What I have started worrying about though is that too many of us may be getting on the express train with very few of us left behind to ride the local train.  With the shrinking NIH budgets and the growing number of alternative jobs available, the “brain drain” from academic medicine may be at an all-time high.  And although that offers a tremendous opportunity for drug discovery, biodesign and growth, it removes some of the most brilliant minds from academia.

I often quip with my friends who are in these alternative fields that they have crossed over to the “dark side.”  Yet, they appear to be significantly happier, generally have a better work-life balance, and are better compensated financially with fewer frustrations than their counterparts in academic medicine.  So, maybe it's the rest of us who are left behind in the “dark side” and if we are truly going to retain some of the best and brightest within our ivory tower, we need a drastic restructuring of academic medicine with “express service” being offered.

Do you agree?

*A version of this article also ran in the August issue of CardioSource WorldNews.

< Back to Listings