Nurturing passion in a time of academic climate change: the modern-day challenge of junior faculty development.

Where Has The Passion Gone? For most physicians, medicine as a professional journey is driven by passion. Medical student essays speak passionately about healing the sick; comforting the bereaved; discovering new insights; and developing new paradigms for diagnosis, prognostic markers, and therapeutics. Academic health centers (AHCs) provide the home for this passion to be nurtured and honed among its trainees, and fueled among its faculty. However, in response to enormous pressures over the past 40 yr, ACHs have increasingly shifted the focus from faculty-relevant issues to strategic considerations about competitive market forces, reimbursement shortfalls, increasing regulatory oversight and compliance requirements, and extramural funding levels. As increasingly complex enterprises, AHCs have been slow to adjust with regard to revising promotion and tenure policies, establishing mentoring and faculty development programs, and creating bridge funding mechanisms, leaving relationships between academic leadership and faculty strained. Under the weight of all these forces, faculty passion and career satisfaction has steadily diminished, particularly among the most junior members. Recent reviews of academic medical faculty indicate that approximately 42% are seriously considering leaving academic medicine in the next 5 yr and that 40% reported that their career was not progressing satisfactorily (1). Career satisfaction is threatened by the lack of time for teaching, scholarship, and personal and professional self-renewal (2–6). In addition to the rapidly changing economic and regulatory environments, AHCs are also affected by the evolving social environment, in which generational differences define distinct approaches to career and family (7). By and large, department chairs and senior faculty are Baby Boomers. Born between 1945 and 1962, Boomers work hard out of loyalty, expect long-term employment, pay their “dues,” consider self-sacrifice a virtue, and respect authority. In comparison, junior faculty are primarily Generation X’ers. Born between 1963 and 1981, Generation X’ers tend to work hard if balance is allowed, expect that their careers will involve several job changes, do not value the concept of dues paying, are willing to endure self-sacrifice only occasionally, and tend to question authority. These generational issues pose an additional set of challenges for AHCs regarding appropriate mentoring, academic expectations, and promotion policies. Yet, it must be acknowledged that, despite the challenges, the most important asset of an AHC is its faculty. Therefore, the future of the academic enterprise depends to a great extent on the degree to which AHCs are successful in nurturing the careers of their faculty, particularly junior faculty (8). The academic community has begun to hear the alarm. Recent editorials and essays speak to “momma, don’t let your babies grow up to be academics,” “time to heal,” “taking root in a forest clearing,” and “new bottles for vintage wines: the changing management of the medical school faculty” (9–12). But even so, passion is not acknowledged as a fundamental core value for next generation of physicians. To nurture their passion for medicine and position junior faculty for academic success, AHCs should appoint faculty to career pathways aligned with scholarship interests, for example, clinician-educator (clinicians dedicated to clinical service and teaching), physician-scientist (clinicians dedicated to clinical service and research), or basic scientists, and to develop assessment tools appropriate for each pathway. Clearly, promotion criteria for both tenure and nontenure tracks differ, and expected funding levels differ between clinical and basic science research. In addition, distributions of effort between research, teaching, and clinical service are greatest for the physician-scientist. Academic policies must recognize current realities (e.g., the increasing importance of team science and work-life balance) rather than remain wedded to outdated frameworks for academic advancement. Expectations must be Published online ahead of print. Publication date available at www.cjasn.org.