Robert Chang writes…
Yesterday I received our finalized list of incoming faculty, and I was struck by the dramatic shift of the type of the physicians we were hiring. Two years ago, we were scrambling to meet manpower needs that were doubling every year (including turn-over). The list this year included several full-time researchers with established careers and several other up-and-coming researchers from other institutions. This is a testament to the importance of stability, which allows an appropriate shift of attention from clinical management of patient load to professional development and sustainability, but also marks how we chose to develop our group over time.
One way that I like to look at the evolution of our hospitalist group is by the core questions we faced over the years, each of which remain true despite the growth we experienced. “What does the job description of a clinically-oriented hospitalist group look like in an academic hospital?” remains a fundamental issue. That question begs the corollary of “does everyone work on the non-resident service?” or “do we all have the same job description?”. “How do young clinically-based physicians achieve excellent resident evaluations and participate in research?” is a work-in-progress. The incoming group creates a question that most established academic fields face: “Should we embrace a fundamental division in our group where this group does the clinical work and that group does the research work?” This is really the same question as “does everyone work on the non-resident service” from the research perspective instead of resident/non-resident time.
To get at the last question, it’s worth thinking about what is reasonable to aim for your group mean. Talent, training and inclination often determine which people are able pursue their interests further (see Outliers for an interesting perspective on success), but in reality, not everyone is trained, naturally endowed or interested in doing research nor working with residents. And yet, that is the purpose of academia and serving at an academic institution. But perhaps we should view research, clinical care and education in the same way we might view fees for hospitalization. A bundled perspective is more sensical in some ways than viewing education, research and patient care as separate essential pieces to the mission of academia. While research dollars have skewed this perspective dramatically, truly, no one part is more important than the other and each part is in fact reliant on the other. We can contribute to the separate or bundled perspective on academia by choosing to add to or decrease the differential value of the academic mission by:
1. recruiting faculty for a purpose that inherently grows division in the group – research faculty are researchers, clinical faculty are clinical workers.
2. leveraging the talents that are bring brought in to the advantage of everyone – as we bring in researches, have a natural expectation to serve as mentors to the younger faculty to develop their research. Likewise for educators.
The world is not so neatly black and white. Both points above have a degree of truth to them but we each have the opportunity to build the framework and vision our groups. I think one last question that faces me as an academic hospitalist leader: as we intentionally build expectations and vision to contribute to the inherent success of each member and as a whole, what ways have we thought through how to recruit and structure the group to that end?