Careers in academic medicine

Abstract

At this meeting at the Royal College of Physicians (RCP), established academics and members of grant awarding bodies advised an audience, predominantly comprising trainees pursuing or contemplating a career in clinical science, on why, when and how to tackle such a career path in the current climate. There has arguably never been a more exciting time to be involved in clinical science. In this era of genomics and proteomics, disease-causing genes are being identified, mechanisms of disease elucidated, and targeted therapeutic strategies developed. At the population end of the research spectrum, large scale clinical trials are facilitating the practice of evidencebased medicine. When discussing reasons to embark on an academic career, this was perhaps preaching to the converted. Clearly there exists a variety of motivating factors between individuals, but common to many, the fascination, occasionally the addiction, of enquiry. To ask the correct question, the first and most critical step, and then to devise methods to answer it. Equally important, though, are reasons not to undertake research. How many research theses have been written not because of interest in the subject itself, but as a perceived means to reach the next step of a clinical career? This issue is becoming more topical with changes in training schemes, particularly with the trend towards shortening the duration of clinical training. Feeling obliged to undertake research is not only undesirable from the trainee’s perspective, taking time away from their preferred activities, but it also removes limited resources from others who do have a genuine interest in developing a research career. There may be a case here for greater availability of one year MSc courses, either to provide subspecialty teaching, or to provide an introduction to research methodology to those who wish to be ‘research aware’ but do not wish to undertake a thesis. Nevertheless, research degrees continue to serve as hard currency in the clinical jobs market. Of greater concern are the disincentives to pursuing clinical science for those trainees who do have a genuine interest. The frequently cited evidence for the existence of a problem is the number of senior academic positions in the UK, which remain unfilled. Since competition for externally funded training (doctoral) and intermediate (post-doctoral) fellowships remains intense, the conversion of postdoctoral fellows or university post holders (clinical lecturers) to senior positions appears to be an area of susceptibility. This may be a consequence of both an inadequate number of posts and of a trickle of such post-holders back to NHS positions. This recruitment and retention problem was noted almost 10 years ago, when the House of Lords Select Committee on Science and Technology expressed concern about the disincentives to an academic medical career. Further complications have since arisen, following significant changes to clinical training with the introduction of the specialist registrar grade. In March 2000 a working party from The Academy of Medical Sciences considered the threats to academic medicine and made seven recommendations, including a key proposal, the introduction of the tenure-track clinician scientist post (the ‘Savill Report’). Discussion of these proposals, with some analysis of their effect some four years on, emerged as one of the main themes of this meeting.1 The Savill Report expressed concern at the declining numbers of clinical lecturers. It suggested that as a consequence of the research assessment exercise (RAE), whereby an academic department’s rating influences its income, there may be pressure on medical schools to replace these training posts Conference programme