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We appreciate the informative letter. There are indeed many barriers to preparing for and succeeding in an academic career. While some such barriers are somewhat generic (ie, common to all surgeons), others may be institution- and country-specific. Mechanisms to overcome these barriers are also likely to be both generic and institution- and country-specific. Our study examined what are, in essence, generic factors important to vascular trainees when deciding whether to choose a career in academic vascular surgery and suggests that young vascular surgeons entering the academic arena desire mentorship, research and teaching opportunities, a clinically busy practice offering a variety of open and endovascular procedures, and the ability to work with like-minded individuals. However, the unfortunate reality is that, in the last decade, medical institutions in the United States have placed more emphasis on clinical productivity, as it generates funding for the hospital and the medical school. This drive to increase clinical activity has had the effect of making it more difficult for academic surgeons in the United States to also engage in and excel in research and teaching activities. Creating divergent pathways for academic and clinical training as outlined in the letter is a potential solution to the pressures of trying to excel in both academic and clinical endeavors, provided both tracks are equally valued within institutions. However, in our opinion, for a surgeon, academic excellence should not come at the expense of clinical competence. Clinical competence is always paramount. If the program outlined in the letter, combined with local barriers to training, does not permit training of a clinically competent and confident surgeon, the new paradigm will either fail or result in two classes of surgeons within the United Kingdom. Obviously, both are undesirable outcomes. Similar to the new 0/5 training paradigm for vascular surgeons in the United States, the United Kingdom academic pathway will require careful ongoing assessment and re-evaluation. It is my hope that leaders in surgical education worldwide remain keenly aware of the angst facing the surgeon contemplating an academic career and engage young people in finding local solutions to common problems. Regarding “Factors affecting career choice among the next generation of academic vascular surgeons”Journal of Vascular SurgeryVol. 56Issue 3PreviewI was delighted to read your Web survey of residents and their choice for a career in academic vascular surgery in America.1 This is indeed one of the few studies examining the actual factors that influence a young vascular surgeon's choice in embarking on an academic and educational career. There are similar parallels with the career choices of young vascular surgeons in the United Kingdom to those of your study. Full-Text PDF Open Archive