Career Talk

Beyond the Ivory Tower

October 2006

It has have been over one year since I last wrote an article for Careertalk. When I was first asked to edit Careertalk four years ago, one of my biggest fears was that I would run out of topics or ideas. That did not happen. To make a long story short, after nearly 20 years in academic medicine, I accepted a part-time group practice job at a local community hospital. Over the past year, I have debated whether to share my decision and if so how. It was important for me to be honest, but would I be discouraging a new generation of young physician-scientists by focusing on the aspects of academia that finally drove me to leave? Would this column merely be a personal forum for venting my own guilt and broken dreams or gloating about my new hopes? After 7 months in my new job, I feel that the time may have finally come to put some of my thoughts and experiences down on paper.

I grew up in a family of academics. Both of my grandfathers were university professors and presidents. My father was a university professor as were most of my uncles. To borrow a phrase, the “honor was great but the honorarium was poor.” It was never about money. I believed in academics as a profession that went beyond mere specialized training and incorporated a specific code of ethics and ideals. I never thought seriously about doing anything else. Academics was not merely a way of life, it was my life.

The first time I ever seriously thought about leaving academics came about three months after the birth of my first daughter. Up until then, I had been able to focus on my training and career without significant distraction. I graduated from college and medical school without much debt. I married and had children after completing my fellowship. Pummeled by hormone shifts, made stupid from sleeplessness, I watched my focus, productivity and efficiency drop. It is hard to be creative and think of new research ideas when you are exhausted by q 3 hour feedings. As I sat and tried to type at my computer and pump at the same time, I thought, no way, this is it, I can’t do it. There were no role models, no footsteps to follow. I was on my own. But I decided that the only thing to do was to just keep moving forward as best I could and hope for the best. I stuck it out, got a nanny, a VA Merit Award and an NIH K Award that brought some stability back to my personal and professional life.

I spoke with a couple of other mid-level women faculty recently, both with young children, and one common theme seemed to be the stress associated with the constant fear of failure. Life often seemed like a precariously balanced house of cards that was always on the verge of tumbling down. Part of my impetus for writing Careertalk, was wanting to share some of the hard-fought lessons I had learned. With more and more women coming into the field, I wanted to be realistic but not discouraging in portraying a personal side of medicine that so rarely gets shared.

The job offer came out of the blue. A former colleague who had recently left the university called and said they were looking for someone to fill a part-time, primarily out-patient position with no administrative responsibilities. Short of completely leaving medicine, it was about as different a job as I could find compared to what I had been doing for the past eighteen years. After investing my heart and soul into academics for nearly two decades, was I moving on or quitting? Seems like a silly question to ask, but for someone trained to deal with multiple patients with multi-organ failure, who thrives on multi-tasking and the thrill of the code, it is hard to know when enough is enough. Like marines in boot camp, academics take a certain amount of pride in the amount of abuse they live with. I recently read Into Thin Air by Jon Krakauer about the Everest expedition that ended so tragically 10 years ago and I was struck by the similarities between these mountain climbers and intensivists. Both groups are extremely persistent, goal-oriented and have a hard time knowing when it is time to quit, even when it means that you will not have enough energy for the climb down. It is one thing to push yourself to the brink when the only thing you have to lose is yourself, but mothers don’t have that luxury. Even with carpooling, nannies, daycare or aftercare, there are some things in life that you can’t outsource. And one thing that was becoming increasingly clear was the growing dissonance between what I was told to do and what I wanted to do, between the institutional and my own life goals and values.

In the end, perhaps, it boiled down to my family and simple curiosity. The offer had opened a door and I was curious to see what was on the other side. This presented a new challenge and opportunity for change that I could not refuse. It was hardly as if I would be breaking new ground. Private practice is not the road less taken. But for me, it would be something new. And the transparency of the job was alluring. I knew exactly what I was being hired to do. Since I had either worked with or helped train many of the people in the group, I knew that I would be working with a group of extremely smart, talented, and hard-working doctors who did not practice “fast food” medicine but were committed to excellence and still put patients first. I would be giving up the flexibility of full-time academia for the rigid schedule practice-based medicine. Although part-time, the salary was nearly equivalent to that of my academic position allowing me to continue with research activities on my days off, although not as a PI. A kind of simplified twist on Pascal’s Wager, I could take a chance on real happiness and a new paradigm.

As you will notice, Careertalk is also entering a new phase, too. The old articles are being archived, making them easier to access by topic. Over the next year, I’ll be going over and updating the articles in Careertalk. There will also be a “Best of the Web” coming out in a few months. We will also continue to have guest authors. Our next column will feature Polly Parsons, recipient of the Elizabeth A. Rich MD award this year, who gave a warm, wise and witty talk at the recent Women’s Luncheon at ATS that I think eloquently captures the underlying philosophy of Careertalk about finding the magic in life and ourselves. I also plan to talk about my new life, the challenges, and the surprises from the perspective of an ivory tower academic crossing over to the other side.

But, I need your suggestions. I have received an email about possibly setting up a blog. I also have gotten a proposal to do a short monthly blurb for the ATS News. Let me know what you would like to see in this column. Contact me at