Some residents will wonder whether an academic job is right for them. I hope I can demystify a few issues to help ensure that graduates make the best choice for themselves. I will describe academic roles in general terms, recognizing that each university has individualized criteria for hiring and promoting academic physicians. At the core, however, there are some universal truths.

A university-based academic position is meant to be devoted to discovery, advancement of thinking, and creation of new knowledge. In 10 years, we will be practicing medicine in fundamentally different ways. Those who do the research, create insights, critically observe, make meaningful improvements, and share that knowledge are often collected in academic environments and on a professorship track. These academicians help create and sustain a dialogue that will change practice in meaningful ways.

Those who like to do this work typically need the support of an enriched environment where people with an array of skills help with research, grants, and publication. The university structure is meant to recognize and reward this work. Those with the right preparation and training will be hired at an instructor level. Some physicians who do not publish may stay at the instructor level for an entire career. Some universities do not allow this and believe that everyone must contribute to scholarly advancement or must leave if there is not academic productivity. While not every university has this up-or-out mentality, the academic world generally expects physician faculty to achieve promotion to assistant professor and beyond.

Sarah Hoper, MD, recently joined the staff at Vanderbilt University in Nashville, Tennessee. She is interested in health policy and is the legislative advisor for the Emergency Medicine Residents’ Association (EMRA). Jordan Celeste, MD, is president of EMRA and is an emergency physician in Florida.

Career Path

The assistant professor is typically acknowledged to be one who is fulfilling the academic promise with evident publications, presentations of research work, and other output. Typically, three to five publications are needed. Those on the educational track must similarly be developing a portfolio that demonstrates a quality and quantity of educational work that is meaningful and impactful. It is expected that the academic educator will not just teach but will critically assess and meaningfully improve the way education is conducted, the way curricula are designed, and the way new physicians are trained. When there is evidence that other programs are using an assistant professor’s ideas and concepts, then academic promotion is facilitated. At the very least, there must be output that is judged by peer review or some other means to be worthy of sharing widely.

When the academic physician develops a substantial body of work that results in recognition or has evident impact, then the person is working toward becoming an associate professor. The associate professor probably has eight to 15 publications, in addition to much evidence of involvement and impact. The associate professor must be working on the national stage, producing publications, doing committee work, or giving lectures in the field that are well-received by other thought leaders. There needs to be some evidence that the work is making a difference and influencing others, perhaps because others are referencing the work, others have chosen the associate professor for leadership roles, or subsequent external grant funding has been achieved.

My advice is to choose the career that makes you happy. Be excited to wake up every day. Know you are influential, even powerful, in the lives of those you come in contact with. I wish you peace, happiness, and fulfillment. You deserve it.

As the career progresses and the body of work expands, professorship will be considered. The professor is a widely recognized authority. At least 20 publications, perhaps dozens more, are required to be considered in this category. National or international work will be sustained over time, a continuous record of productivity will be maintained, and other top leaders in the field will validate that the person is among the best thinkers in the field. This is a high bar, as it should be. Different universities have different standards, with top-tier places clearly stating that they will name a professor only when they find clear evidence that the person is one of the leading authorities in the field.

It gets confusing, however, because some universities will call a valued doctor “clinical professor.” This carries a different meaning. In some cases, this specifies a clinical doctor who does not do academic work. In other cases, there is expectation of academic work, but the many clinical hours of work, administrative leadership, and university committees are taken into account. Universities recognize that this work contributes greatly to the culture and environment of a scholarly institution, as well as recognize that this work allows less time for research and publications. Promotion can be successful as the full range of contributions is taken into account, not just publications and academic work. The “clinical” modifier is one way to note the difference.

For those who work full time on research, it is expected that external grants will be consistently obtained. This is a tough task and takes deliberate additional preparation through research fellowships and mentored projects. When a faculty member takes this route and is willing to be judged based on the quality of research and grant funding, then tenure is possible. Most tenure tracks have a strict up-or-out policy. By a defined time—six to nine years is typical, depending on the institution—the promotions committee will judge whether tenure should be granted. If it is not granted, the person has to leave the faculty. This is tough and has changed the trajectory of many academicians’ lives, sometimes for the better and sometimes for the worse. Tenure is a rare and honorable recognition in the field of emergency medicine.

There are new tracks emerging for those faculty members who are part of an academic system but do little work inside the university. For those who are affiliated and perhaps only occasionally teach a student or resident, universities are creating new types of appointments that do not have the word “professor” in them, such as “health system clinician.” Some universities use the titles “clinical instructor” or “clinical assistant professor.” As systems grow larger, the importance of a professorship can get diluted so new titles are being invented. These by no means lessen the importance of the physicians’ contributions. They do recognize that these distinguished physicians are dedicating their lives to essential clinical work but not dedicating their time to creating new knowledge, new discoveries, or new educational models. This is a work in progress.

In the final analysis, all roles have enormous importance to the university, to the community, and to society at large. Every physician, through clinical, educational, or academic work, is meaningfully and powerfully impacting the lives of others. My advice is to choose the career that makes you happy. Be excited to wake up every day. Know you are influential, even powerful, in the lives of those you come in contact with. I wish you peace, happiness, and fulfillment. You deserve it.

Dr. Adams is senior vice president and chief medical officer of Northwestern Medicine and professor and chair in the department of emergency medicine at the Northwestern University Feinberg School of Medicine in Chicago.