Commentary
Navigating the stages of an academic career
for paediatricians
Denis Daneman MBBCh FRCPC1,2,3, James Kellner MD, FRCPC4,5
I
n Canada, a major proportion of the country’s paediatricians
work within the context of the paediatric academic health science centres (PAHSCs). These are either free-standing children’s
hospitals or children’s units within general hospitals, all affiliated
with a university faculty of medicine. In a recent work force analysis by the Paediatric Chairs of Canada (PCC), an association linking the 16 medical school departments of paediatrics, 1701 full-time
and major part-time faculty members were identified, representing
slightly more than one-half of the country’s paediatricians (1). The
remaining paediatricians are increasingly involved in academic
activities as more community hospitals become associated with
expanding medical schools.
Medical students intent on a career in paediatrics and, perhaps
more importantly, paediatric residents deciding on their career
paths, ought to be well informed about the options open to them,
the appropriate training for each of these options as well as the
expectations when entering their field of choice. Here, we address
the issue of stages or phases of an academic career, and what to
expect and how to successfully navigate the challenges of each
phase. We make some assumptions, namely that the training for
the position has been appropriate and that the job or career activity profile into which the candidate has been recruited matches
this training. This is not to minimize either of these aspects of
career planning and development; rather, they warrant attention
in a separate article.
For simplicity, the PCC has defined the following career activity profiles for academic paediatricians:
1. Clinician investigators for those with more than 50% of their
time protected for research;
2. Clinician educators for those with a major commitment to the
education mandate of the department;
3. Clinician specialists/academic clinicians for those whose major
commitment is to clinical care; and
4. Clinician administrators for those, usually more senior faculty,
with a major commitment to medical leadership and
administration.
Two important considerations relate to careers in academic
paediatrics. First, independent of one’s career activity profile, all
faculty members in PAHSCs have a responsibility to contribute to
the advancement of their department and institution by providing
the highest quality, evidence-informed clinical care, and participating actively in undergraduate and postgraduate education programs. Second, all faculty members should be involved in creative
professional activity at some level and should have time protected
to pursue these activities.
Here, we identify four main stages of the typical academic
career, influenced by a lecture by the late Colin Bayliss, Professor
of Surgery at the University of Toronto (Ontario), attended by one
of us (DD) more than 20 years ago. These include the ‘Nervous
Novice’ stage, the ‘Gung Ho’ stage, the ‘Self-Respect’ stage and
the ‘Reluctant Retiree’ stage. We also highlight how these stages
can be influenced by various factors, most notably mentorship,
the emergence of leadership and the concept of ‘branching
morphogenesis’.
Stage 1: the NervouS Novice
New faculty recruits arrive via one of two routes: as trainees from
their home institution or as trainees from outside institutions. In
either case, there is a need to focus intensely on the expectations of
their position as detailed in their offer letter to establish their career
trajectory. For the internal recruit, this means establishing an identity and credibility beyond being a ‘super’-trainee and apart from
their training supervisor(s). In the case of the faculty member from
outside the institution, it means being accepted in their new home.
The career activity profile into which a new faculty member is
recruited will determine the major focus of their first three to five
years. The focus at this stage is inevitably on individual career
development, with almost single-minded concentration on the
required deliverables, whether in clinical care (outstanding care
within existing or newly established services), education (teaching
at the bedside or in classrooms, curriculum development and
evaluation, education scholarship) or research (grant funding,
publications, research supervision). In all profiles, new faculty
members are expected to contribute to innovation (2).
This is obviously a time of high anxiety for the novice faculty
member: Will I make the grade? Am I good enough? When will
‘they’ discover how little I really know? These are all parts of the
impostor syndrome, a ‘syndrome’ that commonly affects new academics. Despite external evidence of their competence, those with
the syndrome remain convinced that they are frauds and do not
deserve the success they have achieved. Proof of success is dismissed as luck, timing, or as a result of deceiving others into thinking they are more intelligent and competent than they believe
themselves to be (3). The impostor syndrome was once believed to
be more common among women who are successful in their given
careers, but has since been shown to occur for an equal number of
men. For most, this is a passing phase, for some it may be paralyzing to career development.
While there is no doubt that there are certain individual characteristics of new faculty members that are essential to their navigation of this early stage, the department’s ability to provide
support through easily identifiable approaches cannot be overemphasized, namely: protected time, realistic expectations, startup funds, space, exposure to content and methodological expertise,
and career and topic-specific mentorship. The most successful selfstarters will be able to establish themselves quickly, including seeking out appropriate mentors and collaborators. The more nervous/
reticent individuals will need support to do so.
Factors that militate success include inadequate training for the
position and/or excessive expectations with an inability to focus
1Department
of Pediatrics, University of Toronto; 2The Hospital for Sick Children; 3RS McLaughlin Foundation Chair in Pediatrics, Toronto, Ontario;
of Pediatrics, University of Calgary; 5Alberta Health Services, Calgary Zone, Alberta Children’s Hospital, Calgary, Alberta
Correspondence and reprints: Dr Denis Daneman, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8.
Telephone 416 813-6122, e-mail [email protected]
Accepted for publication January 12, 2012
4Department
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©2012 Pulsus Group Inc. All rights reserved
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Daneman and Kellner
one’s time and effort on the core expectations of one’s career activity profile. Other factors that may challenge the likelihood of success include inadequate income and the need to ‘moonlight’ to
meet expenses, as well as excessive travelling for academic
activities.
By three to five years, the nervous novice ought to have started
on the upward, more exponential trajectory of their early career. If
not, serious questions need to be asked as to whether this individual
is in fact suited to this career path. The longer decisions like this are
delayed, the more difficult it becomes for the faculty members to
consider alternative, perhaps more appropriate, career paths.
Stage 2: ‘guNg ho’
‘Gung ho’ is a slang expression meaning wholeheartedly enthusiastic and loyal, arising originally from a fighting context. Here, we
use it to describe the faculty member who emerges not only
unscathed, but emboldened by success during the first years on
faculty. An alternative label might also be the ‘Yes stage’, as the
faculty member, now recognized as a valued and valuable member
of the department, is increasingly asked, and often requests to
participate in departmental, hospital, university, national and
international activities, and invariably says ‘Yes!’. The upside of
these activities is recognition and movement to and achievement
of the first academic promotion, from assistant to associate professorship. The highly accomplished faculty member manages to
juggle their new responsibilities and influence with ongoing personal development. Nirvana is reached when the balance between
individual career advancement and commitment to the collective
of the department is also in harmony with work-life balance.
The downside occurs when multiple new commitments interfere with the career expectations and aspirations; too much time on
committees, attending meetings, too many invited lectures, etc,
can quickly erode the initial gains and cause a career plateau or
even regression. Ongoing, although less formal mentorship, as well
as input from their division head and department chair, is needed to
help the gung ho faculty member maintain their career trajectory.
There are some faculty members who remain somewhat reclusive, preferring to continue along a path of intense focus on their
specific strengths. They should be encouraged to do so, provided
productivity and some commitment to the collective are evident.
The concern here is that this reclusiveness may portend the inability to reach out to others for collaboration and assistance, thereby
limiting the scope of their achievement.
We have observed that those who fail to meet the metrics of
success required to advance in their careers, as well as many of
those whose career trajectory is slower than they or their department head would have liked, inevitably ‘blame’ lack of sufficient
protected time and/or lack of mentorship for their predicament.
Conversely, the successful faculty members are invariably those
who manage to protect their time and seek out appropriate mentorship. These are not all or none responses, but apply rather widely.
The Gung ho stage ends abruptly when the overcommitted
faculty member emphatically says ‘No!’ to yet another request to
participate.
Stage 3: Self-reSpect
With time, often in association with promotion to full professorship, comes academic maturation. The faculty member at this stage
is very much in tune with their strengths and the roles that play to
these strengths. Rather than being involved in a very broad spectrum of activities that often stretch far beyond their comfort zone,
the self-respecting faculty member now focuses their attention on
a narrower set of activities that are in line with their accumulated
expertise and achievements. It is at this time that faculty members
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can play their most powerful role as career and content mentors to
their junior colleagues.
Individuals at this stage often lead ever larger groups: research
teams, education endeavours, clinical programs, division heads
and department chairs/chiefs. From being the centre of attention,
they now focus more on trainees and junior colleagues.
Stage 4: the reluctaNt retiree
As academic careers wind down, more senior faculty members shed
or reach the end of their tenure in leadership roles, their places
being taken by junior colleagues reaching their own maturation.
When the transition of power is smooth, the program or unit can
undergo a healthy cycle of review and renewal under new leadership. Too often, however, the leader stepping down has difficulty
‘letting go’ and whether consciously or not, does not properly step
aside to create space for the new leader to develop his/her own
identity. This can lead to all sorts of stresses on both the previous
and new leader.
Since the removal of mandatory retirement laws in Canada in
2006, a move supported by the authors, it has become increasingly
difficult for many individuals to wind down their careers and retire.
Rather, a significant proportion, perhaps even the majority, now
remain on as full-time staff three to five, and more, years beyond
65 years of age. This poses some difficulty for department chairs
trying to recruit new, young faculty members with exciting new
academic skills. Either a phased retirement program or one in which
retirement occurs with ongoing activity rewarded by an academic
stipend, will be necessary to allow new recruitment and not turn off
the next generation of paediatricians from a career in academics.
The success of any individual academic career depends on
many factors, some individual, others interpersonal, yet others
institutional and/or societal. Individual factors include resilience
and sustainability, in other words, does the new recruit have the
training, both in content and methodology, to provide the foundation on which their own innovations in research, education and/or
clinical care can be built? Too often, young faculty members are
appointed before they have completed sufficient training to have
achieved this foundation, or they are given expectations that are
not in sync with their sphere of expertise, or institutional demands
make accomplishment difficult, if not impossible.
Interpersonal factors include the knack for collaboration and
cooperation with colleagues inside and outside their own institution. Some of this will depend on the individuals themselves, some
on their mentors and supervisors helping to open doors for them at
critical times in their career.
The institutions in which individuals ply their trade are also
essential. Often, as pointed out by Joe Simone in his excellent article, Simone’s Maxims, the individual is out of step with the institution. The planning framework of large institutions is often much
longer than that of the individual; similarly, institutional priorities
may not encompass the individual’s aspirations (4). Also, many
institutions are not agile enough to accommodate the goals and
objectives of leading-edge faculty. Finally, societal factors, such as
the funding environment for research, the health care system and
the economy, are all important contributors.
ModifyiNg factorS
1: Mentorship and career guidance
The key role of effective mentorship at all career stages, particularly in the early years, as the well-known David Sackett has stated,
must include the provision of resources, academic opportunities
and advice, and also ensure the protection of time (5). In addition,
Sackett stated that a good mentor must be a competent academic
Paediatr Child Health Vol 17 No 6 June/July 2012
Navigating the academic career of paediatricians
themselves, academically generous (ie, not competitive with their
colleague), not control the appointment or compensation of their
colleague, enjoy mentoring and be willing to make time for it, and
be willing to seek feedback on their own performance.
2: leadership does not need a title
Evidence of leadership capability and aspirations should be identified early and appropriately nurtured. What emerges quite early in
some academic paediatricians is the innate desire and capability to
lead. For some, taking charge comes naturally and in no time they
are directing the action, while others wait and wait to be asked to
participate or else feel uncomfortable doing so. Mentorship may
help the reticent develop a sense of direction. Formal leadership
courses may also be helpful.
3: Branching morphogenesis
Although this is a term borrowed from the developmental biology of
the lung and kidney, for example, we use it here to describe activities
that take the faculty member on a trajectory very different from their
original one, branching out while at the same time needing to develop
new skills (morphogenesis). At any stage during the evolution of their
career, a faculty member may be offered or seek an opportunity to
change course, for example, from academic clinician to clinician educator or investigator or vice versa. Others may alter course by assuming additional administrative responsibility. These opportunities may
alter the mix of staff within a division and requires careful thought
before approval is granted. Similarly, those assuming the change in
responsibility need support and development to meet the new challenge. This may involve a new period of training (‘training the
trained’) and time protection to do so. This is quite a risky approach,
although experience suggests that it succeeds as often as not.
There is no doubt about the potential for enormous career
engagement and satisfaction as an academic paediatrician. For
Paediatr Child Health Vol 17 No 6 June/July 2012
those meeting the expectations, the rewards of working in such an
environment are tremendous: secure employment; time protection
for innovation; interaction with undergraduate and postgraduate
students; provision of the highest quality clinical care; as well as
entry into the national and international arena through membership in societies and associations that advocate, educate and
research issues most relevant to child health. In his book Drive:
The Surprising Truth About What Motivates Us, Daniel Pink provides evidence that, as long as money is off the table in the form of
a decent income, the factors that determine job satisfaction are:
autonomy to develop new ideas and approaches, mastery of the
topic at the highest level and contribution to the big picture
(important societal issue, health) (6). Can there be a better
example than a career in academic paediatrics?
refereNceS
1. Paediatric Chairs of Canada (PCC) <www.paediatricchairs.ca/>
(Accessed December 2011).
2. Wright JG, Daneman D, Mainland J, Rossant J. Innovation as the
core strategy for the future success of academic health centres.
Can J Surg 2011;54:150-1.
3. Wikipedia, Online Encyclopedia. <http://en.wikipedia.org/wiki/
Impostor_syndrome> (Accessed December, 2011).
4. Simone J. Understanding academic medical centers: Simone’s
Maxims. Clinical Cancer Research 1999;5:2281-5.
5. Sackett D. On the determinants of academic success as a clinicianscientist. Clin Invest Med 2001;24:94-100.
6. Pink D. Drive: The Surprising Truth About What Motivates Us.
New York: Riverhead Books, 2009.
additioNal readiNg
• Filler G, Piedboeuf B. Variability of the pediatric subspecialty
workforce in Canada. Journal of Pediatrics 2010;157:844-7.
• O’Brodovich H, Beyene J, Tallett S, MacGregor D, Rosenblum ND.
Performance of a career development and compensation program at
an academic health science center. Pediatrics 2007;119:e791-7.
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