As a Professor Emeritus in good standing in the Department of Pediatrics of the John A Burns School of Medicine (JABSOM) since 1977, I have dedicated 47 years, circa 60% of my life to academics at the University of Hawaii (UH). Approaching 78, I am in the last year of my career at the UH and would like to include a postscript to this nearly half century commitment. I have held important leadership positions in the Department of Pediatrics, in the JABSOM’s Dean’s Office, in the Vice Chancellors Office at UH Manoa, and in the UH Systems Office of Compliance. Moreover, I served the community in developing a fine-tuned system of regional perinatal care in Hawaii that includes outlying community and neighbor island hospitals, Tripler Army Medical Center (where I additionally orchestrated a joint Neonatal Fellowship Program), the Kaiser Medical Center consortium, and the flagship Kapiolani Medical Center for Women and Children where I was the Director of Neonatology for over two decades.
To contextualize this commentary, I will briefly reflect upon my academic career. Having instructed hundreds of medical students and pediatric residents, 30 neonatal fellows, I have also mentored hundreds of faculty members in my role as the Director of an NIH funded Clinical Research Center as well as during my tenure in the JABSOM Dean’s Office as the Director of Clinical Research. While I continued to develop my own research career in the animal laboratory (pulmonary focused), in the Neonatal Intensive Care Unit (exogenous surfactant studies) and in the community (health disparities), my research was never earth shattering nor insightful enough to gain traction or lasting national recognition. What this research did for me was improve my analytical, critical thinking, and ostensibly my clinical skills, to make me a much better, up-to-date, discerning, and empathetic clinician. My academic success was rather related to leadership in institutional grants development, derived in part from mentoring received from Fredrick Greenwood PhD, who was the Director of the Pacific Biomedical Research Center at UH, and credited with sparking the original seeds in the origin of both JABSOM and the Cancer Center programs. Indeed, Fred’s visionary and significant programmatic academic and institutional approach and accomplishments had a profound effect on the direction of my career and life.
With the recruitment of Edwin Cadman as Dean of JABSOM, with a bolus of institutional development funds, and support from an innovative NIH initiative that funded the “Biomedical Research Infrastructure Network”, a Grants Development Office was created under my leadership by 2000. This sparked an explosive transformation in grants development activity at JABSOM. Twenty-three years of grants writing produced almost a half a billion dollars in grant funds for JABSOM. About 40% or $200,000,000 of those dollars involved my contribution in one form or another: creating an appealing rationale for JABSOM applying, concept development, inclusion and organization of cores, conscription of junior and senior faculty participation, active involvment as key personnel, grant writer and or editor, overall leader of grant development and completion effort, and consultant on many fronts. As I became more involved in the NIH, I was constantly consulting the program office for guidance. And I was constantly interacting with faculty members, not only at JABSOM, but throughout the UH System.
JABSOM is one of a minority of community medical schools in the US, which lacks a University Hospital and as such, the equilibrium between clinical and academic activity of the faculty members is often shifting and at odds causing constant tension and conflicts of interest. This is particularly relevant considering that the lion’s share of faculty salaries come from our medical center partners, with increased scrutiny and emphasis placed on clinical performance and accountability, at least at the UH. The high cost of living in Hawaii imposes further liabilities on the burgeoning clinical faculty members recruited to fill vacancies and enrich newly developed areas of care. In short, it’s never been more difficult than the present to prosper as a successful clinician scientist in Hawaii, while concurrently pursuing your own interests, owning your own home, enjoying, and raising a family, and integrating successfully into the community. My interest in promoting faculty well-being was derived from the backdrop of this emerging environment enveloping the lives of the clinical faculty at JABSOM and UH in general.
There comes a time in one’s career, no matter how successful, for reflection and review. Do I continue to pursue my academic and or research interests? Do I shift to consider other leadership roles in the department, medical school, or main campus? Do I relocate to another university that offers me more opportunities for advancement? Some might even default to consider how best to do the least amount to get by and maintain their good standing. Finally, other might begin to contemplate the specter of and opportunities surrounding retirement.
Particularly in medicine, I have found that contemplating retirement strategy for my colleagues is at least as problematic and often as frightening as choosing one’s career and area of specialty. Too many identify so strongly with their “doctor” privilege and status that they resist retirement thoughts and discussions until the very end when it is too late. The alternative is that many of them genuinely love what they do and have no interest in veering out into an unknown and uncertain terrain. Nevertheless, there comes a time for many of us in academic medicine that opportunities arise for changing direction, taking on new roles and responsibilities, or just pulling back from the constant rat race of leadership constraints that requires 24/7 concentration and personal sacrifice. My goal from the very start of my medical career was to retire early enough and to enrich my life through new experiences and experimentation in unexpected and opportunistic ways. After 30 years of fulltime medical practice, I retired from full time academics and clinical medicine into what I expected to be a short parttime transition into full retirement in 2007. It has fortunately or unfortunately taken me 17 additional years to accomplish a full retirement from academics and clinical practice, which prompts me to relate my personal experience as a lesson for others at similar points in their career.
My parttime faculty role took on many backdoor activities including non-leadership positions in numerous NIH grants, many of which I helped author from the outset. I gravitated eventually to assisting faculty members with their academic pursuits, with manuscripts under development, institutional, community, and national grant applications, and as a byproduct of my developing associations with junior faculty members, providing help for those seeking promotion to the next academic level. I transitioned my interests away from my own career partially because other than the one mentor who appeared at a later stage of my development, I received virtually no help in navigating my academic career. At UH, the process of promotion and tenure is a lengthy, burdensome process that includes hundreds of pages of documentation and a circa 12-15 page “Statement of Endeavors”. This calls for documenting every academic encounter and external evaluation since the last promotion to one’s present academic status through the creation of a well-written and engaging document that is evaluated in a process that includes six separate levels of review in a year long process of development and documentation.
One of the first and most memorable faculty members that I helped was a member of the Institute for Biogenesis Research and the Department of Anatomy at JABSOM. English was not her first language and her ability to communicate in writing was accordingly lacking. It didn’t help that miscommunication arose with her department chair that led to a mixed review that was also reflected in the Dean’s assessment leading to a lack of full support for her promotion and tenure application. Nevertheless, this faculty member had a solid foundation of academic accomplishments, and I was asked to help her construct a rebuttal to the initial recommendation to disapprove her promotion and tenure application. Clearly there was no malicious intent on the part of the Chair or Dean, and the rebuttal document was successful in accomplishing the faculty member’s goal. I was surprised and delighted by how important my contribution was in formulating a convincing argument to counter the misunderstanding and miscommunication and to exact a just conclusion and outcome.
Again, the focus of this chapter of my career, as I conceded as my last, shifted from my own, to the careers of others in need at the medical school and broader university. I have mentored faculty members at JABSOM as well as other units at UH Manoa. In fact, one of two faculty members I assisted with both their promotion dossiers to associate as well as full professor status resides in the College of Engineering. I have counselled about a hundred faculty members all told, at least a quarter of which I have helped with their dossier development. A few were clinical faculty members; most were compensated fulltime faculty members residing in the Departments of Pediatrics as well as Medicine. The extent of my participation varies depending upon the faculty member and the priority placed on completing the dossier in a timely fashion. It is important to state that while my contribution does vary based on each faculty member’s involvement, organizing, and writing skills, my role is never trivial and at best it involves a continuing cycle of document exchange to introduce and revise sections of the statement of endeavors over time. It is not unusual for 50 such exchanges to occur although a dozen exchanges represent the minimal effort that is needed to provide some meaningful level of contribution on my part. Syntax, content, organization, flow, tables and figures, quotations from students, residents, and patients, supplemental materials, letters of support are all topics for discussion, review, and edit.
Perhaps I’ve jumped the gun in discussing this line of support for medical school faculty members. Beyond the department chairs who clearly understand and value this focus on faculty development, its not too far reaching to consider that most senior faculty members who have prepared their own promotion dossiers are not sympathetic or in support of this type of mentoring and faculty development. I do not profess any expertise in understanding the requirements or environments present at other medical schools or whether I would myself feel as dedicated to the cause in other environments. But I clearly do both enjoy and value this role at JABSOM. Conversely, I did not enjoy applying for my own promotion. More accurately, I hated the experience and believed it a waste of my time, and that it was axiomatic that I should be promoted to the next level, enamored with my accomplishments and too busy and important to dedicate so much effort and time to such a trivial application. Nevertheless, since my last application for promotion about 30 years ago, I have not been interested in re-reading what I wrote at the time, fearing that I would be highly critical of the product despite the successful outcome.
To be continued........
No comments:
Post a Comment