Laura Weiss Roberts Editor The Academic Medicine Handbook A Guide to Achievement and Fulfi llment for Academic Faculty 123 The Academic Medicine Handbook Laura Weiss Roberts Editor The Academic Medicine Handbook A Guide to Achievement and Ful fi llment for Academic Faculty Editor Laura Weiss Roberts Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford , CA, USA ISBN 978-1-4614-5692-6 ISBN 978-1-4614-5693-3 (eBook) DOI 10.1007/978-1-4614-5693-3 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2012955677 © Springer Science+Business Media New York 2013 This work is subject to copyright. 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Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) For our sweet Tuli Introductory Commentary by Philip A. Pizzo, MD While each of our life journeys is distinct and even unique, most of us who chose a career in academic medicine share in common a deep personal fulfi llment that comes from pursuing unchartered questions, making discov- eries, educating students and trainees, learning constantly, and being able to bring one’s individual and collective knowledge to improve the lives of oth- ers, especially those suffering from illness or disease. I am not unique in those goals and aspirations. However, as I re fl ect on the course of my own career, I also recognize that during its various stages, including its ups and downs, starts and restarts, it would have been impossible to predict the path ultimately traveled. I didn’t plan most of what has transpired over the past several decades. Looking backward, the seemingly distinct threads of my own career, each a different journey, some of which I anticipated, but many others of which were the result of unexpected forks in the road, now seem to have woven together in a pattern that makes sense to me, at least in retrospect. But that too is one of the great ful fi llments of a career in academic medi- cine—one’s personal career portrait is really de fi ned by looking backward rather than forward. This does not mean that one’s career is unplanned—but, rather, that adventuring in the unknown can lead to the greatest ful fi llment—in time, space, and personal growth. The individual threads of one’s career are bound by common principles that glue and connect them. At least for me, these have been the very deep sense and resolve that one’s career is more of a “personal calling” than a job. A career is something one relishes and is excited about—not just something to fi ll time and space or to march in the path of proscribed expectations. Linking the threads of one’s academic career is a sense of vision and mission—often to tackle the big challenges that negatively affect the lives of others or that threaten the integrity of institutions and individuals we value and admire. To the contrary, it should not be about the gathering of titles or super fi cial “metrics” of success—in academic medicine or beyond. In them- selves, titles and positions are simply transition points to me, not stopping places. When they become endpoints or goals in their own right, they can blunt creativity and the sense of risk that makes science and medicine so exciting. Although we all work at institutions and serve as its leaders, when the need for a “position” and the trappings of power become goals in their own right, the opportunities for bold leadership shrink exponentially. We should aspire to positions of leadership because they are vehicles for bold vii viii Introductory Commentary by Philip A. Pizzo, MD change, not because they bolster who we think we are—or should be. Success comes from serving others and is re fl ected in the glow of spawned accom- plishments, the light of which should be more transparent and dispersed, rather than a search for a personal limelight. If I were to narrate the beginning of my life journey, I might start with gradu- ating from high school—now nearly 5 decades ago. In some ways with that accomplishment I would have reached a pinnacle of success in the fi rst-generation working-class family in which I was raised in the Bronx and Queens. I was the fi rst to graduate high school and to go on to college. Some of the threads that had begun earlier in my life began to interconnect at this phase. Without immediate role models, my heroes were the discoverers, inventors— fi rst in physics and science—about whom I read as a young child and adolescent. From Newton to Pasteur, Fleming to Burnet—they were my guide through the Penguin “classics” or the pages of S cienti fi c American . I am not sure now how I imagined them other than with awe and vicarious admiration. Although I was highly interested in science, my college years were more marked by the works of Heidegger and existential philosophy—including the social justice of Huxley and Pauling. In many ways I was coming of age dur- ing the turbulent period now affectionately called “the 60s,” which has many stereotypic portraits but one enduring value that has marked my own career— and I am sure many of my generation. More speci fi cally, it was the sense that one could “change the world,” that individuals could make a difference by taking on big issues with big visions. That aspiration, with all of its youthful naiveté, proved a galvanizing force and a lifelong guidepost. The goal of becoming a doctor emerged from multiple beginnings: the hidden and sometimes stated aspirations of parents hoping for a different life for their children, the sense of pursuing a career path that seemed to have social value, meaning, altruism, and professionalism (at least at that point), at a time in history when social issues were dominant. There were no role models of academic medi- cine in my personal orbit before I started medical school, other than the champi- ons I had imagined or the stories told in Paul DeKruif’s “M icrobe Hunters .” In fact, my original plan was rather circumscribed. Before going to medi- cal school, I had envisioned a career that would likely mirror the family doc- tor who had come to our house for interval illnesses when I was growing up. That began to change dramatically when I entered medical school—as new doors of inquiry opened and new possibilities seemed to abound. Yet, even when I graduated medical school, my planned career pathway turned out to be quite dramatically different than I had anticipated—even though the val- ues, integrity, and sense of mission were still clearly manifested. My goal when I left Rochester for Boston was to shape the future of pediatric health care for the underserved. Although I had been quite involved in research at the interface between stress and risk for infection during medical school, social issues seemed more pressing—likely re fl ecting the in fl uence of incred- ible leaders and mentors in my medical school but also the sense of social inequity and racial injustice that was so apparent, especially as the 1970s began in the wake of President Johnson’s “Great Society Program” and his “War in Vietnam”—seemingly diametrically opposed forces that had a big in fl uence on impressionable young people, including me. Introductory Commentary by Philip A. Pizzo, MD ix The threads that connected me to the research that has dominated the largest part of my career occurred with my transition from Rochester to Boston. It started immediately with a research project I conducted on the sources and value of teaching and learning experiences during internship and was soon accompanied by a study of “unexplained fever,” which I conducted while a resident. It was a dramatically different time of expectations and mores—of individuals and institutions. My “on-call schedule” in the hospital was 132 hours/week—and during that time I used unscheduled night call times to do research. In retrospect this seems pretty “pathological”—but at the time it was exciting and ful fi lling. These intense days redirected my inter- ests to two seemingly unlinked career paths—hematology-oncology and infectious disease. At fi rst it was not clear how to choose between these dif- ferent life journeys—but unexpected coincidences found a way to link them and create other connections in the seemingly disparate threads of my then nascent career. It was an unexpected detour from Boston to Bethesda that occurred weeks before I was about to begin my fellowship in hematology–oncology at the Children’s Hospital and Dana Farber Cancer Institute that changed my life and career journey. There was a need for a pediatrician to care for an 11-year- old youngster who had developed aplastic anemia and who had been placed in a special “protected environment” room in the Clinical Center at the NIH that changed my life. I was literally “drafted” for this duty and found myself immersed with the care of a young patient who would change my life person- ally and professionally. While my time in Bethesda was supposed to be for 2 years, I wound up spending 23 years—the fi rst 7 of which were involved with Ted, who grew from 11 to 18 years of age in a room the size of a modern bathroom. Because of the nature of his illness and the uncertainties it posed, my research moved quickly to efforts to understand bone marrow failure and immunocompromised host defenses. Suddenly a link between infectious dis- ease and hematology became apparent and extended to my decades’ long work as a pediatric oncologist and infectious disease specialist. In another unexpected turn of events, the links between my earlier work and commitment to underserved communities intersected with a new disease that emerged in the early 1980s and that arose at the intersection between infectious disease and pediatric oncology—and earlier work that I had done in virology. As HIV/AIDS became de fi ned and children became involved— fi rst by transfusion, then coagulation factor replacement for hemophilia, and fi nally by vertical transmission from mother to child—my research journey moved quickly to de fi ne pathogenesis and treatment for this new and frightening dis- ease. Indeed my previous work in childhood cancer and the use of clinical trials and translational medicine had important rami fi cations for the early days of pediatric AIDS research and again linked threads that seemed parallel rather than interlocked. Soon these were coupled with advocacy positions for chil- dren who were being excluded from school or who were unable to receive experimental therapies—and which brought confrontations and struggles with leaders in industry, the Food and Drug Administration, Congress, and the pub- lic community. Science, social justice, medicine, advocacy, leadership—the power of children and parents—all served as catalysts for unanticipated changes in medicine, science, and my career development—at least looking