Over the past year, Twitter and LinkedIn have been filled with notifications about job transitions among physicians. And a disproportionate number have been academics transitioning into other industries.
While the academia-to-industry transition is nothing new, the increasing frequency during the COVID era should be a cause of concern. The “brain drain” from academia poses long-term threats to the independent research that results in innovation.
The academic exodus underway should force us to reflect. There are readily available opportunities to improve retention in academia — and even to recruit previously untapped pools of talent.
A Transition Worth Making?
I’m an academic medical oncologist. It’s easy to read about colleagues leaving academic medicine and wonder, Am I missing out?
Ravi B. Parikh, MD, MPP
I graduated from hematology-oncology fellowship about 3 years ago. I spent one year as an instructor — a glorified postdoctoral fellow — while practicing at both an academic practice and a large VA. After a year, I joined as an assistant professor in 2020. Having secured enough funding to protect my academic time, I now see patients about 1 day a week, while leading a research group focused on innovating care delivery in oncology and advanced illness.
I love my job. On any given day, I could be letting my patient know about a fantastic scan result, discussing a complex case at a multidisciplinary tumor board, analyzing hot-off-the-press data about COVID’s impact on oncology practice, or designing a clinical trial with a large national payer — and still make it home to pick my kids up from school and read to them before they fall sleep. And, as part of a dual-physician household, we make a reasonable income.
It’s hard to find a position — inside or outside of academia — that allows this much flexibility, creativity, and work-life balance.
And yet I am fascinated by the possibility of a life outside of academia. Startup companies are spurring innovation in artificial intelligence, digital health, and diagnostics that are transforming the way we approach disease. Nonprofit and government organizations are shaping policy in ways that touch more people’s lives than I likely ever will as an academic.
Arif Kamal, MD, MBA, is a medical oncologist and palliative care physician who recently transitioned from a clinician-investigator role at Duke University to become chief patient officer at the American Cancer Society. For Kamal, the key was “an intense motivation to make an impact through channels not traditionally available in academic medicine.”
David Steensma, MD, is a hematologist-oncologist who held an endowed chair position in the Division of Hematologic Malignancies at Dana-Farber Cancer Institute and taught at Harvard Medical School. He recently took on a position as global hematology head of Novartis. “What really drew me to make this change was the opportunity to influence patient care on a different scale,” Steensma said. “I wanted to try something new where I could work on a broad range of programs and with a wide range of institutions and centers.”
Their stories provide a snapshot of what’s happening in academic oncology at the moment. And their insights can help academic departments better respond to the exodus of young oncologists leaving for industry.
Three Trends Worth Noting
It’s common for seasoned full professors to transition out of academia. But an increasing proportion of transitions are from junior faculty or associate professors — many before they even hit tenure.
Perhaps even more alarming than physician departures to industry (but not nearly as well documented): Turnover rates are higher than ever among other academic staff, including research coordinators and project managers. These coordinators and managers perform tasks that are critical to the success of clinical studies, including data collection, study documentation, regulatory tasks, and coordinating co-investigators. These positions are notoriously hard to fill, but they are essential to the innovative studies that truly excite academic-physicians.
“The turnover at study sites affects the entire clinical trial apparatus,” said Steensma. “It has become more challenging than ever to retain and attract new clinical trial staff at academic centers, because there are so many interesting and often better-paid opportunities outside of academia.”
The common model has been transitioning from academia to industry — namely pharma. However, a second emerging trend is that more and more job transitions are from academia to early-stage companies in digital health or care delivery, with advocacy and government organizations also attracting their fair share of academic talent.
Finally, the pace of transitions has been brisk during the COVID-19 pandemic , particularly as VC funding for early-stage companies has been rising. Investment in digital health startups, for example, was $21.6 billion even during the peak of economic decline during the COVID-19 pandemic , and it is likely to soar in 2022.
Drivers of the Transition
It’s difficult to ignore the number of social posts from oncologists leaving academia. Burnout and pay are commonly cited as motivating factors, and it’s not hard to see why. Academic salaries are notoriously lower than private-practice physicians’ or C-suite executives’.
But attributing these transitions to burnout and pay alone is an oversimplification. According to Steensma, “I was a well-funded investigator with a combination of NCI and philanthropic funds. I had terrific and smart colleagues at Dana-Farber, a balance of clinical work vs research that I enjoyed, a great department leader, and I really enjoyed teaching residents and fellows. There was certainly no pressure to leave.” Steensma admits that there were annoyances around adherence to financial and volume metrics, along with exasperating EHR documentation. “But what drew me to industry really was much more of a ‘pull’ than a ‘push.'”
Today’s academic is less likely to eat crap and call it caviar, and the barrier to leaving is lower than ever before.
Factors beyond pay are arguably more important in driving transitions. Obtaining early career funding — whether as a mentored “K” award or an independent “R” award — is harder than it has been in nearly 20 years. This funding is key to being an “independent” investigator who can shape one’s own career direction. Other funding mechanisms exist — pharmaceutical companies and foundations, for example. But even these are harder to come by, particularly in the COVID era, when many foundation and industry grants have fallen through. Plus, academic departments value them for promotion less than they do NIH awards.
Promotion is an even harder pill to swallow. Getting promoted from the assistant professor position can take 10 years in academic medicine. Furthermore, the prestige of tenure is not valued as much outside academia, and the requirements for tenure can be overly onerous. According to Kamal, advancing in academia, particularly as a leader or administrator, was a “tall ladder, having a lot to do with experience and age even more sometimes than merit.”
For junior faculty, the “imposter syndrome” of transitioning from clinical fellowship to academia is real. When graduating clinical fellowship, you feel ready to see patients. But research is an acquired skill. Even aside from basic science and statistical methodology, there are skills required to hire your own staff, frame a grant application, build a lab website, and foster collaborations — skills that physicians have literally no idea how to do coming out of training. It takes years to develop these skills, but we are expected to be productive right off the bat.
Today’s junior faculty value independence and broad-reaching projects that are often difficult to satisfy with the incremental progress expected in academia. Short-term outputs — publications and small grants, for example — are often the signs of success that are most valued in academia. But it is exactly these short-term outputs that lead to the burnout academics abhor.
All of these issues are amplified for female academic physicians. Succeeding in academia often means spending evenings and weekends writing papers and submitting grants. And in the midst of a pandemic that has upended the traditional work day and forced children out of school, women in academia have lost even that sliver of time. We’ve seen disproportionate losses not only among women in oncology, but in women in medicine overall. One in five female academic oncologists are now thinking about leaving. It’s not hard to see why. For the past 2 years, female academics have been covering extra service blocks when colleagues get sick, managing high-volume research groups, and coordinating remote learning and childcare when their children have been forced to be home from school because they (or at my school, their sibling’s classmate) came down with COVID.
As Kamal noted to me, there is also often outspoken pressure in academia to focus on a narrow, specific area or methodology. Granted, becoming an expert in a specific domain has its perks. But if you want, like Kamal, to be involved in multiple areas of a field, you can feel “boxed in.” Incremental grants and papers may boost publication rates, but does that really make an academic happier than having a broad base of knowledge?
According to Steensma, “When you move from academia, you often transition from being a content matter expert in a disease area or biologic pathway to filling a broader need.” In academia, Steensma was primarily focused on myelodysplastic syndromes and clonal hematopoiesis. Contrast that with his typical day in industry: “Today, I was on separate meetings on developing new small molecules, disease strategy in lymphoma, novel sickle cell therapeutics, and mentoring young physician colleagues.” That breadth of focus is a big draw to industry.
Bottom line: Today’s academic is less likely to eat crap and call it caviar, and the barrier to leaving is lower than ever.
Is the Grass Really Greener on the Other Side?
The long-term vision, the chance to build a lasting product that affects many lives, the likely higher pay are the factors that are convincing many physicians to leave academia.
But there is also the possibility that much of the hype around industry jobs is overblown.
First, for those in academia who are used to the structure of writing a grant or executing an experiment, the lack of structure in a startup culture can be overwhelming. Company interests often change day to day, and business priorities (not academic direction) often shape these redirections. According to Steensma, who works in early drug development, “You have less control of projects [than in academia]. Sometimes a promising project is canceled because of commercial imperative, and that’s just the way it is.”
Second, the hyperfocus on individual productivity in academia is often replaced by anonymity in industry. Imagine that you are working on developing a potentially blockbuster drug. In academia, your revolutionary work is acknowledged in papers, interviews, and press releases. In industry, most of your work goes “under the hood,” and the chance that your work may be radically changed — or even discontinued completely — if a stock price drops or an investor drops out is high.
“Physicians coming from academia have to be prepared for being relatively anonymous in industry,” Steensma said. “In academia, you’re out there on stage at meetings, writing papers, being a ‘key opinion leader.’ Industry is more team-focused.”
Granted, whether in academia or industry, the passion for the underlying work should always outweigh the need for individual accomplishment. But having your work be anonymous can be a jarring transition.
Finally, for all of the complaining that academics do about working nights and weekends (as I sit writing this article on a Saturday afternoon), academia offers a work-life balance that is often difficult to achieve in the startup or business world. My friends in business are expected to travel at the drop of a dime, to respond to Slacks and emails and even take meetings late at night, and have often unpredictable schedules. The ability to control your own calendar is a perk of academia.
Perhaps the bigger point: Young academics are more likely to be attractive to industry, more likely to move, and less likely to demand unreasonable terms.
Stopping the Exodus
Academic oncology needs to invest in junior faculty to prevent the brain drain that is already ongoing. Otherwise, academic missions will be compromised.
What can academia do to maintain and grow talented faculty? Here are a few ideas:
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Offer earlier opportunities to lead projects and programs. As Kamal notes, “It shouldn’t be that academics are forced to choose between research and operations.” Passionate researchers who care about care delivery want to see an avenue for implementation in their backyard. Deliberately integrating health system business and operations with research and discovery can be a very powerful experience for early-career academics.
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Allow individuals who are not meeting these metrics to leave. Academia isn’t for everyone. But most academics, even those who struggle with publications, grants, or other metrics, aren’t always given clear signals that they are underperforming. Contrast that with industry, where regular performance reports, job reassignments, and yes, even firings, are common. It shouldn’t be entirely on a junior faculty member to decide that they are fed up enough to leave academia. Academic leadership should provide early signals that perhaps someone’s true calling may be outside of academia, in order to ensure that people who would succeed in nonacademic settings can do so.
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Don’t demonize innovative collaborations with organizations outside of academia. “For clinicians of a younger generation, they are recognizing that real change requires capital and influence, which academic institutions don’t always make available,” Kamal said. Startups and large companies often have that capital that allows for high-risk, high-reward studies that can impact populations at scale. And yet, these collaborations are valued less for promotion than federally funded research. Embracing a startup culture in academia could lead to more happiness — and perhaps more innovative sources of funding.
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Allow exploration of outside opportunities. In most jobs, it is a standard for employees to explore opportunities with other companies. Promotion and leadership opportunities are still available for those who may have interviewed with another company, and in fact employees can use competing offers as leverage for promotions and new opportunities when negotiating with their current employer. Yet in the hierarchy of academia, being seen as willing to leave can prevent promotion and new leadership opportunities. Furthermore, leveraging competing offers to negotiate is often frowned upon in academic medicine, even though it is a perfectly reasonable thing to do. Allowing individuals who may leave to still be promoted and assume leadership responsibilities can convince many to stay.
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Redefine metrics of impact. Papers and grants are important, but today’s academic can have far-reaching effects through community-based partnerships, developing clinical pathways or education programs, or building a national reputation. “Academic leaders need to recognize that investigators’ meaningful contributions are not solely first and senior author papers,” said Steensma. “Collaboration on research or leadership in quality-improvement efforts can provide huge benefits to institutions and patients.” But these contributions historically have been less likely to get someone promoted at an academic center.
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Allow for bidirectional movement. A common refrain is that individuals who leave academia won’t come back — it’s a “one-way street,” as Steensma put it. However, there are many skills to be learned outside of academia, particularly managing budgets or a team, that make someone a better investigator. Being clear that an investigator can retain an academic affiliation or come back to academia after leaving would help to remove the stress and tension around these transitions. Additionally, hiring talented, experienced clinicians into the academic ranks is one potential way to ameliorate the workforce drain and to ensure a consistent talent pool in academia.
A Wake-up Call
Again, I love my academic job. I work with incredible faculty, have the chance to develop and test meaningful ideas, and collaborate with oncologists who are driven to innovate, from translational research all the way to health policy and care delivery systems.
Is it possible for me to leave? Absolutely. But if I transitioned, the reason won’t be an offer from industry that I couldn’t refuse. It would be for reasons that could have been rectified through meaningful investment and a proactive approach to retaining academic faculty. The rash of transitions we are seeing should be a wakeup call for academic health systems everywhere.
Ravi B. Parikh, MD, MPP, is a medical oncologist and faculty member at the University of Pennsylvania and the Philadelphia VA Medical Center, an adjunct fellow at the Leonard Davis Institute of Health Economics, and senior clinical advisor at the Coalition to Transform Advanced Care (C-TAC). His research and writing focus on policy and innovation in cancer care, with specific interests in advanced illness and predictive analytics.
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