FEATURE ›› ACADEMIC MEDICINE

IS ACADEMIA Right For You?

These retina specialists always envisioned themselves having a career in academic medicine.

BY DESIREE IFFT, CONTRIBUTING EDITOR

If you find yourself gravitating toward a career in academic medicine, it’s probably a sign it would be a good fit for you. The desire to gain knowledge through research and share it with patients and students seems to be part of some physicians’ DNA. Take for example J. Fernando Arevalo, MD, FACS, and Paul Hahn, MD, PhD. Even when they were students, academia appealed to them.

“As a student sitting in meetings and listening to talks, I would think to myself ‘I want to be that guy at the podium,’ an active, not passive, part of the meeting,” Dr. Arevalo says. “To prepare to teach and be an international speaker, I began training through a series of fellowships.” He completed his first of five programs at the Barraquer Institute in Colombia and his last at Wills Eye Hospital in Philadelphia. Next came a slight detour from the strictly academic track when Dr. Arevalo returned to Venezuela and opened a private clinic. His inclination to perform research didn’t go away, however, so he continued to conduct clinical studies and publish papers. After a few years, he was appointed professor of ophthalmology at University of Los Andes in Merida, Venezuela, as well as chairman of ophthalmology at the Clinica Oftalmologica in Caracas. In addition, he affiliated his private clinic with the university and began training residents there, and he founded the Arevalo-Coutinho Foundation for Research in Ophthalmology, in honor of his late father who was also a renowned ophthalmologist in South America. The foundation has trained fellows from Colombia, Ecuador, Peru, Argentina and Venezuela, and it funds surgical care for Venezuelans in need.

Dr. Arevalo’s work in Venezuela and around the world led to his current position as the first Edmund F. and Virginia Ball Professor of Ophthalmology at the Wilmer Eye Institute at Johns Hopkins University in Baltimore and chief of the retina division at King Khaled Eye Hospital in Riyadh, Saudi Arabia. Hopkins formed an alliance with the hospital in 2010 with the goal of further elevating the Middle Eastern institution’s clinical, research and academic capabilities.

Dr. Hahn, who recently implanted the seventh U.S. patient with the Argus II artificial vision device, took a somewhat more direct route to his current position as assistant professor of ophthalmology at the Duke University School of Medicine. However, a big question did arise along the way. His PhD research centered on age-related macular degeneration, and at the time, his plan was to continue basic scientific research. “But during my fellowship, I fell in love with the surgical aspects of vitreoretinal diseases, and realized I needed to make a decision between dedication to basic science and to surgery,” he explains. “While I decided to pursue a surgical route, I didn’t want to give up an academic, research-oriented approach. I joined the faculty at the Duke Eye Center, which has given me a perfect blend of clinic and surgery with dedicated research time.”

Figure 1. J. Fernando Arevalo, MD, FACS, performs surgery at King Khaled Eye Hospital in Saudi Arabia, where he supervises 11 retina specialists.

PAUL HAHN, MD, PHD

Assistant Professor of Ophthalmology at Duke University School of Medicine

TRAINING

›› MD, University of Pennsylvania School of Medicine

›› PhD, Molecular Pharmacology, University of Pennsylvania

›› Fellowship, Vitreoretinal Surgery and Diseases, Duke Eye Center

›› Residency, Ophthalmology, Scheie Eye Institute, University of Pennsylvania

›› BA, Harvard College

HOW TIME IS TYPICALLY SPENT

›› 75% patient care (1.25 days/week in the OR and 2.5 days/week in clinic)

›› 25% research (1.25 days/week)

MIX OF RESPONSIBILITIES AND REWARDS

Dr. Hahn continues, “For me, the primary reason to be in academic medicine is the diversity of experiences. While patient care in the clinic and the OR is a privilege, the ability to also be able to teach, ask and answer questions in research and disseminate information is a treat. I believe the interaction with colleagues, lack of repetition and constant stimulation in an academic center keep you energized and cutting-edge.” Dr. Arevalo, too, appreciates the variety that comes with practicing academic medicine. “You can ‘do it all’ if you like, and many positions allow flexibility in how you divide your time,” he says. “For instance, you may prefer to spend 60% of your time with patients and dedicate 40% to research, or just 15% in surgery or clinic and the rest on research, which may be clinical or in a lab.”

Dr. Arevalo also believes academia has given him more opportunities to network and collaborate globally with colleagues than he would have had if he were running a private practice. In addition, he welcomes the frequent complex cases and diagnostic puzzles that tend to make their way to academic centers. And being surrounded by residents and fellows keeps him on his toes. “I’m obligated to be on the cutting edge; the doctors in training tend to be aware of everything that was published just one day prior.”

CONSIDERATIONS

While you may be convinced you’re attracted to a medical/academic career overall, there are details you’ll want to consider. One is compensation. “While every private practice and every academic center is different, compensation in an academic position will almost always be less than in a private practice setting,” Dr. Hahn says. “In retina, the difference may be two- to five-fold. Starting salaries may not be too dissimilar, but someone in a senior position in academia is likely to make less than a senior partner in a private practice. It’s important to consider other factors, though. A physician in a private practice may be working 5 to 6 days each week, whereas the academic physician may be involved in patient care 1 to 4 days a week and pursue research endeavors on the other days. The research may be funded, and may be more flexible. It’s a personal decision whether the ability to conduct research and the multifaceted opportunities in academic medicine are worth a sacrifice in compensation.” Dr. Hahn notes that quality of life is a personal factor as well. For some individuals, quality of life is closely tied to compensation. For others, it may hinge on the flexibility to, for example, come to work after they drop their kids off at daycare. “I would argue that academic positions generally have more flexibility, particularly on teaching or research days, compared to private practice where clinic volume is paramount.”

While some flexibility may be built into an academic job, other aspects may make you feel less like your own boss than if you’re in private practice. “If you ever happen to be sick when you’re scheduled to see a large number of patients, having someone cover for you tends to be complicated,” Dr. Arevalo says. “And if you want to change your clinic schedule or plan time off, you will likely have to make those arrangements well in advance.” Dr. Hahn adds that a lack of ‘control’ over day-to-day operations can be frustrating. “The processes at academic centers are generally not optimized for efficiency as they are in a private practice,” he says.

Consider also that to work in academic medicine, you should enjoy writing and clinical trials and be OK with the fact that you may need to be involved in securing research funding. “Writing for publication you can learn as you go, especially if you have great mentors in that area as I did, but it doesn’t come easily to everyone,” Dr. Arevalo explains. He recommends that anyone who plans to do research and write about it take a course or courses in epidemiology and biostatistics. “There is a general lack of this knowledge, and because I had no formal training in it, I had to learn it through hard work over the years.” With regard to clinical trials, he continues, “Some large private practices conduct them, but most if not all academic centers do. Recruiting patients for trials and the detailed data collection required make clinical trial participation somewhat different than general patient care.”

Drs. Hahn and Arevalo say having dedicated research time is a major reason they love their jobs, but they point out that research requires funding. “Most of my research is clinical and may not need extensive funding,” Dr. Hahn says. “But it’s typical for colleagues who spend at least 50 to 75% of their time on research to focus on projects that are basic science-related or require more extensive funding. In this situation, they tend to be very involved in securing that funding, which may be the cornerstone of their lab and their salary.”

As you work through deciding what career path you will follow, this insight from Dr. Hahn may reassure you: “In the end, we’re all lucky in that no matter what job we pursue, we can take care of patients, which ultimately lies at the heart of what we love to do best.” NRP

J. FERNANDO AREVALO, MD, FACS

POSITION

›› Edmund F. and Virginia Ball Professor of Ophthalmology at Wilmer Eye Institute at Johns Hopkins University School of Medicine

›› Chief of Vitreoretinal Division, Senior Academic Consultant at King Khaled Eye Specialist Hospital in Riyadh, Kingdom of Saudi Arabia (Wilmer’s affiliate hospital)

TRAINING

›› MD, Central University of Venezuela, Caracas, Venezuela

›› Fellowship, Ocular Oncology, Thomas Jefferson University, Wills Eye Hospital

›› Fellowship, Uveitis and Intraocular Inflammation, University of California-San Diego, Shiley Eye Center

›› Fellowship, Retina and Vitreous, University of California-San Diego, Shiley Eye Center

›› Fellowship, Retina and Vitreous, El Rosario University, Fundacion Oftalmologica Nacional, Bogota, Colombia

›› Fellowship, Retina and Vitreous, Barraquer Institute, Bogota, Colombia

›› Residency, Dr. Domingo Luciani Hospital, Ophthalmology Service, Caracas, Venezuela

HOW TIME IS TYPICALLY SPENT

At King Khaled Eye Specialist Hospital in Saudi Arabia:

›› 20% research

›› 20% teaching/training

›› 50% clinical

›› 10% administrative

During two visits per year at Wilmer Eye Institute:

›› 80% teaching/training

›› 20% administrative

(will also see patients and conduct research beginning in July 2015 after moving full-time to Wilmer)