The balance between academia and the clinic can mean many things to many physicians. It can come in the form of higher education vs clinical practice. There are teaching hospitals, often the setting for a strong balance. There are even private practices that have a surprisingly large teaching component. Keeping an open mind, retina specialists can see how academia and the clinic can be combined, says Edward Wood, MD, assistant professor of ophthalmology who practices adult and pediatric vitreoretinal surgery at Stanford University School of Medicine. But one element, he offers, is often indispensable: curiosity.

“It started for so many of us as a curiosity and an interest in exploring how things can be done differently or in a more innovative way,” Wood says. “Being academic just is defined in too narrow a way by many. A private practice can be very academic and an academic medical center not always. Academic, in my mind, means having a passion and an interest in pushing the field forward and that can be predominantly through teaching and elevating the people that will be replacing you and they can push fields forward. It can be through basic science research as a retina specialist. A lot of our clinical experience and surgical experience really informed how to be a positive with high-impact knowledge.”

The balance between academia and clinical often can fluctuate, says Dr. Wood. “Presently, mine is about 50/50 between academic and clinical but that could change at any time,” he says. “Part of the way you’ll have balance, no matter your percentage split, is through truly wanting to do both and being engaged.”

Dr. Wood remembers needing to switch away from an academic project that, while interesting, didn’t fit his personal need for a project that more directly affected his patients. Balancing academia and clinic is often best done when the settings are related to each other, he says. “Initially, some of my research and academic pursuits were mitochondrial-based research and I’m still interested in that area. It’s an important part of medicine, fascinating and up-and-coming, but it wasn’t as immediately relevant to my clinical practice as doing sort of basic science mitochondrial biology,” he says. “I’m still doing that, but we’re ramping that down and ramping up other more translational projects that are a bit more directly clinically relevant. So, for me, I think it was a little bit of a challenge balancing both of those things … it was less enjoyable switching gears between these two seemingly separate projects.”

Dr. Gareth Lema, a retina surgeon at New York Eye and Ear Infirmary of Mount Sinai, a teaching hospital, also sees patients at the Bronx VA. For Dr. Lema, balance is there, but he also admits that having an all-in personality helps. “I’m able to do it but I also don’t mind changing things up, being all in. It’s always been a key part of my practice and my day-to-day life to have that attitude,” says Dr. Lema, who shares that his organization presently has the largest retinal residency program in the country. “For myself, I generally have been in positions where I’m full-time faculty at an academic center so I’m teaching quite a bit. Generally, one of my clinic times has been with residents in the clinic. When you have people also working with you and learning then the teaching comes naturally. I think that to balance academic and clinical, you have to ask yourself if you’re the kind of person who can get overwhelmed. Doing more than you can handle can lead to you disliking both. It’s OK to admit you need limits or to make a change and then try to see if you can balance both at a later time.”

Wood also believes in looking out for your limits, advising that balancing both can come down to whether both academic and clinical fit into your talents. “There are many things I’m not good at,” he says. “The things that I am good at allow me to help. When you can’t do something well, just admit it and adjust. You don’t want to waste anyone’s time or yours. And, honestly, you’ll likely be unhappy if you’re trying to engage where your talents just aren’t there.”

Another real factor can be income. Dr. Wood says that you need to be honest about how much money you want to make and whether trying to balance academia and clinical fits enough into your fiscal plans. It’s not to say that one will make you more than the other; it can really depend. “Some want to get further in something important to them that might pay less and others aren’t willing to do that,” Dr. Wood says. “Neither one is wrong — just assess your feelings honestly.”

Regardless of what you choose, Dr. Lima says, the balance of academia and clinical can sometimes really be what you make it. “I’m full-time faculty, and teaching will come to you with a lot of responsibilities — teaching residents and medical students and, depending on how you set up your schedule, then you may be able to set up what you focus on,” he says. “But you can choose private practice and still be a part of academia in a volunteer faculty position where you spend a day or a half-day a week working with residents. There, you may have the most freedom to set your academic schedule, but it’s usually less rigorous in terms of the academia. Again, what’s your priority? People in private practice also can write a lot, some work with students a lot, and some just come and teach and that’s what they want to do. There are many ways to do it, but I think it’s important to identify what you’re passionate about and explore those to the best of your ability. I can say, for me, I’ve gotten so much out of both.”