So, good afternoon, it's a real pleasure to be here. Just by way of background, I am at UIC, University of Illinois at Chicago, and I've been in academic practice since finishing residency in 2000. I spent the first couple of years of my academic practice at the institution I trained, which was Mass General Hospital, and then moved here to University of Illinois at Chicago after that. My subspecialty is in cerebrovascular surgery. So I think this is really the first talk that's broaching the academic side of things. Interestingly, though, you guys are really most familiar with academics in the sense that you've all trained in residency programs that are, by definition, essentially academic. So you're actually, in a lot of ways, most familiar with what that entails. And I thought I would start out with kind of the premise of why one would choose academics. Again, you're familiar with what you've encountered in your own residency, but the transition from resident to being in practice in academics is certainly a big one. And many of you have already perhaps made that definitive decision, but some of you are perhaps considering, well, what's really right for me based on the interests I've had so far? So what are some of the reasons you might actually consider staying in the academic arena and developing your career in that sphere? And I kind of phrase it as three parts to this element. And really, all three apply to drive someone, I think, into the academic arena. And in no particular order, I would say the first is the type of clinical practice you might be interested in. In general, if you're very subspecialty-focused, academics is going to allow and foster that the best in a lot of ways, because you'll be in an environment where you're with other folks who have subspecialty interests that will then complement what you're doing and have a department where you're able to manage an entire population of patients which you can really focus in on what your interests are. So if you're not someone who's particularly interested in running general neurosurgery, and although it is possible to subspecialize in larger practices where you have partners with specific interests, probably that's most feasible in the academic arena. And I think another important component of that is you really have an ability to develop mentoring relationships potentially with senior people who can help foster your subspecialty expertise and develop your career over time. Now, the other obvious components, obviously, are research interests. If that's something you've developed over your time as a student and then as a resident, really academics is what allows you to foster that, because it's the environment where you're going to have the infrastructure, the ability to obtain funding, the mentorship that you need to be able to develop an independent research profile, get federal grant funding in the future, et cetera. And then, obviously, the teaching component, the fact that you yourself would then be teaching the next generation of neurosurgeons, working with residents, medical students, fellows, you know, in the research sphere with PhD students, et cetera. So those are the types of interests that I think would drive you into wanting to stay in academics primarily. And I would argue that there's a lot of soft factors, too, things that are a little bit less concrete, perhaps, than those three things, but are equally important in a lot of ways. There is a lot of camaraderie and community in the academic field, not just within one's own department, but nationally, too. There's a lot of that amongst neurosurgical meetings, smaller ones, national larger meetings, et cetera. And it is the kind of environment where you can really look to advance the field. So not just practice what you've been told and what you've been trained to do, but be the person that suggests the next technique, the next way to approach a disease, you know, the next cure for some problem within neurosurgery that you find particularly, you know, interesting to you. There's some prestige element, you know, being in an academic center, having a title as a professor, or being in the position where you're influencing the training of others. And I'd add to that the fact that you've heard a lot about the necessity to know the business of medicine in different spheres, and in academics, you don't necessarily have to. It doesn't hurt to, but you're not the one that's going to have to make the decisions necessarily that relate to negotiating with insurances and whatnot. You can more focus towards your academic interests and let the business be handled within the department, potentially. I would argue that academics in some ways gives you a little bit more flexibility and control of your schedule. I've certainly encountered with colleagues of mine that I trained with that are now in private practice, I find it's often harder for them to figure out when to take time off. It's going to hurt their revenue, their business, their income if they're taking time off to go to meetings, to go on vacation, et cetera. In academics, you kind of have a buffer zone with your colleagues within the department, and that often actually gives you more flexibility. And then finally, the very thing that you are now is one of the advantages of being in academics is working with residents, not just the opportunity to train them, but residents actually make your practice in a lot of ways easier, your clinical practice. You're working with people who are very invested in the patients, just like you are, and can take care of sick patients along with you and lift some of that burden from you. I take care of a subarachnoid hemorrhage population. I think it would be incredibly difficult to do that in a private practice setting where who's going to check on the EBD in the middle of the night necessarily? You might have nurse practitioners, you might have PAs, but I would argue that residents are kind of obviously a higher level of essentially assistance in your practice, and what you give to them in training, they give back to you in that same fashion in terms of the care of your patients along with you. Why not academics? I mean, I think there's some obvious factors. In general, academics is not going to make you as much money by any means as certain private practice or hospital-employed settings, but it's not a situation where you're out on the street and having trouble carrying your life forward. You can make a very good and comfortable living. If you really have absolutely no interest in research and training or teaching, you don't want to work with residents, you want to do your cases on your own, then it's not going to be a good environment to be in the academic setting. And if you really want to be independent, because in academics you are within the constrained environment of a chairman, colleagues, people to answer to, the dean of the medical school, the hospital. So there are people that are setting rules and regulations for you to some degree. You're not making all the decisions. Even the hiring and firing of people that are your staff are, by and large, not necessarily going to be in your control at all. And if you don't really feel like you have academic potential, you're not interested in presenting and publishing and doing things that are scholarly beyond practicing what you've trained for in neurosurgery, then those are reasons, I think, to really not be considering academics strongly at all. Now, Ed Smith, the next speaker, is going to speak, I think, a bit more about the idea of how you would actually go if you've decided to go into academics, really finding the right opportunity for you. But I'll just give you a few quick thoughts of my own from my experience with it and experience of others and residents I've trained as a program director myself now in terms of when they go out into the job hunt, so to speak. I think as far as resources for academics, the most useful, I would still say, is the people connection. Neurosurgery is a small world. Your chairman knows every other chairman and knows what other academic departments may be looking for people with your interests. So if you have a supportive chairman or program director or any of your faculty, especially in the subspecialty of your interest, they're your most important resource for trying to get connections about what jobs may be available out there. And you've got to keep in mind, I mean, location-wise, there's not hundreds and hundreds of academic departments. There's 100 or so, right? So you've got to be mindful of that in terms of not being super restrictive with your location requirements and really using your resources to find out if programs within locations of interest have opportunities. I think exposure at national meetings, meeting people from other departments, meeting them through visiting professors that come to your program, or going to some of the smaller, what I like to call boutique meetings, like the academy meeting, which is chairman, basically, that you have an opportunity to chat with in a smaller group setting can be very useful as well. And they can hear from you, because you're presenting, potentially, your research or other things, and you can make a very strong impression in these smaller meetings, subspecialty section meetings, for example. I would say the neurosurgical journals, as far as postings and kind of cold contacts where you just send an email, can be done, but they're probably going to be less fruitful overall, because, as I said, it's a small community of people, and that people connection, a direct recommendation from someone to another chairman who's looking to fill a position can be very powerful. I think, again, the considerations for finding a job, whether it's academics or not, are kind of all similar. And you already heard this earlier this afternoon. It's the idea of the location, the package, which is the job, the people, everything that goes along with that. I would add to that, in academics, it's very important to look at the stability of the department, as far as the chairman goes. If the chairman's going to be out of there in a couple of years, things may change dramatically with a new chairman. So you want to be mindful of a situation where you might be losing a chairman in an academic position you're going to take. And you have to be really mindful of what the expectations of the department are, and what those opportunities are in the area you're interested in. I would distill this, and this is kind of a version of what you heard from Judy Rosner as well, is there's kind of three key elements. My sense is you're going to have to compromise on one of these in an academic position. And often, it may be location for academics, just because, again, the number of programs is relatively limited compared to non-academic environments, where you might have to compromise on exactly where you are to be in the position where you're doing the kind of cases you want, making the kind of money that you want, and you have working with the kind of department that you want to be in. So as far as preparation is doing a little bit of homework before you actually approach and visit a program, find out about the faculty, find out about the environment. And really sit down and list for yourself what will help you be successful academically. Because you may need really strictly defined protected time to get your lab off the ground, to get your research ventures going. You may need to get your MPH, to get your clinical research really at a high level and be competitive for funding over time. You may need ancillary services for your subspecialty. If you're a functional person, but there's no movement disorder neurologist, guess what? You're going to have a hard time getting your DBS program off the ground. So you've got to look at all those things. And if they don't have the equipment in the OR, and they're not willing to get it for you, or it's not clear that they are, that's going to make it hard for you to build your subspecialty practice as well, if it's not something that they've been doing already. At the same time, you're not going to be completely inflexible on all these things, but they're all things that you have to be mindful of, that you're going to start finding information out about when you're evaluating a position. And questions you'll need to ask, but not all of these at the first visit, is how's the salary structure going to be? Most academics is salary-based, maybe not 100%, meaning that there may be financial incentives, bonuses. You'll need to know how those are required. You'll need to understand your own personality. If you're someone who really wants to get your research going, but your base salary is very low, and you're going to end up just working clinical cases all the time to make an incentive, then you're probably not going to make much headway in your research. So presumably, you'd want an environment where you would feel comfortable not getting an incentive for a while, so you can really get your academic profile going the first few years. It's important to know call expectations. Many academic departments now have coverage at multiple hospitals, affiliated sites. That kind of call coverage burden can affect your protected time. So it may be a situation where you're going to have 40%, 50% time off, but guess what? You're actually on call at hospital A or B that's a half hour away, and that can really soak up a bunch of your time. So you need to at least be aware of and mindful of that. You want to know what the tenure promotion pathways are and what's available to you. Usually you're going to have five to seven years, your first five to seven years in academics to really progress, go from mentored research to independent research, and you want to be sure that those requirements will be adequate for getting you on that promotion path if you're in the tenured situation or pathway. And understand what the coverage of expenses are. Can you go to a lot of meetings and the department covers it? What are the limitations to that? And what other kind of obligations you might have in the department? Maybe you need to be the liaison to the trauma committee, and that's going to soak up a lot of time even though it's not your primary interest. So it's important to know if those kind of obligations exist. But again, don't be completely inflexible on all those issues. So lastly, I would just leave these words. Ed is a much more humorous speaker than I am, but I thought I'd at least end with this so I'm not totally outdone by him. Things you don't want to do, right? Whining. If you expect to score points by whining, join a European soccer team, except Germany did pretty well, so I guess they're not whining. Illusions. Don't delude yourself. He who chases rainbows may eventually catch tornadoes, right? So be honest with yourself in terms of what a program can offer and what you're looking for. And finally, some things cannot be overcome with determination and a positive attitude. If you have an anaphylactic reaction to sunlight, you're not going to practice in Florida, right? So you're not going to be able to overcome things that are just not overcomable. And again, it's more about being honest with yourself and what you can expect from yourself and what you can expect from a department in an academic program. Thank you. So, Sepi talked a little bit about what the reasons might be for going into an academic practice. As many of you are here, as a neurosurgeon, sort of a practical person myself, I'm going to talk a little about how to actually try to get the job. I don't really have any disclosures. From a practical standpoint, one thing I've talked to at a lot of different folks is they've started their process, and it sounds kind of simplistic, but I think it's really important. Write a list. Really, you know, especially for academics, but for any job, when you're starting out, you really want to think about what it is that you like and why you're committing to this line of a career. I would suggest, you know, get a bottle of your favorite stuff, scotch, wine, beer, you know, diet soda, write it first alone. If you have a significant other, you know, it's worthwhile to include them, because if they're gonna be with you on whatever your career path is, you know, you want to make sure you have a sense if they are absolutely averse to going to Florida or something like that. You want to know about that ahead of time. As you write your list, I think, you know, you've heard from a lot of people with all the different practice opportunities about the key things of lifestyle, location, who your coworkers are, and your salary. I would suggest that in addition to those characteristics, with academics, you really got to think about some unique and specific things. Your clinical practice set, we talked a little bit about what it is you want to do, why you're doing academics, what kind of research you want to do. Is that part of what you want in your academic practice? Is it benchtop? Is it clinical research? Do you like teaching? And if so, what kind of teaching do you want to do? Is it at a podium? Is it in a classroom? Is it with residents? And then, do you want to be involved in leadership? Things like the AANS. Are you interested in, you know, national neurosurgery or other types of hospital organizations? And the question is, these are a lot of different factors to consider. How can they coexist? One thing to look for are mentors, people who can help guide you on your path in your residency now and in other places. I think one thing that's really important, if there's one take-home message I can suggest today, people are not going to do well if they go out and say, I'm going to be an academic neurosurgeon that does pediatrics, and I'm also going to compete for yeast genome research at a benchtop. Because if you have a PhD that's working 24-7 that only does research, you're not going to be as competitive if you're going to try to take their lunch and they're living for this job to be a scientist. So my suggestion to you is think about ways that your primary job as a neurosurgeon can enhance whatever it is that you're doing in your research or in your teaching so that they can feed off each other and you can provide something unique to what you're going into for academics. So you want to have that overlap. And you really want to think about how you're going to chart a course to achieve your goals. I think too many times, one of the biggest problems for all of us, at least for me, when you start out in academics, your whole life you said, I want to get into the best high school, the best college, the best med school, the best residency. It's clear what your next step is. And what's difficult when you start a job is all of a sudden your whole world's your oyster and there's a million possibilities. It's almost easy to get overwhelmed. And I think it's very easy to take the first thing that comes on your plate, and I think you really need to be thoughtful about what it is you want out of your career and try to chart a course of where you want to go. And that's something I think that really needs to be thought about when you have some contemplative time and not scribble on a napkin when you're on call for your third night in a row. When you decide on what you're interested in, when you start looking, as Sepi mentioned, you got to list your dream places. And one of the best ways to find what places might be hiring, ask recent grads, ask faculty. You are all in academic programs now. And you need to work the meetings. It's like Kevin Bacon, your seven connections to Kevin Bacon. There are people out there who know what jobs are available that may not be advertised yet. When you go to these meetings, ask your senior residents who have just started new jobs, ask your faculty members who are in your department, figure out how to find people, do your homework ahead of time, and work these connections. As Sepi mentioned, it's important to be flexible, right? You're not gonna get the perfect alignment of the $17 million a year at a Bayside job in Southern California. You're gonna have to give a little bit and take a little bit. One of the best ways you're gonna get what you want, or as close to as possible as what you want is to be prepared, right? And when you're applying for a job, for any job, private, academics, whatever, it's not a right. Just because you've done a great job in your residency and your chairman thinks you're the best thing since sliced bread, that doesn't mean you're gonna get a great job. You need to earn it. One of the ways you're gonna be best positioned to get the job you want, you have to prepare your CV. You wanna have other people look it over, make sure there's not errors in it, from typos to how you're representing yourself. Highlight your strengths, and I think particularly for academics, use your CV to tell a story. What is it that you wanna be? How has your program in your residency, although you're not fully established scientists yet or fully established clinicians, do you have some interest? Have you written papers? Have you been to meetings? Have you expressed work in the area that you wanna work in? Tell a story with your CV. Understand your strengths and weaknesses and sit down with some of your faculty members and have them tell you what you're good at and what you might need to be aware of as a weakness so you don't go blindsided when you get to interviews. When you research employers, make sure that you know with them what their needs are. When you walk in, if you're saying, gee, I really wanna be a vascular neurosurgeon, they have six vascular neurosurgeons on staff, you're not gonna get a job there. What can you offer to them that's unique? Again, come up with a plan. If you walk in, you have to be flexible, but you should have some idea of what it is that you wanna do. One of the practical things when you go for interviews is preparing for the interview, just like any interview you've had in your life. You wanna know what the job wants and what you can provide, right? And so what is the job? You wanna know who the players are. It may not just be the chair of the department to which you're applying. Are there other people in the faculty? Is the hospital the person that really holds the purse strings? Who gives the money to support the academic mission? Because you can bet that if you're applying for a job, they're gonna have some say in what type of filling. If the hospital has a major push to develop, you benchtop science or to develop a neuroscience institute or a spine institute, if you're applying for spine, you bet you're gonna have a better advantage for that. What is the clinical area of need? What kind of coverage, as Sepi mentioned? Where are you covering other places? And do you have areas of overlap with other academic centers within the institution where you're applying? So those are the things that you wanna look for for what the job wants in terms of what you can provide. What are your skill sets? I mean, none of you are walking in as a full professor with a Nobel Prize, presumably, but you do have skill sets, and what are those? Be aware of what they are. Know what your research objectives are. If you're doing clinical research, benchtop research, you wanna be able to articulate clearly what it is you want to be able to do and what you can bring to the practice. And one of the best ways to do this is at your home institution, look at models that exist already. If you have a spina bifida clinic, how do they run that clinic? How do they get referrals from there? What research is being done in that clinic? If you have a vascular program or a stroke program, who are the people that are involved? How do they get people to come in and what kind of ancillary research is done with that? Look to your own institution, and when you interview for these processes, say, you know what? At my home institution at Children's Hospital in Boston, we have this kind of clinic. This is what they do to get practice built up. This is what they do to build research. So use those tools in your home institution to study what exists elsewhere and to bring that as a tool when you come to interview. When you're preparing for an interview, if there's one other thing I can drive as a take-home message, think about in the process of applying for a job, what are the metrics that are gonna be used to measure your success? Is your chair or your future boss, do they care about caseload? You've heard a lot about these mystical RVU things like unicorn hair and leprechauns. Do you need to develop new patient numbers? Do they wanna know about your grant numbers? When you're gonna produce papers, there's a thing called an H-index. You can look up, many of you probably know this, so it's a measure of how well-reviewed your papers are. How about hospital service? Are you gonna have to contribute to the hospital? Are you gonna have to participate in teaching? What are the things that are gonna control whether you keep your job and how you get paid? You wanna know that ahead of time. And then you also wanna know, as you get further along in the process, again, not in your first interview, what's provided, right? What's a hospital, what are they gonna give you as a startup package, and how long are they gonna have it? Are they gonna give you lab space? And if so, for how long? Is it a free ride forever or a couple of years? Do you get protected time? Who do you have as potential mentors there, both clinical and research-wise? What kind of space or support staff are you gonna get and for how long? These aren't, I mean, these come at a cost from your chair, from your department. They're not freebies. And you have to understand, if they're giving you something, it's costing them something, and what are your metrics for how long you get to have this? And then how is that gonna influence your salary? How is that gonna influence your promotion? You wanna have a good sense of this as you progress along the path. In terms of thinking the revenue of what you can bring, what is your academic focus? Does the hospital want a particular type of academic focus brought to bear in their department? As I mentioned, one thing that you can bring in is learn from your home institution or from your colleagues in other institutions. Are there clinic models that exist that you can learn from? Are there strategic partnerships with orthopedics, with vascular surgery, with IR? Are there things that you can try to do or strategic partnerships with research groups? And then what are the needs of the practice you're looking at and what is your plan individually for a year, three years, five years? If you just kinda walk in and say, hey, give me a job, I'm happy to have it, you're not gonna be very well-received. You wanna have some sense of where you're piloting your ship. The way you can figure out some of these questions, and you'll hear this course this weekend is a great way to get some of them addressed, but figuring out, talking to your billing office. I don't expect them to open their books to you, but you may wanna figure out what is an RVU? How do things go about billing? What are ways you can generate revenue? What are some practice models that exist in the academic setting? Are there different types of practice models in different types of academic institutions? What are the lifestyle of different attendings that you work with? Look at other departments that exist within your hospital and others. And the most important thing, I think, for an academic job in particular, but any job, find somebody who's doing your dream job. Someone who's a few years along, three years along, 10 years along. Sit down with them, have a coffee with them, and ask what it is that they do, whether you do it in person or on the phone. I really can't overstate the benefit of finding someone who can sort of describe the pitfalls and the strengths of what you're pursuing. The last couple of things here, you wanna be a smart shopper, right? As you go through your interview process, no one really talks about the actual interviews, right? They talk about what you should ask about, they talk about how to get your CV ready, but they don't really talk about actually going to the interviews. One thing is you don't wanna commit too early. Everyone's all nervous about getting a job. You don't necessarily take the first thing that comes off your plate. I've learned terribly at my prom experience that's a bad decision. So you wanna have some balance in your interview process. And you have to think, as strategic as it sounds, have some reasons to delay. You wanna be honest. But you may wanna say, look, this is a negotiation. You gotta be able to dip and dodge and dive and whatever the five Ds are there from the movie. And part of that involves how to say no, right? You're gonna have to learn as you progress through your practice, you can't always be the yes resident. Yup, yes sir, three in the morning, I'll go put a drain in, that sounds fantastic. Yes, yup, yes. You gotta be strategic about it, and you'll need to say no. You should never burn bridges when you say no. You should always try to provide a clear reason and a justified reason why you're saying no. And whenever you can do it personally with personal communication, that's always better than like a Twitter account like hashtag, you know, get lost, jerk. So you really want it, this is an important process of the interview in academics in particular. We all have fragile egos, but throughout any job. And part of this most sensitively will be talking to your chair, right? There are situations, many times residents over the years have come up to me and said, hey Ed, you know, chair X sort of expects me to take this job, what if I'm not interested in that? You wanna be candid, you wanna be honest and say look, I may not really want this, because you know, you don't want your chair pushing you into something you don't wanna do. You also don't wanna go to potential employers and sort of hide the fact that you're looking for, let's say a private job or an academic job. You wanna be honest about everything you do, and one sort of common thing you can say is, look, it's like shopping for a car. You know, you wouldn't buy the first car you get in the lot, you shop around a little bit, and this is much more important when you're looking for your career. The very last point I will make here before I close off is, you know, it's a mixed metaphor here, but you gotta negotiate when the iron is hot. And that's a mixed metaphor, it's not really the best English, but the idea here is that when you are negotiating, not on the first visit when you walk in and say I want $10 million a year, give me a parking spot right here, but as you get further along, and particularly with academics, when you're negotiating your research time, your protected time, what it is you're gonna do for teaching, your promotion, people will tell you a lot of things, but practically speaking, once you sign that contract and start your job, the strongest positioning you have for negotiating has closed at that window. You've heard about soft negotiating, there are other things you can do, but really this is your strongest period. You wanna know what your expectations are. You wanna be clear, you want your timelines and deadlines are, if there's specific expectations for when you get promoted, when you get a grant, when you write a paper, when you build up your practice to a certain volume, and you have to recognize what are musts and what are just wants, because you have to be flexible. I mentioned before metrics, these are really important, and I think things that are often understated in academics where they just give a handshake and say yes, I'll take it. You wanna, in your own mind, be able to document what's important, what's not, and how you're gonna be able to negotiate for what you want. If you have mutual self-interest, both the academic group and yourself, that's the best course for success. And so the last slide here, just to say, for all of you who might be considering an academic career, it's never too early to start looking around for them. You really wanna work your contacts. It's important to understand that academic neurosurgery is a relatively small group of people, so it's helpful to understand that. You wanna be prepared, both knowing in your own mind what you want, but also what people want from you, and you wanna sort of achieve that good mix of being humble, but also being confident. You wanna undersell yourself, but you can't be a jerk. Most importantly, know what you want, because if you don't know what you want, you're not gonna be happy. And the last thing good for the job interview and good in life is just be pleasant and honest as best you can. Again, if you can fake sincerity, you can fake anything. So I think that that's sort of what I have to say about that and hopefully I finished in the allotted time. All right. Thank you.

academic practice

neurosurgery

choosing academia

research opportunities

teaching and mentoring

academic job pursuit