The trouble with serving two masters

May 28, 2004

"The reality underlying academic medicine is that career structures are very fragmented and there is no clear way through," admitted Geraint Rees , a senior clinical research fellow at University College London's Institute of Cognitive Neuroscience.

He argued that doctors were often tempted by the promise of job security, structured training and clear career progression in the National Health Service.

Although he didn't think junior academics were necessarily focused on the implications of the research assessment exercise, Dr Rees said that its emphasis on research, to the exclusion of teaching and clinical work, could prove damaging.

"Those coming into the academic system see that they are likely to be on short-term contracts and they will have to perform or they are out. That's pretty stark," he said.

But Dr Rees, who works evenings and weekends to manage his clinical and academic commitments, remained convinced that he had chosen the best career path.

"I think academic medicine is a fantastic career because of the sheer variety it offers. You are focusing on research, the creative challenge of having original ideas, and patient care," he said. "I would find being a clinical consultant rather repetitive."

* Callum Youngson , professor of restorative dentistry at Liverpool University Dental School, said: "It is almost impossible to fulfil all the sets of criteria as a clinical academic and have a normal existence as well."

He argued that the key problem was that clinical academics were torn between satisfying two very different masters. "You have your NHS training master and your university master. And often your university career splits down again into teaching and research."

He said this became demotivating for many clinical academics, especially because they generally want to be excellent at whatever they do, rather than simply meeting the basic requirements.

Professor Youngson said that it took at least six years longer to become a consultant if you took the academic route. "That's a major disincentive."

He pointed out that a decline in staff numbers could have serious consequences for patient care.

"We are directly responsible for our students' clinical management of patients," he said. "If you increase the numbers of undergraduates, are there going to be enough staff to supervise them? That's a serious safety issue."

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