On the determinants of academic success as a clinician-scientist.

I believe that the determinants of academic success as a clinician-scientist (defined in terms of principal investigatorship, lead authorship, promotion, tenure, career awards, honours, power and reputation) are not “academic” (defined in terms of intelligence, theoretical understanding, mastery of a body of knowledge and teaching skills). Although some academics fail because they are crazy and others because they lack minds that are “prepared” to generate important questions based on their clinical observations, the range of their intelligence is so compressed at the top of the scale that even if it were an important determinant, attempts to correlate it with success are doomed. Furthermore, the prevalence of academic failure among those who understand the theory, know the facts, and can out-teach their colleagues, coupled to the frequency with which they are left in the academic dust by those with much smaller supplies of these attributes, are just too great to sustain that argument. While it may be that the ability to generate novel, imaginative hypotheses plays a role in the academic success of basic researchers (a field I abandoned 35 years ago), this rarely applies to the burgeoning field of patient-based and clinical-practice research (where the hypotheses usually are common knowledge and often originate with patients). Finally, I assume that no reader will seriously posit that being a nice person is a prerequisite for academic success. What, then, are the determinants of academic success? I’ve concluded that they are 3: mentoring, creating periodic priority lists, and time management. Before describing them I must point out that my conclusions are based for the most part on personal observations of young academics I’ve mentored and to whom I’ve taught priority lists and time management, observations of individuals who did and didn’t receive mentoring or employ time management, or clearly were and were not successful, and personal experiences of being mentored by some simply wonderful and quite awful mentors. I’ve augmented these personal observations with the results of a PubMed search on the MeSH terms “mentors” (510 hits) and “time management” (901 hits), and the evidence I encountered there, which includes important evidence on the experiences and perceptions of women in medicine, supports my thesis. Finally, most of the clinician-scientists I’ve mentored and observed in the United States, Canada and the United Kingdom have been hospital-based internists, and I’d encourage mentors from other health disciplines to identify where the recommendations in this essay do and do not apply to those they mentor.