New challenges and paradigms for mid-career faculty in academic medical centers: key strategies for success for mid-career medical school faculty.

S uccess, like beauty, is difficult to define, but one knows it when one sees it. A reasonable definition is the achievement of satisfaction and happiness in one’s profession, which then defers the definition to that of happiness and satisfaction. These will be dependent on the extent and directions of one’s passion, the pursuit of which promotes satisfying productivity. Physicians who choose to conduct their careers in an academic setting have a multitude of career models to pursue, representing varied mixes of effort devoted to clinical care, research, teaching, and administration. Not uncommonly, the particular blend of activities may evolve over time and there may be transition from one institution to another. Despite these variations, the mid-career faculty member of North American medical schools share many common experiences and challenges. Despite their track record of success within academic medical centers, mid-career faculty may also experience frustration or loss of direction. There are many reasons that this may occur. For example, the academic “honeymoon” is over, whereby forgiveness for the errors of inexperience or naiveté are long gone. Filling a niche within the institution brings stability, but may also engender the perception by the midcareer faculty member of being taken for granted. This may, in fact, be a misperception. In contrast to junior colleagues, the successful mid-career faculty member may no longer receive direct mentoring or institutional resources and may misinterpret this as abandonment. Contrary to this sentiment, supervisors of mid-career faculty members may see this evolution of institutional support as a discrete indication of success and the opportunity to redirect resources to those at an earlier stage in their careers. It is with these observations that we offer insights into maintaining and advancing a successful academic medical career. These challenges are part of a developmental process that unfolds in response both to individual and setting-specific characteristics. This paper explores this process, organizes the themes that are encountered along most career development pathways, and offers suggestions to promote both success and satisfaction.