Aligning Health Care and Academia: The Clinician Innovator

To the Editor: Traditionally, faculty at academic health centers (AHCs) have been promoted along one of two career pathways: the clinician–investigator (CI) and clinician–educator (CE) tracks,1 the latter of which may be undervalued.2 As the combination of unprecedented health care expenditures and unfunded liabilities are added to government debt, it is inevitable that federal expenditures will contract. This financial reality will accelerate the already-increasing competitiveness for federally funded grants, making the CI track unattainable for all but a select few and leaving the majority of junior faculty seeking promotion and tenure only one option. But what if one is not particularly interested in medical education? The promotion and tenure process was designed to incentivize physicians working for AHCs to produce “things” valued by their employer. A key to its success was alignment—universities sought to generate and transfer knowledge, and traditional career tracks rewarded individuals who assisted them in this endeavor. But now, over a century after the Flexner report revolutionized medical education, AHCs that focus only on the production and distribution of knowledge at the expense of patient-centered outcomes and objective measures of quality place themselves at risk. On the other hand, AHCs, with their culture of inquiry, focus on education, and adherence to evidence-based medicine, are perfectly positioned to take advantage of this new reality. Fundamental to this will be a realignment of incentives. Four years ago, Ackerly et al3 described a framework for careers in health system improvement. Subsequently, Ostrovsky and Barnett1 proposed the development of a third promotable career track—the “clinician innovator.” The focus of the clinician innovator is on the development and execution of clinical programs designed to simultaneously improve quality and produce financial savings—programs that will likely be essential to the survival of AHCs. Success as a clinician innovator will require expertise in the assimilation of evidence-based medicine, leadership, behavioral finance, and economics—disciplines no less scientific or rigorous than those required of the CI. Unfortunately, AHCs do not have a strong record of embracing such nontraditional subjects.4 That needs to change. Many readers of this journal are in positions to alter the trajectory of academic medicine. It is my hope that they will empower the growing number of junior faculty who are keenly interested in the optimization of health care delivery by ensuring that the changing priorities of modern AHCs are aligned with the professional incentives offered to their younger colleagues. Robert H. Thiele, MDAssociate professor, Department of Anesthesiology, and member, Board of Directors, University Physicians Group, University of Virginia School of Medicine, Charlottesville, Virginia; [email protected]; ORCID: https://orcid.org/0000-0001-7262-0653.