Five steps to your first academic job

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Well hello everyone, welcome to the Clinician Researcher podcast. I'm your host Toyosi Onwuemene, and I am super excited to be talking with you today. Thank you so much for tuning in. Today I am bringing you an episode from a recent coaching conversation that I had with my clients, excited to share this one with you, and enjoy listening.

1:24 Welcome and thank you for being here today, and for everyone who's catching the replay. Hello. So today I'm talking about looking for academic jobs. I'm talking about looking for academic jobs and maybe... I'm back. Yes, welcome back. All right, so I'm talking about looking for academic jobs, and maybe it's not so much looking for academic jobs as looking for jobs overall. Many of us will kind of want to look for just academic jobs, but I do want to talk about the breadth and the depth of what is available as far as the jobs want. Alison, welcome. I'm talking about looking for jobs. Okay. So I will say that when I started looking for jobs, I had my big decision.

2:06 I definitely want to stay in academics, and to be honest, the academic decision was made for me the moment I started medical school. I just knew that the medical school environment was the environment I wanted to stay in, and so I knew I was going to do very much an academic job. But I think the next big decision, other than academics, was that I wanted... We were pretty particular about location, because at the time we had one child who was maybe one and a half years old, and we realized that we just wanted to be supported as much as we could. And so we were either going to stay where we were at the time in Chicago, where we already had a community, or we were going to move to North Carolina, which is where we had family, and we had kind of like a ready-made community.

2:51 So we were pretty big on where we were going to stay or we were going to move to. And then I wanted to do research, and I knew that I was staying in academics so I could do research. That was like number three, actually. It probably was more number one, because it was my driving force. I assumed that academia meant a research job. That's what I assumed. And so I was surprised when I started looking for jobs, and what people were offering me was pretty much a full-time clinical, wow, you've got a lot of patients, and you're pretty much just going to see patients all the time, jobs. And I was so surprised, because most of my mentors who at the time, they're in their 70s, one of them in his 80s, was very much like, you have to make sure you accept a 75% protected time job.

3:36 All of that, and that's what I was looking for, but nobody was offering it to me, which is interesting. Anyway, so I ultimately selected a job that didn't necessarily give me the protected time I wanted, but had the promise of protected time. And I didn't realize that was a fallacy when I first started, the whole idea that you're going to come from clinical training, and you're going to be able to accept a research job in academia. And I'll talk about that in just a little bit. But so I ended up actually accepting the job I didn't want. And I think at the time, I thought when they were offering me 20% protected time, and that was truly protected time, 20% time in an 80% clinical role is really just administrative time, because everybody needs administrative time, and administrative time to catch up on notes, make phone calls, all of that, that's not protected time.

4:25 I didn't recognize that. I took the job I didn't want. Anyway, so I was seeing patients five days a week, and then I got pregnant with my second child. And it was just rough. It was so rough, because I'm the kind of person who really loves to sit in corners and think, I don't mind seeing people talking to them as long as I can go back to a place to rest and recover. And I was doing a job where I was doing aphoresis specifically, which I think that our job in aphoresis is to say no as much as possible, unless the other person can figure out a way to convince you to say yes. So it's very, it was just, it was kind of job that at the end of the day, I always wanted to recover from. And there really wasn't a space for recovering. I was a miserable person. And then when it came to negotiating my first job and negotiating salary, I had no frame of reference for what my salary should be.

5:12 I accepted whatever it is that they gave me as the anchor. And I mean, I negotiated up because people always said women don't negotiate. I did negotiate, but I think I wasn't prepared for the fact that it was such a low ball offer. My negotiation was pretty silly. Anyway, I know better now. So here I am to share some thoughts with you about what you should be thinking about as you're looking for jobs. Okay. I do think the most important thing about looking for jobs is always start with what you want. Start with what you want. Many times I hear people looking for jobs and they'll say, oh, we'll just see what's available. We'll just see what's available. And I want to say at the end of the day, the truth is you are not necessarily, I mean, you're not the one offering yourself a job.

5:58 So yes, you are going to shape what's available to yourself, but you can't start with what's available. You have to start with what you want so that you can understand the gap between what you want and what you're being offered. And that's important because to be honest, most of us, for example, the job I have today looks nothing like the job I started with. And I'm at the same institution, but knowing what you want allows you to continue to shape and shape and shape until you're like, yep, this is the job I want. Right. And just as you change, your needs and your wants will change as well. But the most important place, number one, like without question, is start with what you want. Don't say, oh, we'll just see what's available.

6:40 Start with what you want. And the reason it's important to start with what you want is because if you are not happy in your job, I mean, it's just, it's a problem. You spend a lot of time working. You spend a lot of time with your colleagues. And if you don't have a job that you want, it'll be miserable. And there is no, in medicine, I think we've been in our training where we spend a lot of time being miserable and there's no need to continue to perpetuate the misery. And at some point you do need to stop. And I think training is a good time to stop being miserable, to say, you know what, I'm not just here for the glory of this institution and its beautiful name. I'm here because of what I want to build. And so I think the harder thing for us to do is to be very clear on what you want.

7:22 Because to be honest, in our training, we've never thought about what we want. We're always, for the most part, we're big on like, well, okay, well, I need internal medicine training. This is one of the institutions that does it really well. Okay, let's go here. And a lot of what we wanted is driven by what the institution has available. And we have the sense that the institution makes us because it's, you know, the institution has a name. At the end of the day, you are the one who makes the institution the institution and you're the one bringing your skills and expertise to the institution. The institution doesn't make you. You make the institution. And so you are the gift to the institution. It's important to know that. So what does it take to know what you want? It takes thinking about it and talking to people and thinking about what is important to me.

8:05 What are the things that I like about my job or I like about medicine? What are the things I hate? And how can I minimize the things I hate so I can maximize the things I like? I think all along I said I wanted to do research. And what I realize now is that I'm not sure it was necessarily research that was my goal. As much as I really like the idea of academia for being able to really think clearly and think long and deeply about things. I love to think and I love to teach. Research has those opportunities. And so research makes sense to me. And even now research makes sense to me in a way that it didn't when I first started. But it's important to know who you are.

8:46 I'm the kind of person. I'm an introvert too. I love to be around people. I think people think I'm mostly extroverted. But I need times to recover. And the whole idea of just being on the run every day without fail is just very hard for me. There needs to be space for me to recover. So knowing yourself is important. But number one is to start with what you want. And that really starts with understanding who you are and how you want to live your life. It's not even so much how you want to practice, what patients you want to see. It's just who do you want to be? How do you want to feel at the end of the day? Because all the rest of the stuff is negotiable. You can decide I want to see only patients with lymphoma. You can decide I only want to do MDS.

9:27 And ultimately you can shape your clinic experience. You can shape your faculty experience. And if you're in an academic medical center, there's a whole range of jobs you can do. And your job is going to be changing over time. So first of all, start with what you want. That's number one. Number two, think about location. Okay, so for many of us in our medical training, we just went everywhere. Wherever it was like, oh, Duke is the best. I'm going there. That's where you went. I do think that the more seasoned you get, I think it becomes important that you are surrounded by communities that support you. It's kind of like if you played basketball at the high school level and it was hard at high school, then you go to the big leagues.

10:12 You know, and that's when you start your faculty positions, like the big leagues where people don't, they're not there to cheer you on. Some people are there to like destroy you for whatever reason, right? I mean, there are people who just for whatever reason, they don't want you to succeed. Think of it as a ball game. There's the side that's cheering for your team and the side that's not cheering. You're not playing on home territory. And people have different reasons or different ideas about who they think should be successful. Some people are going to be downright evil to you. They're just going to be. And it's not even a thing to be sad about. It's just to be like, oh, okay. I've identified you as one of those people who's going to be evil to me. Thank you so much for showing yourself. And so to be able to play at the level, you really need to be surrounded by a community of supporters who believes in you no matter what.

10:59 You can build that for yourself wherever you go. Absolutely can't, but you do need to be intentional about it. And so you need to think about location. Where are there going to be people who love me, who support me, who encourage me, where I can go and meet my people? Because when you're at work, you're on. I mean, some people are in environments where it's totally nurturing, totally supportive. I want to say most people are not. If you come into any environment and you have any idea that's different from the status quo, either you want to do research that nobody else is doing, or you feel like things in medicine are not equitable and need to change, anything at all you think about that deviates from the status quo, you will find that you will make enemies very quickly.

11:43 Because there are people whose lives depend on nothing changing, everything staying the same. So everywhere you go, people will say, well, you want change. We want everything to be different. And in reality, people don't want change because change means they have to change. Nobody wants change. They lie to you if they say they don't, they want change. Most people don't because it really takes a lot of work in terms of personal development to be someone who embraces change. And so to be honest, if you want anything at all in medicine to be different, and I believe that most of us do, you will find that there will be opposition. And so it's okay to have opposition. Many of us already know what that feels like, but you can survive better, you can do better knowing that you have a community.

12:25 Now do you have to have the community in that geographic location? Not necessarily. Now, especially post COVID, many of us have virtual communities and we can build those virtual communities if we don't have them. But I want to say that one of the biggest threats to mental and emotional health is isolation. I want to say that again, one of the biggest threats to mental and emotional health is isolation. And so what you want to make sure is that you're not going to be isolated. Whatever you need to do, I want you to think about that as you look for jobs. And it's so important because honestly, I mean, there are going to be times where people are going to bait you because they want you to get mad. They want you to self-destruct. They're going to trip you up intentionally so that you can fall.

13:08 And it's different. It's different from the supportive communities you came from in training and residency and med school. And you want to know that you can find people who will encourage you and support you as you navigate that. You are more than capable, absolutely more than capable, but you want to be supported as you navigate that. So number two, number two is really think about location and not so much geographic location though I do mean that too, but really communities that are going to nurture you so that you can continue to thrive. All right. Number three is the job. Job is not number one or two, but number three is the job. Here's the truth. Most of the jobs that you first of all find are not going to be exactly what you want.

13:49 What you're going to do is shape them over time to be the kind of job you want. So what you're really looking for is you're looking for the seed of goodness, right, in the job that you're going for. You're not necessarily looking for the perfect job. You may not find the perfect job though rarely you could, but what you're looking for is is there opportunity to change, shift, adapt? Is there opportunity to move things a little bit? And then, and you'll have a sense of that. Who's your division chief or your division director? How open are they? You'll get a sense of just the community, the vibes of the place that you're in as you share the ideas that you have. So number three really is the job, but also seeing to what extent is that job movable rather than being set in stone?

14:36 That's number three. As part of number three, what you want to do is you want to go find their metrics for promotion. Now, I think institutions are becoming more clear about what promotion metrics are, but for the most part you have to go find it and say, okay, here are the metrics for promotion. Now some people are like, I don't even care about promotion. I just want to say that if you're in an academic medical center, you do need to care about promotion. You may decide I don't want to be promoted, but you do need to know exactly what it takes to be promoted. Whether you choose to do it or not, it's fine, but you do need to know so that you can actively say don't even want to do that even though I know it's necessary for promotion. You want to know what I think the challenge is that people say I don't care and they don't know.

15:19 And then when they finally are like, wait a minute, I do care. Then it's like, oh, now I'm just starting to figure it out. The reason you want to know upfront before you even accept the job offer is you want to know what they value. Here's the challenge that happens for a lot of physicians. Many times people, even in academia, are growing, growing more towards just full-time clinical work for academic physicians. So it's like you don't get to pay a private practice, but you're working like a private practice doc. It's becoming increasingly common. However, as much as they put you to work in clinical full-time, then they also are grading you on the metrics of academia. So it's like, oh, your publication record, your reputation, which is like you have no reputation unless you're publishing or giving talks.

16:05 They grade you on research and you may not necessarily be the one leading research, but are you part of collaborative research teams? Do you do team science? That kind of thing. So if they are grading you based on academic work, but you have no space in your schedule for said academic work, they are setting you up to be not promotable. That's really important. Now, does that mean, oh, there you go. You only give me clinical work. I have no space to be promotable. I'm not coming to this job. It doesn't mean that. But it does mean you get to say, because the ball is in your court when you're negotiating your job, you'll get to say, hey, here I see you put me in clinic for days a week. Okay. I can manage that, I think.

16:47 But I'm also seeing here that you need me to have published 10 manuscripts to be able to move from assistant to associate. Where is the time and effort for this piece? That's just an important question to ask. So people can really start to say, can they be honest with you? Then you say, well, you know what? Actually, we don't want clinicians to be promoted. Then you know, you're going to be like, okay, maybe this is not the space for me. Or you can say, yeah, yeah, yeah, the money is good. I don't care about that. But you get to choose. And so it's important to get the metrics for promotion, see what they value. And every institution has different tracks for promotion now, I think. There's tenure track, there's non-tenure track. But no matter the track, reputation still matters.

17:28 Scholarly productivity still matters. And you want to make sure that if those things are valued, because they put them in the promotion and tenure materials, that you also have the opportunity within your job description to do them. And if you don't ask the question, why? Okay. So that's really about the job and the environment for the job. That's number three. Number four, okay, you got to think about money. You absolutely need to think about your salary. One of the things that physicians don't do well is think about money. Because to be honest, in our training, I mean, medical school, you're just looking for how do I pay my medical school debt, right? Many people take out loans, not everybody.

18:09 Most of us take out loans. So we just always think about giving, giving, giving, right? We're applying for medical schools. In the past, we fly all over the country. We're spending our own money trying to get into medical school. You get to residency. Well, you're not negotiating salary. It's just PGY4 is PGY4. Sorry, here's what you get. Here's what you get. You get to fellowship, it's the same thing. You're not negotiating anything. You get to your faculty job, it's the first time you're expected. There is an expectation for negotiation. Expectation. And so you've got to be prepared to negotiate. I will say don't negotiate alone. I did that. I was totally like, okay, well, I'm supposed to negotiate, but I had no idea what I was supposed to negotiate. I negotiated by myself and I ended up with a very, very, very bad deal.

18:52 It took them years to, it took me years to unravel the bad deal, you know? And I'm still figuring it out. But it's really important to negotiate. No matter how great the offer, you're like, oh my gosh, this money is so stupid. Oh my gosh, I love it. And even accept at face value. At a minimum, what you need to do is find the AAMC salary compensation report. They print it annually. As long as your academic medical center contributes to that data, you get the report for $60. Don't say I don't have $60. Is very, very important. And if you don't have $60 or you don't have access to it, because if you are not part of an institution that contributes to this data, then you pay $1,500 for the report.

19:37 I have the report. At a minimum, just ask me. We will look it up together and I'll say, this is a salary based on the part of the country you're in, blah, blah, blah. There's 10th percentile, 25th percentile, 50th percentile. At a minimum, aim for the median as like, this is what I want. And you know what the thing about negotiation is? As long as you have a clear justification for what you're negotiating, you have every right to ask for it. All you have to say is that the median salary at the AAMC benchmark across institutions that are private in the Southeast United States is $353,000. You don't have to ask any questions.

20:18 And they can argue that. They can come and say, well, we don't really do the median, blah, blah, blah. Then you can say, well, if you don't do the median, how will you make up for this for me? What are the other benefits? So it's hard to do because we don't do that. You had no practice for 10 years. You've been just doing stuff and accepting at face value what people give you. But when you go for your first faculty position, don't be desperate. Take all the time you need, but you need to negotiate. Now one of the things that's challenging is that we tend to be desperate when we come to our faculty jobs because we're just like, I just need to pay off my student loan debt.

20:59 I just, I need to start this job yesterday. Like I finished fellowship July, June 30th. I need a job July 1st because I can't afford life without the job. Don't be desperate. You are full fledged attending once you finish residency. Even if you didn't finish residency, you can still work. Go find a locum's job and do it until you feel like you have the position that you really want or the salary that makes sense for you or the benefits that make sense for you. Don't accept a job out of desperation. Whatever they give you, review it with a team. Now let me tell you that when academic institutions are negotiating with you, they're negotiating as a team.

21:40 No division chief makes a decision by himself. He takes whatever it is you say you want, takes it to like a team and then they say, oh no, we don't want to give her this much. No, no, no. This is what we want to do. This is what we want to do. And then they come back to you. So if this big bad institution has been around for hundreds of years is negotiating as a team, please don't do it by yourself. At a minimum, find someone who's senior who you can just talk with and be like, hey, what's your salary? How did you negotiate this? How can I negotiate it? And do the negotiation, but don't do it by yourself. They're not doing it alone. You don't do it alone. You have someone look at the contract with you. You have someone help you. And one of the things that I worked with a mentor when I did my second negotiation, I didn't do the first one with anybody, but I would get it and she would say, great, is this what you want?

22:30 What's the median salary? I was like, I don't know. Go find out the median salary. What kind of support is expected for someone who's studying research? Go find that out. What is common as far as research package? Go find that out and then write a letter. So for each phase of the negotiation, that was she wouldn't allow me to do anything verbal. I would always respond with a formal signed letter. I would say, thank you so much for the offer that I see, blah, blah, blah. Here's where I want to, you know. And then, you know, they can talk and you think you're talking to friends, but it's a formal contract negotiation and that is exactly how you should treat it. Again, you're not used to doing that. So don't try to do it by yourself. I really, really, if you do, if you learn nothing at all, I, every job search should always be done with someone supporting you, someone in your court, preferably a team, but at least one more person other than you.

23:17 So that's the salary. Number four, the reason you really want to negotiate the most, the highest salary you can get for the work you do is because to be honest, you're trading life years for money. You are, you know, you spend a lot of time working. You absolutely do. What you want to do is you want to make sure you command a salary so that you don't have to go find, you know, have to find the moonlighting job to make up your salary. And a lot of people do that. And to be honest, gosh, that's more time. Kills you. And, you know, earn the highest you can and then decide I want to go part time and earn a third of it, whatever. But just make sure that you get maximum value for the time you invest. And especially if you're underrepresented, if you're a woman, people will do their best to give you less than is standard.

24:04 That's why you do need to work with somebody to make sure that you get the maximum value for the money that you have. I will tell you that as a physician, your capital is an opportunity to invest so that you can ultimately become financially independent, you know, and so the more you have to be able to invest, the better it is for you. And that's why it is really important. Don't let anybody tell you it's not important. Absolutely is important. So please think about that. The fifth thing and the last thing that I would say about what you should be thinking about in the job is to be thinking about like what package would you negotiate for yourself? Definitely, even if you're just coming out as a full time clinician, the question is what support do you have for the job you're being hired to do?

24:48 I, oh my goodness, I took a clinical job. I didn't even have an administrative assistant, didn't have an MA I would work with. I didn't, I had no support. So I wasn't even resourced to succeed at the job I took. And that's a problem. If somebody says, I want you to come be a full time clinician, you want to know that you have the full time clinician support to be successful at that job. Otherwise you fail. So that's part of your negotiation is do I have what it takes to succeed? For example, let's say they take you on in a research role and they say we're going to give you 75% protected time for three years. And in three years, we expect that you're going to be able to make the transition. Now I have to tell you that PhD researchers who've done seven to 10 years of research as part of their PhD training and their postdoc, they still need career development awards to be able to like transition to independence.

25:40 So for any MD three years is actually not enough because you have much, much less clinical training relative to a PhD researcher. Now most people are going to give you only three years, but what I'm saying is that you want to make sure that you are optimally resourced at the end of those three years to run, right? You don't want to be at the end of three years saying, well, what, what just happened? Three years will go by very quickly. What you want to do is say, if you're hiring me to succeed in research, where are the resources to help me succeed? Where's my clinical research coordinator who's paying for that? Where's the biostatistician I'm going to work with? Who's paying for that? Where's the grant writing sessions that I'm going to have access to?

26:22 Who's paying for that? You got to ask those questions because at the end of the day, if you don't succeed, you know, they'll say, oh, what a waste of time. But if they didn't resource you to succeed, then you weren't set up to succeed in the first place. But at the end of the day, it's up to you to be clear about what resources you need to succeed. And that's what you should negotiate. So before ever you even start looking for the job, write a list of all the things you need to succeed clinically and a list of all the things you need to do to succeed as a scholar. Write them down. And when they say, oh, I'm so sorry, we know the meeting is $350,000, but we can only offer you $325,000. And you can say, okay, can I get $25,000 worth of a research assistant?

27:06 You know? It's not salary because they don't want to commit to this, you know, extra of $25,000 every year. But it can give you something that helps to resource you so you can succeed. Okay. So that's it. Those are the five points. And if I remember correctly, number one was to start with what you want. Number two is to be clear about community, the location that you're going to be. Number three is then the job. Like does it even have a semblance of the kind of job that you want? Number four is salary. And number five is what's the package that's going to support you in the job that you're taking? Okay. I think I would just say that the big, the summary of it all at the end of the day is that you are, you're coming into the job to succeed.

27:52 If you do not succeed, you disappoint the people who hired you, you disappoint yourself. So be very clear about what success looks like and be very clear about what you need to succeed. That's what you negotiate. You negotiate what is needed to succeed. It's not just salary. It's the whole benefits package around how you succeed. Salary is important because if they don't give you a certain salary, you can negotiate other things, but you do need to know what you're negotiating and don't do it alone. Make sure you do it as a team. All right. Excellent. I'm going to stop recording and then I would love to hear your thoughts. Well, there you have it. I hope that was helpful to you. I look forward to talking with you again next time on the Clinician Researcher Podcast.

28:36 Thank you for listening. Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it. As you share this episode, you become part of our mission to help launch a new generation of clinician researchers who make transformative discoveries that change the way we do healthcare.