Molecular Genetics and Metabolism 113 (2014) 2–3
Contents lists available at ScienceDirect
Molecular Genetics and Metabolism journal homepage: www.elsevier.com/locate/ymgme
Editorial
Save the biochemical geneticists!
According to Wikipedia there are around 80,000 humpback whales in the world. I got a call from a friend the other day to let me know that he was leaving his genetics practice for industry. It wasn't the first this year and it won't be the last. Another friend, a pediatric department chair and a really nice guy (for an intensive care doctor), called to say his only biochemical geneticist was retiring and could my team help manage their State by telemedicine. Bottom line is that we have an aging and increasingly dissatisfied workforce in clinical genetics as a whole and biochemical genetics in particular. We also aren't doing a particularly good job of replacing ourselves. Over 40% of this year's genetics training slots went unfilled. The American College of Medical Genetics salary survey for 2013 showed that there were 1045 eligible respondents of M.D.s and Ph.D.s.; however, there were fewer than 40 respondents with any form of biochemical board certification. This conforms to an informal question I asked at the ACMG meeting last spring of the American Board staff. I was told there were only about 150 active certificates in biochemical genetics (including co-boarded folks) and that some of them were dead (they don't pull the certificate without notification). I realize that there are a lot of physicians who care for our inborn error patients who aren't boarded in biochemical genetics, but the trend is indicative. To put it in endangered species terms: there is one humpback whale for every 86,000 humans on the planet and one American board certified biochemical geneticist for every 2,260,000 Americans. Lest we go the way of the Dodo and Great Auk we should pay attention. This is all happening at a time of unprecedented growth and technological advancement in our field. New treatments are announced all the time particularly for inborn error patients. So what's going on? For starters, we don't offer a lifestyle that appeals to millennials (the current 20–30 year olds) and our time to go after the generation X group has passed. A great article in Forbes magazine summed up what the current generation is looking for in work (Rob Asghar, Forbes Magazine, “What Millennials Want In The Workplace (And Why You Should Start Giving It To Them)”. 1/13/2014): 64% of them say it's a priority for them to make the world a better place. (check) 72% would like to be their own boss. But if they do have to work for a boss, 79% of them would want that boss to serve more as a coach or mentor. (check, sometimes) 88% prefer a collaborative work-culture rather than a competitive one. (check, theoretically except for grants/promotion/RVUs/etc.) 74% want flexible work schedules. (oops) And 88% want “work–life integration,” which isn't the same as work–life balance, since work and life now blend together inextricably. (double oops)
http://dx.doi.org/10.1016/j.ymgme.2014.09.006 1096-7192/© 2014 Published by Elsevier Inc.
It's easy to judge the younger generation and what they expect out of work. I also think that it's wrong to. It's not, however, difficult to see that the current crop of potential replacements is not interested in having their entire lives defined by their careers and frustrations. I firmly believe that we are in the most interesting field in medicine. Nowhere else are the puzzles greater or the chance to impact a patient and their family larger. So, is there hope for our field or will we go quietly into that good night. I think there is but we have to change up some things and actually look at some tough issues beyond just talking about them. Money: Simply put the starting salary for a starting Pediatrician is $135,000 (healthcaresalaries.com). Add 4 more years of genetics and biochemical genetics training to that and the starting salary is…… $135,000 (my division of 12 docs) while most Pediatricians have progressed to $175,000/year. Since most fellowship/residency salaries are under $60,000 (American Association of Medical Colleges) that's $300,000 in lost revenue for staying in training for four more years. The gap widens since wages are relatively flat in academics and increases have been under 3% for several years now. According to Bloomberg's Janet Loring: “The median education debt for 2012 medical-school graduates was $170,000, including loans taken out for undergraduate studies and excluding interest. That compares with an average $13,469 in 1978” or about $50,000 in 2012 dollars. As leaders in the field we didn't face these challenges. We had less debt and our salaries were relatively higher. We are also told by our colleagues in hospital finance that we lose money for every patient we see. That's not true on the bottom-line roll up but we'll save that for another day. Is this going to change overnight? Of course not, and the new Lean initiatives at most academic medical centers ensure it won't. But we have to figure this out and that means different models for care and reimbursement. It means a way to value and compensate a “thought” specialty that has no procedure. This means a serious examination of alternative care delivery models. The current systems of hospital administration are heavily invested in the fee-for-service model. We have to figure this one out for ourselves. Burnout: Most of us remember the classic model of the Triple-Threat faculty member who can see patients, teach, and do research without working up a sweat (I think tall buildings and single bounds are involved here). What few will admit is that this model leaves little time for anything else. The work–life integration that our younger colleagues are seeking cannot shoehorn it all in. We tell our junior faculty that their clinical contributions and teaching are valued on their road to advancement, and then ask them when their next grant submission is going in (or the Dean does). What this doesn't account for is the 24-7, 365 day a year access that patients have and demand. As a colleague put it, “patients always triumph over bench”. This results in unavoidable mission conflict and what often suffers is the quality of life away from the hospital. We commit to 70% protected time for new investigators either at the
Editorial
expense of their clinical colleagues or by believing that an unrealistic model in fact is. Many of our younger faculty are starting families and have an expectation of being involved. These irreconcilable priorities lead to frustration and burnout. We have to re-examine the priorities that we place on our faculty and adjust the expectations and the rewards system to adapt. Deans like the indirect cost recovery from grants but we have to actually value the different models we pay lip service to. This may mean longer timelines to advancement and more avenues to get there. Why should a brilliant clinician who helps countless patients be of less worth than a skilled researcher with grantsmanship abilities? We need both. These are two facets of a multi-faceted problem. By nature I'm an optimist, but I'm realistic enough to realize that if we don't address the issues our field will continue to decline in numbers. At some point,
3
we fall below critical mass (perhaps we are there already) and become firefighters putting out blazes and brush fires. We have some of the smartest folks I have ever met in our field. It's time we turned them loose on this problem. I hope we don't need bumper stickers that read “Save the Biochemical Geneticists!”
Marshall Summar MD Division of Genetics and Metabolism, Children's National Medical Center, Washington, DC, USA
Contents lists available at ScienceDirect
Molecular Genetics and Metabolism journal homepage: www.elsevier.com/locate/ymgme
Editorial
Save the biochemical geneticists!
According to Wikipedia there are around 80,000 humpback whales in the world. I got a call from a friend the other day to let me know that he was leaving his genetics practice for industry. It wasn't the first this year and it won't be the last. Another friend, a pediatric department chair and a really nice guy (for an intensive care doctor), called to say his only biochemical geneticist was retiring and could my team help manage their State by telemedicine. Bottom line is that we have an aging and increasingly dissatisfied workforce in clinical genetics as a whole and biochemical genetics in particular. We also aren't doing a particularly good job of replacing ourselves. Over 40% of this year's genetics training slots went unfilled. The American College of Medical Genetics salary survey for 2013 showed that there were 1045 eligible respondents of M.D.s and Ph.D.s.; however, there were fewer than 40 respondents with any form of biochemical board certification. This conforms to an informal question I asked at the ACMG meeting last spring of the American Board staff. I was told there were only about 150 active certificates in biochemical genetics (including co-boarded folks) and that some of them were dead (they don't pull the certificate without notification). I realize that there are a lot of physicians who care for our inborn error patients who aren't boarded in biochemical genetics, but the trend is indicative. To put it in endangered species terms: there is one humpback whale for every 86,000 humans on the planet and one American board certified biochemical geneticist for every 2,260,000 Americans. Lest we go the way of the Dodo and Great Auk we should pay attention. This is all happening at a time of unprecedented growth and technological advancement in our field. New treatments are announced all the time particularly for inborn error patients. So what's going on? For starters, we don't offer a lifestyle that appeals to millennials (the current 20–30 year olds) and our time to go after the generation X group has passed. A great article in Forbes magazine summed up what the current generation is looking for in work (Rob Asghar, Forbes Magazine, “What Millennials Want In The Workplace (And Why You Should Start Giving It To Them)”. 1/13/2014): 64% of them say it's a priority for them to make the world a better place. (check) 72% would like to be their own boss. But if they do have to work for a boss, 79% of them would want that boss to serve more as a coach or mentor. (check, sometimes) 88% prefer a collaborative work-culture rather than a competitive one. (check, theoretically except for grants/promotion/RVUs/etc.) 74% want flexible work schedules. (oops) And 88% want “work–life integration,” which isn't the same as work–life balance, since work and life now blend together inextricably. (double oops)
http://dx.doi.org/10.1016/j.ymgme.2014.09.006 1096-7192/© 2014 Published by Elsevier Inc.
It's easy to judge the younger generation and what they expect out of work. I also think that it's wrong to. It's not, however, difficult to see that the current crop of potential replacements is not interested in having their entire lives defined by their careers and frustrations. I firmly believe that we are in the most interesting field in medicine. Nowhere else are the puzzles greater or the chance to impact a patient and their family larger. So, is there hope for our field or will we go quietly into that good night. I think there is but we have to change up some things and actually look at some tough issues beyond just talking about them. Money: Simply put the starting salary for a starting Pediatrician is $135,000 (healthcaresalaries.com). Add 4 more years of genetics and biochemical genetics training to that and the starting salary is…… $135,000 (my division of 12 docs) while most Pediatricians have progressed to $175,000/year. Since most fellowship/residency salaries are under $60,000 (American Association of Medical Colleges) that's $300,000 in lost revenue for staying in training for four more years. The gap widens since wages are relatively flat in academics and increases have been under 3% for several years now. According to Bloomberg's Janet Loring: “The median education debt for 2012 medical-school graduates was $170,000, including loans taken out for undergraduate studies and excluding interest. That compares with an average $13,469 in 1978” or about $50,000 in 2012 dollars. As leaders in the field we didn't face these challenges. We had less debt and our salaries were relatively higher. We are also told by our colleagues in hospital finance that we lose money for every patient we see. That's not true on the bottom-line roll up but we'll save that for another day. Is this going to change overnight? Of course not, and the new Lean initiatives at most academic medical centers ensure it won't. But we have to figure this out and that means different models for care and reimbursement. It means a way to value and compensate a “thought” specialty that has no procedure. This means a serious examination of alternative care delivery models. The current systems of hospital administration are heavily invested in the fee-for-service model. We have to figure this one out for ourselves. Burnout: Most of us remember the classic model of the Triple-Threat faculty member who can see patients, teach, and do research without working up a sweat (I think tall buildings and single bounds are involved here). What few will admit is that this model leaves little time for anything else. The work–life integration that our younger colleagues are seeking cannot shoehorn it all in. We tell our junior faculty that their clinical contributions and teaching are valued on their road to advancement, and then ask them when their next grant submission is going in (or the Dean does). What this doesn't account for is the 24-7, 365 day a year access that patients have and demand. As a colleague put it, “patients always triumph over bench”. This results in unavoidable mission conflict and what often suffers is the quality of life away from the hospital. We commit to 70% protected time for new investigators either at the
Editorial
expense of their clinical colleagues or by believing that an unrealistic model in fact is. Many of our younger faculty are starting families and have an expectation of being involved. These irreconcilable priorities lead to frustration and burnout. We have to re-examine the priorities that we place on our faculty and adjust the expectations and the rewards system to adapt. Deans like the indirect cost recovery from grants but we have to actually value the different models we pay lip service to. This may mean longer timelines to advancement and more avenues to get there. Why should a brilliant clinician who helps countless patients be of less worth than a skilled researcher with grantsmanship abilities? We need both. These are two facets of a multi-faceted problem. By nature I'm an optimist, but I'm realistic enough to realize that if we don't address the issues our field will continue to decline in numbers. At some point,
3
we fall below critical mass (perhaps we are there already) and become firefighters putting out blazes and brush fires. We have some of the smartest folks I have ever met in our field. It's time we turned them loose on this problem. I hope we don't need bumper stickers that read “Save the Biochemical Geneticists!”
Marshall Summar MD Division of Genetics and Metabolism, Children's National Medical Center, Washington, DC, USA
