Michael J Trepal, DPM discusses the academic positions available in podiatric medicine. Dr Trepal also discusses how these positions can help create a professional and personal life balance and avoid physician burnout.
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TAPE STARTS – [00:00]
Mike Trepal: Alright I think most of you know me, Mike Trepal, the Dean of NYCPM. My life skills talk that I’ve been asked to give is careers in academia.
Now I think it’s something I know a little about, having been in various forms of academia since I graduated in 19 – what I’ve graduated in ’81 and then finished my residency in ’83.
So in terms of disclosures, I guess for this talk, it’s not corporate disclosures, but it would be disclosures relating to the academic positions in which I hold, some of them being obviously as a faculty member and administrator at the NYCPM. Assistant Professor of Surgery at New York Medical College. Assistant Professor in the Department of Orthopedics at SUNY Downstate, and as well as current Vice Chair of CPMA.
Academia, the – I always love etymology and looking at where the origins of words come from. Academia actually refers to a garden, a vineyard in which Plato taught way back when. Probably owned by a Greek named Akademus and that was his garden where Plato taught. And hence, education and knowledge was coming and flowing out of this garden. And it developed the term academia.
Other terms to refer to was faculty. Faculty has several meanings to it. Number one, we talk about someone having their faculties to understand their knowledge. Someone who lost their faculties could be dementia, other loss of the ability to reason.
The other meaning more common as it relates to this talk is being part of a faculty, is a teaching staff, generally, of a university or college in one of its departments. We extend that a little bit into the faculty of a program such as this or other CME programs.
Remember, all of us have the term doctor in front of our name. Doctor emanates from the Latin word docere, which means to teach. So inherently, each and every one of us, whether in a formalized academic institution or not, by the very nature of being doctors or teachers.
Now your options in academia is being part of a faculty. You can be part of a faculty of one of the colleges of podiatric medicine, other medical colleges, teaching hospital or residency program, part of the military or VA system or part of a federal state or local governmental agency.
You can be a faculty member involved in academias as part of the specialty college or board. Being involved in CME programs, either as an organizer or as a speaker. Working for industry or research or in conjunction with receiving degrees.
Usually if you’re going to be involved in teaching and academia, the other degrees will be either PhD in one of the hard sciences, an MD or DO degree, an MPH degree if you’re going to be in academia in terms of public health and population medicine. Other degrees which tend – not so much into the teaching component of the lower degrees or MBAs, more into the business aspect of it.
Now in terms of the colleges of podiatric medicine, there are only nine of us. One is free standing, the other eight are affiliated with universities in one way or another or large institutions. All nine are excellent institutions. Although, it is only nine, so we are indeed limited physicians in terms of what’s available to teach either as a full–time or part–time faculty in college podiatric medicine.
Here’s an ad I pulled out of current APMA news. Something like this back when I was a student or a resident probably would have been unheard of to see. But you see this now as a norm as medical colleges or teaching hospitals looking for full-time academic, podiatric faculty.
Now when you’re part of a teaching faculty at an institution, there’s usually a triad, components that’s involved with it. Number one is teaching which is the main thing. Teaching can take many forms, it’s either in the classroom where you’re putting together formal lectures. That also involves assessment, you have to write questions, administer examinations for the students who are sitting and listening to it. And it also involves other committee work, where you have to use your academic judgment. Admissions committees, curriculum committee, performance and promotion committees and the like, which is generally the purview of a faculty in making these academic decisions.
Teaching also can involve clinical teaching, involve direct patient care. This usually will also involve teaching just, not only of undergraduate students, but residents as well. The second component of a teaching triad is that of research, depending upon how research oriented their institution is. You may be held to the dictum of publish or perish.
More research oriented institutions have as absolute requirement that their faculty, certainly an attended faculty, be involved actively in some form of research and publication. That is a need for promotions. It’s also, in many cases, a requirement for contractual extensions and renewals.
And the last component of teaching at an institution is that of service. Service either to the institution or to the community at large or to the profession. This may involve participating in health as this may be serving various functions, non-academic functions within an institution. Depending upon again the make up of the institution, one or more of these may be stressed.
Certain institutions, their research institutions, that’s going to take priority. That you’re going to spend most of your time doing research and less doing teaching. Other institutions that are more teaching directed, the scale will be tipped in the other direction.
Now whether you’re at a podiatry college or another institution, there are many things to consider if this is what floats your boat.
Advantages, number one, there is prestige. When you are – have an academic title, a professorial rank at an institution that comes with certain prestige.
Oddly enough, we tend in podiatric medicine to value that less than, say, in the other disciplines. If you’re a professor at a medical school, that is revered by the profession. We tend in podiatry, not quite as much to revere our podiatric academic missions, but nevertheless, that prestige follows. To the public, it follows. To industry, it follows. To other professionals.
A personal fulfillment, if that’s what you enjoy –teaching and mentoring other people, what better way than to satisfy that personal need, than to be involved than a teaching position out of the institution?
Regular salary, as opposed to eat what you kill in terms of private practice although recognized the paradigms of practice are changing greatly. Very few of the residents now are going to go rent an office, put a shingle up and open up as a private office – it’s over where you’re purchasing a practice.
Most of you will start off at least in being an employed physician as part of a larger group, but nevertheless, when you’re in academia, there is a regular salary that you can expect to get.
Regular work hours as well. You know you’ll have generally set schedules, you’ll know that your hours are from whatever, you have a class on every other Wednesday, you’re in the clinic on Thursday afternoon. So all that gives you some regularity into your life.
If you’re involved in the clinical teaching end of it, you’re may be on call and patient emergencies that you have to factor in to that as well, but generally, the scheduling is more regular than it would be in non-situations like this.
If there’s faculty practice plan, you can involve and get – generate revenue income from that depending upon the institution’s plan. You are the beneficiary of benefit packages that accrue to faculty member. Usually these things can be substantial in terms of health insurance, disability insurance, vacations, standard of vacation, sick time, participation in pension plans, and these things, tuition reimbursement, tuition reimbursement from large institutions for your children. Many of the larger hospitals or institutions will give tuition reimbursement for wives and children, so the benefit packages can be substantial and usually will surpass that which might be offered going to work for a medical group in there. Professional expenses, dues payment, reimbursement to go to CME meetings, consulting opportunities, industry. Media all kind of like to go towards academics in order to get opinions, medical legal consultations, serving as expert witnesses. All of these things, if done properly and done ethically can add significant revenue at the bottom line for you at the end of the year.
Tenure possibility. Any part of this policy of your institution in which you work, they may or may be tenure. Tenure is… nothing is an absolute guarantee, but certainly if someone is in a tenured position, it gives a little bit more academic freedom for you, and you know that you have a significant job security.
There is a price that you pay on that, all right? In general, compensation is generally lower than could be achieved or the potential that could be achieved in private practice. That disparity is rapidly changing and in fact may even be reversing. In the absence of a tenure system, contracts are term-limited. There’s no guarantee that a contract will be renewed. You’re subject to compliance with institutional rules and regulations. You’re not your own boss, so to speak. You do have some degree of freedom there but certainly you’re subject to when you need to follow the institutional rules and regulations
You’re also subject to student and other external evaluations. If you teach a course and that course is part of the section of a national board examination and your students and your class continue to do poorly in that section of the examination, you can be sure that your superiors within there will be asking you some questions. And if it continues, you know, subject to possibly modification or in fact even non-renewal of a status.
So lastly, there is less control of a personal schedule. I said before it’s a regular schedule but if you’re in private practice and you want to go play golf next Wednesday, you can just look to your office manager and say, “Reschedule my patients for next Wednesday. I’m not coming in,” or “I’m going to take off between Christmas and New Year,” or “I’m going to be off the day after Thanksgiving,” and you set your own schedule and you set your own time. It’s not easy when you pull up an academic faculty and there’s a class that’s scheduled or those committee meetings that you have to be at. So there’s a give and take of all things.
And also, the other advantage is if you’re still inclined is that you can climb up the academic ladder into academic administration. I mentioned before that I started out as a faculty, a rank and file faculty member in the surgery department and rose up the ranks until, you know, one day I was asked to become dean and I said, “Okay.” And I said to myself, “What does a dean do?” And so I ran across town to the then dean of Columbia Medical’s PNS and I figured Columbia is arguably one of the top five medical colleges in the world, certainly I think Ivy League medical college, and I sat down with the dean there then and I said, “Hey, Herb, I’m going to be a dean now. What does a dean do?” And he looked me right in the eye and he said, “Whatever it takes.” And I looked and I said, “What?” He said, “Whatever it takes.”
Now I didn’t know then what he meant. Believe me, I know now. Some days you’re an employment lawyer. Some days you’re an educator. Some days you’re a physician. Some days you’re an engineer. The roof leaks, you… there’s all sorts of disability law, all sorts of problems that come to you, and you really have to be prepared to handle that as it comes along.
You have an opportunity to be served as part of academia as a residency program. This comes right out CPME 320, which is the standard for residency programs that every residency program has a well-defined administrative organization with clear lines of authority and a qualified faculty. Back in the day, many times residency directors were volunteers. They did it in their spare time. There was no hard and fast administrative guidelines as to who they reported to.
Nowadays, it’s completely different. A program director has to be defined by the institution, has to meet the criteria set forth not only by the institution but by the CPME, and it was a requirement that they have to be salaried as well within that position. Now most program directors are not full time and that’s all that they do. Many also have outside sources of income, a private practice, that private practice may be part of a hospital-based system. They also generate income many times as being program director from referrals as a result of your administrative position.
Your name circulates around the hospital, you go to various meetings, medical staff meetings as a head, as a program director. And so you accrue many benefits out of that as well.
As a program director, though, you are responsible for ongoing CPME approval. The hospital is not very happy with you as a program director if the CPME finds that your program doesn’t meet standard. You also have to deal with general hospital compliance issues, discrimination, immigration status, employment issues, from time to time disciplinary issues. So there’s a lot of headaches that come with it as well, but also an opportunity to mentor, for prestige, to mold and to be involved in the next phase of our profession.
You can be involved in academia as part of specialty boards and colleges. Specialty boards, ABFAS, ABPM, you know, associated colleges, associated with ACFES, AFOAM. You can be involved in this in academia as part of committees or you can be part of both of leadership. There is lot that comes with it.
Now very few people do this as their entire career. There are institutes, there are circumstances where people become executive directors and salaried people, personnel as part of the boards but those are very hand few of population of podiatrists who do that. There may be half a dozen in the entire country. You might even add people who are full time, scientific affairs say for the FDA, PMA. But those positions are few and far between. Most of them serve on committees or in leadership positions. These are prestigious to be chair – I was chair of the exam committee for ABPS for six years and during that time I learned a tremendous amount to sit around at exam committee meetings and with some of the top brains of the country and to look at cases and develop case scenarios and to develop questions and to review them and field test them was a tremendous learning experience for me.
There’s also perks associated with being on this committees or leadership. Frequently they meet in nice places, so you have travel benefits accrued to it, there are stipends now. The leadership, the presidents of most of these boards will receive stipends, which are not insignificant, it’s no more than a simple predicament to pay for your lunch expense. Because of the time that it takes out of your office some of these salaries and stipends are quite significant and up until the tens of thousands of dollars per year. The downside is it’s term limited. You’re president for a year, you’re committee chair for a year or two and then one and done. So you have to all take this into consideration. But while you’re in that process, it is a tremendous – and it can be a tremendously gratifying situation.
In terms of continuing medical education being a faculty member at meetings like this, prestigious meetings like this or any of the large conferences where you’re asked to present at that. so again, there is a certain amount of prestige that come from that. There may be honorariums associated with it that could add to income. Also, the meeting are in nice places. There’s travel rewards that come with it. You have to be careful of undue corporate influence in these things. You don’t want to end up a reputation as a shield for any one particular company.
Corporate support is necessary. We wouldn’t have very many CME programs if it were not for the corporate support that goes with it. Corporations, some of them are philanthropic. Some of them really do see as part of their mission philanthropy. They pay for residents to go to various meetings and conferences. But a part of it also is they are in business to make money and they want to show off their wares or their products or their devices. And there’s nothing wrong with that as long as it’s done within the context of educational parameters.
CPME monitors CME credits as they’re awarded. In order to be issued CME credits, you have to be an approved CME sponsor. And along with that status go several guidelines. You’ll as you staff through this meeting over the last few days that drugs and devices were all spoken of generically. So that was important, was the medicine or the science before and you didn’t see flashing corporate signs in the lecture hall here.
You don’t see any advertisements for any particular corporation. That’s all out in the lecture hall, I mean in the exhibit hall where it’s appropriate to be and not in the lecture hall. So it’s closely monitored as well as it should be.
Income that’s derived from corporate is all reported into a national data bank. You can look up any speaker that you – that you – and not only you, any patients. And so if you’re a doctor – if you’re a patient and your doctor says, I want to put this total hip in you, you can go to this national data bank website and you can look to see, does this doctor get, you know, $150,000 in speaking fees from the company that – who’s hip he’s going to put into you. And that’s good. I think Sunshine laws are all very good and public [disclosed and all that] [0:20:53]. And I think, you know, most – the vast majority of doctors and practicing physicians are ethical, honest people that understand this and they always put the patient’s welfare first. But again, just to be sure, all these things are publicly disclosed.
Also in being a speaker at meetings, it kind of forces you to stay current. If you want to be asked to speak at meetings, you need to stay current, you need to be aware of what’s going on so that you stay relevant in it, so again significant advantages.
Industry, you can be involved as a full-time employee in industry. Usually, if you’re going to be on the academic side, it’s going to be in corporate research and product development. Generally, in these you’re going to need some advance training, you need to have statistical skills. You need to have perhaps some additional basic science skills. You’ll have to maybe go out and get another PhD or additional training in order to stay in the academic side of it. You can also be more on the marketing side of it, but that is less academic and and more marketing but nevertheless, these jobs more and more and more frequently are becoming available for podiatric physicians.
Insurance companies, health insurance companies, they all study disease management. They need people experienced in various disciplines and knowledgeable in various disciplines to do population medicine and disease management and to understand the diabetic foot and the healthcare implications of it and what therapies and interventions are proven to be beneficial and what are just a not worth the money that it cost. And this is an ever expanding role for podiatrists, podiatric physicians to be involved in this arena as well.
Again, generally they’re going to want you to have some advanced training, surely an MPH degree or degrees in statistics so that you can understand the data and make sense of the data for the people and the decision making thing on healthcare.
Lastly, government. Usually, this will be in the realm of public health, whether at the federal, state or local level. Public health is an important thing and certainly our area of expertise, certainly houses on niche in there and more and more people are finding themselves getting involved and getting full-time positions in public health for a government agency.
Whichever you do or none of it, if you’re involved on academia or not, it all boils down to you’re going to have to find a way to balance personal and professional responsibilities. Academia is a way for some to balance this a little bit better. It’s likable, it’s what they want to do and they find that it makes more sense and stability within their life, so that they can balance their personal and professional responsibilities and avoid burnout.
Burnout is a real problem. I’ve seen too many of my classmates and too many of my colleagues who reached the stage of burnout. Most of you are way too young to get that. You just get going but you will see people saying, “I’ve had enough. I can’t take it anymore. I’m getting out of it.” Burnout leads to physical afflictions and all sorts of of problems that usually gets as result of out of balance between personal and professional. What are the causes of burnout? Well, lot of different studies of it. Most of it is dealing with bureaucratic tasks that you feel you have no control over. Not that they’re absent in academia. I mentioned before, you’re subject to college regulations and policies and procedures.
But a little bit less tampered than if you were in solely into private practice.
So prevention of burnout particularly for something that you’re doing that you love, academic medicine may be the answer for you that really meets the balance between professional happiness and personal happiness. When you’re happy professionally, you’re happy personally and vice-versa for the most point. And that’s really I think what I found to be the secret of success, not only for myself but for the many people that I’ve come up the ranks with and seen as colleagues in many different venues throughout our profession. So that’s my little take on that. Anybody have any questions on anything? Yes, sir?
Male Speaker: Being involved in academic with all the different activities, would you say maybe somebody needs a more stable home life even if you’re private practice?
Mike Trepal: You know, it depends. It depends what type of private practice you have. It depends upon what type of academic responsibilities that you have. It’s all balanced but in general, you know, you have a more regular schedule when you’re in an academic institution, you know what the classes are. But as I said, there’s a price you pay for that.
Male Speaker: You need to be a more disciplined person.
Mike Trepal: To some extent. To some extent and then on the other hand maybe not because it’s all laid out for you. You know, it’s – you can’t – when someone says, “Hey, Mike, you know, can we go play golf next week?” And I say, “Well, no, I’ve got a class,” so I can’t take off then. Whereas if I didn’t have that, it would be a, you know, just tell the office managers, you know, reschedule these patients, I’m not coming in. So it’s give and take that makes it and it’s not right for everybody.
There’s also a certain skillset that has to come with it. Not everybody is an inborn and innate and a good teacher. Some people – we’ve all sat for lectures that you just want to die. You know, you say how long – you know, you could feel your beard grow sitting there listening to it. And it’s not every lecture is a home run and some people they can get on the front of the podium and they can talk to you, you know, tell you why there are rings around Saturn. And you’re sitting there and you’re just mesmerized with every word that comes out of their mouth. So there’s a dynamic there too and some people are just better at it.
TAPE ENDS – [27:33]