Transitioning From Training to Breast Imaging Practice: Building an Academic Career

Abstract

Launching an academic career in breast imaging presents both challenges and opportunities for the newly graduated trainee. A strategic plan aligned with one’s personal strengths and interests facilitates career success and professional satisfaction. Academic departments offer multiple tracks to accommodate diverse faculty goals. The specific requirements of various tracks vary across institutions. The clinician-educator track typically encourages a focus on medical education and educational scholarship. The clinician-investigator or clinician-scholar track supports original research and grant-funded clinical trials. Finally, the clinical and clinician-administrator tracks allow for emphasis on clinical program development and leadership. As definitions of scholarship broaden, many opportunities are accessible to demonstrate excellence in the traditional areas of clinical practice, education, and research, as well as the broader fields of leadership and administration. Departmental and national society resources that advance knowledge in one’s chosen area of interest are available and should be explored. Mentorship and sponsorship can provide valuable insight into identifying such resources and devising a plan for sustainable career success and work-life integration.

Introduction

After many years of medical education and postgraduate training, embarking on an academic career in breast imaging is an exciting new beginning. Academic medicine offers a plethora of opportunities for professional satisfaction, including cutting-edge patient care, clinical program development, teaching, research, leadership, and administration. However, this wide range of choices can also feel overwhelming. The key to both career success and professional satisfaction is to develop a focused strategic plan (1). This need not be done alone. A variety of mentoring resources are available at institutional and national levels (2). Furthermore, this plan does not need to be static. Continual refinement over the course of an academic career can keep pace with one’s professional evolution. This article will summarize opinions of academic career advisors; suggest available resources for mentorship and sponsorship, research, and funding; and offer strategies for developing a personal path to sustainable success in academic breast imaging.

Benefits of Academic Breast Imaging

Academic breast imaging offers an opportunity for career progression over a lifetime, from developing a reputation of clinical excellence at a local level to establishing a position of prominence on the national and international stages. University-based medicine supports an exclusive focus on breast imaging in an environment of specialists who strive to lead the larger community in both research and best clinical practices. This setting provides the opportunity for junior faculty to learn from experts in the field, to grow intellectually alongside like-minded peers over time, and, ultimately, to disseminate one’s gained experience and knowledge to medical students, residents, and fellows, as well as to the greater radiology community. Working with residents and fellows can be particularly rewarding, as it encourages discussion of the literature and evidence-based clinical decisions in the course of daily practice. Overall, academia encourages the radiologist to remain intellectually curious and strive for excellence throughout one’s career. It must also be noted that academic radiology is not synonymous with working at an academic institution. Many private practices affiliated with university hospitals offer similar opportunities, and academic pursuits can be followed by those in traditional private practice groups as well; a great deal of expertise and scholarship stems from the academic work of private practice radiologists.

An academic practice can provide stability, an advantage for anyone who prefers to set down roots in a particular region of the country, especially given the current climate of frequent changes in radiology practices. Academic departments may offer flexible arrangements, including part-time clinical commitments, to suit one’s desired work-life integration. Part-time faculty typically have the same opportunities for promotion and are treated as equal partners in academic practice. Flexibility in academia also allows one to pivot and change career focus without changing institutions.

Radiologists in private practice can pursue an academic career. Strategic plans are similar, though the clinical experience of a private practice radiologist may allow for an expedited clinical focus on academic priorities. However, research and teaching options may also be available in the private practice setting. For example, larger private groups may be amenable to site participation in national clinical trials. Some radiologists in private practice may also choose to transition to an academic breast program during their career. There are many examples of radiologists in private practice who have made significant scholarly contributions to breast imaging and who have had a substantial leadership, advocacy, and educational impact (3–5).

Choosing a Track

Academic departments offer multiple career tracks that are intended to accommodate the varied interests and strengths of a diverse faculty. Choosing the track best suited to one’s professional goals is a critical first step. Tracks vary widely among institutions, with a variety of options including academic tracks focused on education, scholarship, and research versus clinical tracks focused primarily on patient care, development of clinical programs, and administration. When deciding on a track, it is important to take some time to reflect on personal strengths and interests. For someone who finds scientific inquiry into clinical questions exciting, embarking on a track that supports clinical research may be best. For someone else who finds organizational and leadership challenges rewarding, choosing a track that supports a role in clinical administration may be most appropriate. Conversely, for someone interested in teaching and curriculum development, a track that rewards medical education may be ideal. In a study of 465 faculty physicians in a large academic medical center, Shanafelt et al showed that aligning one’s interests and strengths with professional pursuits leads not only to the fastest trajectory towards the achievement of career goals but also to the greatest sense of professional reward and happiness (6).

An equally important step in choosing a track is to discuss one’s personal assessment of interests, goals, and strengths with a mentor or department leader. A senior faculty member, section chief, or department chair can identify resources and provide advice to refine goals so that they can be realistically met. This person can also help junior faculty to home in on the activities that are most likely to support promotion and avoid those that may not be as productive in the early years of their career. Finally, one’s desired work-life integration should be considered in all decisions regarding career path and discussed honestly with a trusted mentor in order to formulate a plan that is sustainable and successful (7).

Clinician-Educator Track

Academic tracks focused on education have been widely embraced as the value of medical educators has been increasingly recognized. Radiologists on this track generally produce educational research, with few or no requirements for grant-funded original research, though such scholarship remains an option. Depending on the institution, scholarship requirements may be satisfied through the publication of educational materials, such as reviews and book chapters, in addition to medical education activities, including teaching, curricular revision, and residency or fellowship program development (8).

Clinician-Investigator or Clinician-Scholar Track

Academic tracks focused on original research offer ever-expanding options to academic radiologists (9,10). With rapid technological development of new and evolving diagnostic tools, breast imaging provides an opportunity to conduct clinical trials akin to those in medical oncology (11,12). Digital breast tomosynthesis, synthesized 2D mammography, contrast-enhanced mammography, US elastography, abbreviated breast MRI, molecular breast imaging, and opto-acoustic imaging are just some of the modalities that have resulted in single- or multi-institutional high-impact publications in recent years. While requirements vary between institutions, clinician-scholars are typically expected to make significant contributions to the scientific literature, as they generally have a research focus, with a proportion of their time supported by funded grants, thereby reducing their clinical commitment. As such, a successful career on the clinician-investigator track may require training and support in funded research beyond the traditional course of medical education and clinical practice.

Trainees who identify their interest as grant-funded original research may benefit from pursuing a PhD or master’s degree in public health. Incoming residents may seek out a program that offers a research track, providing time to participate in translational research in place of a portion of their clinical training to expedite their academic career (10). Regardless of degree or residency track, clinician-investigators benefit from training in research methodology and design, statistical analysis, and grant writing. Courses on these topics are offered by national societies and individual institutions. Furthermore, it behooves newly graduated clinician-investigators to seek out a radiology department with a research emphasis. Such a department is best equipped to provide the resources and support that are necessary for a successful career in grant-funded original research.

Clinical Track and Clinician-Administrator Track

The clinical track is an increasingly instituted career pathway in academic institutions. While faculty in the clinical track may engage in teaching, research, and administrative activities, their primary responsibility is the delivery of clinical care. The development of clinical programs and quality initiatives are common themes in this track. Educational contributions may include impactful teaching of trainees and delivering invited continued medical education lectures, grand rounds, and keynote addresses. Community outreach, committee work at the departmental or university level, and participation in regional and national professional societies support a service contribution. The clinician-administrator track, offered in relatively few institutions, may be seen as a subset of the clinical track, with important administrative roles considered as a form of service to one’s department and to the larger breast imaging community.

Promotion

In recent years, promotion committees have broadened their definition of meritorious achievements, such that many activities beyond research are considered. Early scholarship is typically achieved at the institutional or local level, building to the national level as one’s career progresses. Promotion criteria vary widely. For promotion from assistant professor to associate professor, faculty must demonstrate that they have developed a local or regional reputation and are on a trajectory to a national reputation. Scholarly work of clinician-educators and clinician-investigators should aim for high-impact journals, as impact factor may be weighed more heavily than number of publications. Assistant professors are typically first authors on published articles when taking the lead role while being supervised or developed by a more senior colleague. At most academic institutions, promotion from associate professor to professor requires significant scholarship and national recognition. The academic reputation of a professor is typically centered on a theme that forms the focus of their published oeuvre. Therefore, identifying an area of special interest early in one’s career path is beneficial (13). In the already specialized field of breast imaging, a specific subtopic of interest may not be readily apparent to a newly graduated trainee and often emerges after some initial experience in various areas of interest. Exploration is to be expected and should not be a source of concern. In fact, career advisors recommend that the first year of practice be focused primarily on developing clinical expertise and exploring areas of research interest (14).

For all academic breast radiologists, it is critically important to read the breast imaging literature on a consistent basis. This practice solidifies understanding of the field and its current clinical concerns. Inevitably, some topics may ignite particular interest in the reader by raising pressing unanswered clinical questions. The most successful research efforts are those that answer common relevant concerns and improve clinical practice. It is strongly recommended that new faculty discuss research interests with a mentor or section chief in their institution. An advisor can orient them to the research already being conducted in their section or department and advise them of existing opportunities. A senior faculty member can also suggest areas of interest in the wider field of breast imaging and help direct their efforts to areas that are most likely to address current needs. Attending national meetings, networking with colleagues from other institutions, and meeting with vendors who are developing new technologies are also important. Opportunities to join multi-institutional industry- or national society–sponsored trials may present areas of interest that are new and unforeseen by a young investigator.

Tenure tracks, though not as common for physicians as for non-physician faculty, may still be offered at some institutions. Tenure tracks typically place a time requirement for promotion by the end of an appointment term. Those on a tenure track may be terminated if they do not achieve promotion within the defined limits of their institution. Typically, those in the clinician-investigator track must show funding from major national organizations, such as the National Institutes of Health or others, supporting research that typically comprises a significant percentage of their work effort. A research-focused department may have ongoing clinical trials and a fully developed research team to aid with recruitment, data collection, and analysis, circumventing the time investment required of a junior faculty member to build such a practice.

For academic radiologists on the clinical track, promotion to associate professor is based primarily on clinical excellence, demonstrated by developing a local or regional reputation as a trusted expert in the field, meeting or exceeding national practice benchmarks, and creating or advancing clinical programs. Promotion to professor reflects greater achievement in scope and depth of impact, and typically requires national reputation with significant scholarship. In addition to consistent clinical excellence, contributions in the arenas of education, service, and/or scholarship may be expected.

Regardless of track, new faculty benefit greatly from attending institutional sessions detailing the specific requirements for promotion at their institution. It is helpful to attend such sessions regularly, as requirements many change over time. Embarking on the activities that lead to promotion early, rather than waiting until it is time to apply, is essential for successful career advancement. Taking advantage of annual reviews of one’s progress with a section head or department chair provides an opportunity for meaningful feedback and advice on direction and resources.

Building Scholarship

Getting Started in Education

A meaningful career focused on education begins within one’s own institution and extends to the larger breast imaging community over time. Junior faculty members are encouraged to develop a thoughtful approach to teaching at the workstation, including asking trainees for feedback and reviewing resident reviews. Further leadership in education may be demonstrated by reviewing current breast imaging resident and fellow curricula and considering how these could be expanded, in collaboration with the section chief. New academic radiologists are also expected to build a lecture portfolio by adding new topics each year. Excellence in teaching is bolstered by seeking out meaningful feedback from those who attend, including asking other faculty to attend and provide feedback about the effectiveness of one’s presentation and teaching styles. Junior faculty members developing their teaching portfolio may consider alternative teaching styles, such as the flipped classroom, to add innovation to the department’s educational programs. Clinician-educators may also engage in departmental educational efforts, including serving on education committees and taking on residency or fellowship leadership opportunities.

On a national level, new clinician-educators are encouraged to develop educational exhibits for national society meetings and, subsequently, build on their content and publish them as educational review articles. Faculty members interested in education may benefit from exploring educational research and review articles about educational topics in radiology journals, such as the Journal of the American College of Radiology (JACR) (15). As their career grows, they may review educational articles for journals. This provides deeper experience that, in turn, enhances personal work. Further insight can be gained by joining educational societies, such as the Association of University Radiologists (AUR), and attending national meetings to better understand the national direction of education in radiology departments. Affinity groups, such as the Alliance of Clinician-Educators in Radiology, offer additional resources and networking opportunities for career advancement in education. Community education regarding breast imaging may also be considered as local and regional contributions.

Getting Started in Research

Participation in research and scholarly endeavors is requisite for the academic radiologist, particularly for those on an academic track. Original research should be differentiated from scholarly activities, and both are valuable to the academic radiologist. Scholarly activities include writing peer-reviewed articles and book chapters, as well as presenting educational material at national meetings, while original scientific research involves rigorous data collection and analysis to help advance medical knowledge. There are many avenues to pursue in clinical research, from small projects limited to one’s breast imaging section to large grant-funded projects that involve multiple departments within or beyond one’s institution. Clinician-investigators can get started with retrospective case series. As they identify areas of research interest, they can learn about clinical trials through workshops offered by organizations such as the Radiological Society of North America (RSNA) and AUR. Networking at national meetings and through national society committees may reveal opportunities for multi-institutional and industry-sponsored trials. Selecting a project that meets individual interests is critical, since a project that is personally interesting is key to the project’s success and one’s own personal fulfillment. Initiating a research project should be done carefully, making sure that the right clinical question and study design are in place (16). Early research should be performed under the guidance of a senior faculty member. While scientific research is typically first presented as a scientific abstract at national meetings, it is important to follow through on the long-term goal of turning the abstract into a peer-reviewed scientific manuscript, as publications strengthen one’s national reputation, support promotion, and lead to networking opportunities. Following established guidelines outlining how to plan and write a research manuscript can help increase publication success (17).

Grant funding can be beneficial as it can provide support for research personnel and allow one to “buy time” off the clinical schedule to devote to research. Faculty development grants are an important resource because they support not only the research but, more importantly, the junior investigator, providing the time needed to learn different research methods and best practices (Table 1). Faculty development grants may have time restrictions and only allow junior faculty who are a certain number of years post-graduation to apply. Young faculty interested in grant-funded research may consider exploring the clinician-investigator track early in their career to take advantage of such opportunities. This consideration is less important for the clinician-educator track, where funding opportunities are less time sensitive.

Grant funding may be investigator-initiated or industry-sponsored. Grant workshops for early-career radiologists are designed to provide junior clinician-investigators with insight into scientific investigation. The RSNA offers valuable training through workshops in grant writing, research development, and academic radiology. The AUR similarly provides a core curriculum on research and statistics. Several professional organizations in radiology award pilot research and seed grants, as well as scholarship opportunities for trainees and early-career faculty (18) (Table 1). Academic medical centers may offer small departmental or institutional grants that can provide an ideal launching pad for junior faculty interested in grant-funded research.

Getting Started in Clinical Scholarship

For clinical excellence, new faculty can lead improvement projects, such as their clinical division’s Mammography Quality Standards Act certification or quality assurance program. Clinical faculty can also spearhead a new program based on emerging techniques, such as abbreviated breast MRI, contrast-enhanced mammography, or molecular breast imaging. Over time, junior faculty may choose to become involved in national organizations, such as the American College of Radiology (ACR), where they can serve on practice parameter and guidelines committees, opportunities that also typically result in publications. In addition, many journals, such as the Journal of Breast Imaging and the JACR include clinical practice articles that provide an avenue for scholarship if one has implemented a new practice or service line at their institution.

Other Opportunities for Scholarship

Finally, it may benefit faculty on all tracks to become involved with professional politics and practice standard initiatives by serving on ACR or Society of Breast Imaging (SBI) committees. In addition to developing professional standards, committee work may lead to society-sponsored publications on a variety of topics, including economics; quality; and diversity, equity, and inclusion. Digital scholarship is increasingly recognized and may include creating and developing informational content via social media (19). Professional societies may also provide a venue for global outreach for faculty interested in initiating global health programs.

Service to Organizations

A key aspect of academic medicine is service to organizations at local, regional, and national levels (Table 2). Committee participation allows one to understand the important work of radiology societies and provides an opportunity to influence policies regarding patient care, clinical operations, finance, informatics, education, and research. A plethora of volunteer opportunities to serve on committees are available through the RSNA and the American Roentgen Ray Society (ARRS), and details can be found on their websites. Committee goals range widely, from diversity, equity, and inclusion to professionalism, informatics, research development, and many others. Interests specific to breast imaging can be pursued through the Breast Imaging Subcommittee of the Annual Program Planning Committee of RSNA, or through working with a subspecialty team on the Education Exhibit Awards Committee. Journal reviewing can also be both a rewarding activity and one that acknowledges expertise and keeps the academic radiologist engaged in new research and developments (20). Likewise, attendance of and participation in national meetings, including developing program content, reviewing abstracts, and moderating scientific sessions, can advance one’s knowledge base, which, in turn, enhances one’s own skills.

While radiologists in private practice can provide service to organizations, there are typically more sponsorship and mentorship opportunities in academic radiology to facilitate involvement on a national level, including work with professional organizations such as the ACR, AUR, RSNA, ARRS, and the leading specialty organization in breast imaging, the SBI. Many of these organizations have groups and programs focused on early-career academic radiologists. All these activities also serve as opportunities to find additional mentors, sponsors, and friendship outside one’s own department.

Mentorship

Mentorship is indispensable for advancement in academic radiology. The benefits of mentorship include professional support, advice, and skill building, as well as enhanced career satisfaction and reduction of burnout. Mentorship can help advance the careers of junior and minority faculty by facilitating publications, academic awards, and new leadership positions (7). Mentorship can also guide faculty in work-life integration, time management, professionalism, and networking. It is important to recognize that mentorship does require input and accountability from the mentee.

Both formal and informal mentorship programs exist, and it is useful to have multiple mentors (7,21). Ideally, mentors and mentees should have compatible work styles and shared career interests. Mentees should consider establishing a written outline with their mentor, including short- and long-term goals. In addition, a shared plan regarding the frequency and duration of mentorship meetings may help to facilitate the relationship. Mentees should consider sending a specific discussion topic a day or two in advance of their mentorship meeting to enhance the conversation. Overall, the mentee should be proactive and respectfully drive the mentorship relationship.

Mentors may be found outside of one’s subspecialty division, but also in other departments within one’s own institution, as well as academic departments outside one’s institution and even outside of medicine. The SBI Mentorship Committee aims to foster effective relationships between mentors and mentees, providing a valuable resource to junior faculty. Similarly, the ACR mentorship program has a broad pool of mentors, including private practice radiologists. Under the ACR umbrella, the Radiology Leadership Institute offers a new mentorship program inviting young faculty to mentor trainees. Some mentorship connections may be phasic, providing support over a limited period, perhaps through a certain phase of one’s career. Mentorship is differentiated from sponsorship. Sponsors help navigate one’s career by nominating an individual for projects, committees, or roles that they may not be aware of, allowing key introductions and vertical moves (22). Both mentorships and sponsorships serve to facilitate career advancement and bring out the talent that advancing junior faculty have to offer.

Leadership

Healthcare in academic medicine is dynamic and complex. Transformational leadership and strong management skills are key ingredients for a successful academic medical center (23). Leadership in radiology provides personal and emotional growth beyond being a strong clinician, educator, and/or researcher. Leadership opportunities are available in all phases of one’s career, from residency to early and late faculty career stages (Table 3). Formal leadership training is often available within one’s own institution, as well as from professional societies and other formal healthcare management programs. The ACR Radiology Leadership Institute is one such valuable resource.

Leadership also encompasses opportunities for advocacy. Women are under-represented in radiology, accounting for approximately 29% of all radiologists and 13% of all radiology leaders (24). Specific programs to address this disparity include Women in Radiology groups led by residents and faculty within a department, as well as programs available through the Society of Chairs of Academic Radiology Departments and the American Association for Women Radiologists (24,25). In addition to mentorship, sponsorship is paramount to career advancement for all emerging leaders. A trusted mentor may also serve as a sponsor or, alternatively, provide an introduction to leaders in breast imaging who can offer further opportunities to junior faculty.

Conclusion

A career in academic breast imaging can be highly rewarding, with opportunities for professional growth in patient care, education, research, administration, and leadership. An honest self-analysis of personal strengths and interests at the outset of one’s career is an important first step in choosing a career path. Identifying an academic department that is fully supportive of one’s goals is also instrumental for career success. Along the trajectory of achieving a growing academic reputation, the support of mentors, departmental and national society resources, and professional networks of like-minded colleagues is indispensable.

Funding

None declared.

Conflict of Interest Statement

None declared.

References