Letters to the editor.

Dear Editor:

I found Jeffry Peters article ("Attracting and Retaining Physicians in Academic Medical Groups requires new Sources of Revenue," The Physician Executive, 32(1), Jan/Feb 2006) interesting, well thought out and useful for those of us who daily recruit academic physicians. But recognizing the financial limitations of academia, it is extremely important to recognize the non-financial advantages an academic career offers to young doctors; and, perhaps, to disillusioned physicians who too early in their careers entered private practice.

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I think we must remember that there is a large group of doctors who are now graduating from residency to whom financial rewards are secondary to lifestyle considerations, and who place a greater weight on scheduled time for family and outside interests. This is particularly true in OBGYN, where we are seeing an enormous increase in female residents (such that the fate of males interested in this specialty is speculative at best.)

There are several non-financial "opportunities" which I think are key to recruiting the next generation of academic physicians.

First, academic positions can offer defined hours and clinical responsibilities and clearly defined job requirements that emphasize time free from clinical medicine for personal development, family time and child rearing.

Second, a defined CME time can be planned with input from academic faculty who serve as mentors to new physicians. It can help with career planning; young doctors do not want to become the "local" MD whose patients they cared for, amazed by how much the LMD had fallen behind.

Third, specialty board preparation can be built into academic programs already functioning at the home institution, as opposed to private practice situations where one must actually leave the office setting to travel for CME and board preparation--stay current or accept that you are falling behind.

Fourth, these young doctors who want to "practice medicine" and be free of the "business of medicine" can join academic practice plans that use senior faculty to represent their interests and ensure optimal business management and opportunities for retirement, disability and other benefits, while freeing the young doctors from the day-to-day aspects of operating a financially sound practice.

Fifth, for those young doctors who wish to become fluent in the business of medicine, academic programs can offer mentors and access to advanced business training, i.e. ACPE membership and programs.

Sixth, instead of going it alone in a community setting where the sub-specialty and other tertiary care services are not available, young physicians can begin their careers practicing in an academic setting which offers all of the tertiary care back-up services that they became accustomed to as students and residents. After years as students and residents of caring for patients referred from the "local" MD, they can see themselves as not falling into the mode of referring all complicated cases, but rather learning to work with the sub-specialists and academicians they learned to rely on during their training.

Seventh, they can still participate in clinical research, to which they were exposed in their training, with the academic centers handling the IRB and other time-consuming aspects.

Eighth, they can participate in TIAA/CREF or other institutional programs instead of trying to find a financial advisor to develop an individual program for them, which they lack the sophistication to evaluate.

In short, academic centers can offer young graduates a transitional phase where their clinical skills may be enhanced with the support of faculty mentors. Their business skills can be developed through faculty practice plans and ACPE, etc. The prejudice all academicians have against private practice doctors is mitigated by remaining involved in CME, research and interaction with sub-specialists. Their life styles will be favorably affected by planned and limited clinical duties that allow time for family, personal development and the non-medical aspects of life.

To me, this suggests a clear advantage for academic programs in their recruitment of young doctors!

William Mann, MD

Neptune, N.J.

Dear Editor:

I enjoyed the article on personality types in The Physician Executive ("What's Your Type and Why Does It Matter?" The Physician Executive, 32(1), Jan/Feb 2006). I have been interested in the use of psychology in better managing my organization and I think you touched on some important points.

I would have included more caution in using such techniques. The modern view of psychology doubts that each of us has one personality type that does not change as we live our lives. Walter Mischel's Personality and Assessment showed that such tests do not predict how humans will act in the real world, and he is credited with establishing that our personality type depends upon the context we find ourselves living in. We will be aggressive in some settings and passive in others.

The scientific validity of personality testing is also suspect. Careful studies have shown that people who take the tests at different times will be assigned to different categories. Annie Murphy Paul's The Cult of Personality is a good summary of some of the problems with personality tests. It contains fascinating detail about how the most popular tests (Rorschach, Myers Briggs, MMPI, etc) were developed by seriously flawed individuals with seriously flawed academic credentials.

Finally, I would take issue with your approach to conflict. While it is true that affective conflict can get in the way of good decision making, I try to increase the amount of cognitive conflict in my organization because that is a good way to get different points of view expressed and good decisions made.

John F. Kennedy made a bad decision in the Bay of Pigs because he relied on the experts at the CIA to predict that Castro would be easily toppled. He changed his decision-making process to increase cognitive conflict and many credit that change to better decision making in handling the Cuban missile crisis. Michael A. Roberto's Why Great Leaders Don't Take Yes for an Answer is a good place to start exploring the importance of cognitive conflict.

Kent Bottles, MD

Grand Rapids, Mich.