Undoubtedly, those pursuing a career in academic medicine have a tough time line.  In most medical schools, somewhere between the 7th and 10th year, depending on whether the academic clock was stopped for pregnancy, the fate of the academic physician is decided.  During these years when women have the biologic clock ticking, they also have the “up or out” academic clock ticking.

This rush to create academic contributors is pure insanity, even for men who don’t physically “have” the children, but are increasingly interested in being with their young children.  When careers extend over 3-4 decades, it is time to think about changing the timing of academic productivity.

Let’s take the story of one woman physician who is in the “twilight” of her academic career. For more than 25 years she has worked as a surgeon in a top Children’s Hospital.  She became a full professor only 7 years ago.  She has recently acquired an NIH grant. She has assumed leadership roles in major specialty organizations in the last 5  years.  So how did she do it?

In the first decade of her career, she had her children.  She build her practice, taught the residents, and established her expertise.  She did some research and acquired skills she didn’t know she lacked and needed.   She didn’t attend national meetings regularly, because that required travel.  She did not take on too many administrative responsibilities (i.e. committee work).

And most importantly she found her research focus from among the patients she had cared for during the first 10 years. She established relationships for meaningful inter-disciplinary collaboration.

The kids got older.  She had more time and more energy.  She turned more attention to her academic career. She wasn’t burned out.  Her flame was beginning to burn brighter and brighter and brighter.  The next 15 years have been incredibly productive.

This is a true but not a unique story or women in academia.  Unfortunately it is not as common story as it should be.  This is an “inverted” career trajectory — starts off slowly and accelerates and peaks much later.  But over a lifetime, it results in productive, contributing academic physicians.  Her department was smart enough to invest in her differently, and their investment has more than paid off.

So what needs to be done?  Get rid of the current model of promotion and tenure that place emphasis almost exclusively on the first decade of one’s career.  Instead, using self-evaluation and input from colleagues who understand motivating physicians over a long career, use continuous career building mini-milestones that build a foundation that will support more advanced work later on.  These are good years to help junior faculty find their focus, their passion and the best way they can contribute.

As the complexity of medical education increases, as the process of producing quality research becomes more difficult, and as the administrative demands of  academic institutions multiply — all in the face of decreasing revenues for academic departments — new models for academic advancement are critical to the success of the academic physician and our medical education system as a whole.  The way women physicians work best should become the way all academic physicians are made to pursue their careers.

Linda Brodsky is a pediatric surgeon who blogs at Women MD Resources.