Association of Academic Physiatrists
Podcast
2015
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Podcast
2015
Dr. Alice Hon:
Hello, and welcome to the Association of Academic Physiatrists podcast
featuring career options in academic medicine for graduating physical
medicine and rehabilitation residents.
Today's podcast will include a Q&A with Dr. Michael Boninger.
Dr.
Boninger is a professor and endowed chair in the Department of Physical
Medicine and Rehabilitation at the University of Pittsburgh School of
Medicine.
He is Director of the UPMC Rehabilitation Institute, and the
Senior Medical Director for post-acute care for the Health Services Division
of UPMC. He is a physician researcher for the United States Department of
Veteran Affairs.
I am Dr. Alice Hon, a Spinal Cord Injury Fellow at Kessler Institute for
Rehabilitation and a member of the Association of Academic Physiatrists. I
will be hosting this podcast.
Welcome to the program, let's get started.
Dr. Michael Boninger:
Dr. Alice Hon:
Sounds good, thank you for having me on.
So could you tell us about your career experience and background?
Dr. Michael Boninger:
I think probably it starts in my honor graduate degree, which is
mechanical engineering. But I knew from the very beginning that I was going
to go to medical school. I went to medical school, met a patient who was
brought to rehab on a cart and walked out of the hospital, and decided that the
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2015
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intersection between engineering and rehabilitation was a cool one and one
that I wanted to pursue, and so I went into a rehabilitation residency.
I went to the University of Michigan. While I was there, I got tired of seeing
one patient after another and decided that research was probably the right
pathway for me.
And my first job out of residency was at the University of Pittsburgh, which is
where I still am today. Most of my time is spent – or at least in the beginning
was spent in research, and so I focused my research effort probably 75% of
the time as a junior faculty member. And that has changed now over time
where a significant part of my time is also spent in administration, as you can
tell from all of those titles you rattled off.
And so I run the department here at the University of Pittsburgh. I have a
research program that I think the easiest summary for that is to say it's about
technology for enabling people with disabilities to participate more in society,
and the technology runs the gamut from wheelchairs to stem cells to brain
computer interfaces. And that's where I do the majority of my work.
I also spend a lot of time mentoring and have been Director of Rehabilitation
Medicine Scientists Training Program, which is an AAP/NIH joint program
that helps train the next generation of (sounds like: physiatric) researchers.
Dr. Alice Hon:
Could you tell us why you decided to pursue academic medicine?
Dr. Michael Boninger:
Sure. I think part of it was what I discussed in the beginning, which
was I was tired by the fact of seeing one patient after another. It seemed to be
working on small problems. When I was doing my engineering degree, I
actually was working full-time for my last two years as an engineer, and I
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Podcast
2015
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missed working on larger problems. So for me, the entry into an academic
career was really purely about being able to do research, working on bigger
problems. I think maybe one of the more famous physiatrists, Dan Barry, who
was on the TV show Survivor and was an astronaut and did a few spacewalks
off the space shuttle, was a faculty member at the University of Michigan at
the time. And I told him how I was unhappy and he said, "You should
consider a research career."
So that's what I looked for from the very
beginning.
And then once you start in the research, really the only place that you can be
and do the kind of research that I was interested in doing was an academic
medical center.
Dr. Alice Hon:
What do you recommend to trainees interested in academic medicine?
Dr. Michael Boninger:
Well, the first thing I'd say to them is great choice. I think academic
medicine is a wonderful place to be. You get to influence medicine on a much
broader scale, both by possibly conducting your own research, which will
change people's lives, and by training the next generation of researchers.
What I would say is, look for role models in the place that you're undergoing
training.
Ideally role models in both research and in clinical work, in
teaching, all of those things are great. I think there's a strong demand for
academic physiatrists, and so you've made a good career choice. I would
read, stay up on the literature, and try to get to know as many people at your
health center as possible. And if you're at a health center that doesn't have a
lot of academics, then look nationally for mentorship.
The AAP has a
mentorship program that you can get involved with. I think there's a lot of
resources available specifically through that organization that can help you
out.
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2015
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Dr. Alice Hon:
Would you recommend that trainees pursue fellowship training if they're
interested in academic medicine?
Dr. Michael Boninger:
I would pursue fellowship training if you are interested in what the
fellowship is trying to teach you. I think that what you find is that people who
are really interested in brain injury or very interested in spinal cord injury,
really the only two settings that you can practice that – this isn't uniformly
true, but for the most part – those area academic medical centers. And so if
you're interested in one of those two things, absolutely do a fellowship. Same
thing is true for pediatrics.
A pain fellowship or a sports fellowship probably is a little bit more portable.
I would tell you if you're interested in sports and academics, that you should
definitely do a fellowship, because being able to sit for the boards, which
that's a requirement now, means that you really want to have that board
training so that you can be an active member of the teaching faculty.
There are research fellowships as well. NIH funds a series of programs called
"T" awards, and so you can actually search for T32s and you could do a
fellowship in that realm.
But if you're interested in academic medicine, don't necessarily have a special
interest in one of the fields I already mentioned, like spinal cord injury or
traumatic brain injury, I don't think you need to do a fellowship to stay in
academics. I think that a lot of academic medical centers are interested in
generalists who are interested in outpatient, inpatient, (sounds like: EMG),
and that should not be considered a requirement for going into an academic
career.
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Podcast
2015
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Dr. Alice Hon:
What resources in mentorship is specifically available for trainees interested
in academic medicine?
Dr. Michael Boninger:
Join the AAP, Association of Academic Physiatrists. Obviously this
is their podcast. By way of full disclosure, I'm a past president of the AAP, so
I love that organization. I love that organization because of their focus on
academics. So join the AAP. There's a ton of resources that are available
through that organization. Attend an AAP meeting. One of the great things
about their meetings is that you get – breakfast and lunch are generally
communal activities, and so you'll have an opportunity to interact with a
bunch of great people in the field and learn about the resources that are
available.
It's not entirely clear to me if this is something that a resident, a junior faculty,
a medical student would listen to. And so if it's for all of the above, I think
that if you're junior faculty, there's a specific mentorship program that the
AAP offers. If you're a resident, there's a residency group that has a really
strong impact on the AAP and meets at the AAP, so become involved with the
residency council of the AAP. And if you're a medical student, there's a
whole bunch of resources related to getting a summer experience. There's a
program called RREMS, which is research focused, and there's another
program which I'm blocking on a little bit. But all of these things are on the
website, and so I would go there.
I know that sounds like an advertisement, and I'm sorry that it sounds that
way, but that's where the resources are and it's a really good place to start.
Dr. Alice Hon:
What advice would you give to trainees interested in becoming a residency or
fellowship program director?
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2015
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Dr. Michael Boninger:
Well, the first thing I would say is do a great job during residency. I
think it's great to have "chief resident" on your application. So that would be
one thing to strive for.
As you go on in your career, what you want to do is make sure that you're
actively involved in teaching. And sometimes that can be challenging because
clinical work is always there. And often you need time to teach, and so you'll
have to push that a little bit. So volunteer for opportunities to teach both in
the residency program and in other venues, like medical students.
We have some junior faculty here at the University of Pittsburgh who started
an independent journal club where they just said, let's meet for dinner, and
they did this casual thing which I think is fantastic. Anything that I think
gives you more experience in the residency program or enables you to interact
more with the residents, again, is a good thing to look at.
The residency program directors meet at the AAP and they have a program.
I'm sure that part of that program is open so you can learn about the
regulations and the other aspects of being a residency program director. And
so those are some of the things that I can think of.
But the – probably the first and most important thing would be sit down with
the person who's currently in that position at your institution and talk to them
about their career path. You'll gain a mentor, and I'm sure you'll learn a lot of
interesting things.
Dr. Alice Hon:
What do you recommend to trainees interested in administration?
Dr. Michael Boninger:
Pretty similar recommendations. The administrators for the different
rehab departments meet at the AAP, so that's another source.
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2015
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I would say that you can sit down with the people in your institutions that
have administrative responsibilities and find out what that is about.
The other program I should mention is the program for academic leadership
called the PALs program, which is run by Gary Clark who's from Metro
Health in Cleveland. Gary does a great job of preparing academic physicians
for leadership roles.
I would consider applying for the PALs program,
learning more about the PALs program. And then, again, I would talk to
people in administrative positions at your institution, both in rehab and maybe
not in rehab.
I think a great source for mentorship and for learning is – for instance, the
administrative directors at rehab hospitals, we have a title here which is the
Director of the Rehab Network, which is an administrator job, it's not a
physician, and there are an amazing amount of items you can learn from
someone like that. So that's another person to sit down and talk to.
If you go into someone's office and say, tell me about your career path, tell me
about what you do, most people are thrilled to do that, and it's a great way to
learn about how people got to where they are.
Dr. Alice Hon:
What job opportunities are available in academic medicine? And where do
you see the current job market?
Dr. Michael Boninger:
The current job market is one where larger medical centers are really
the norm. Smaller hospitals are being purchased. In every city there will be
an academic medical center. I think that academic medical center is going to
be part of a larger hospital system. So opportunities for academic medicine
are strong. It has a bright future. Most of the people who I know who are
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2015
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department chairs were looking for people last year. It's interesting because it
seemed to be delayed a little bit, and then there was a big push. But I know I
got a number of different phone calls asking me what my spinal cord injury
fellow was doing next year.
And so I think there's a very positive outlook for academic medical centers,
because I think that there will be leadership in these large hospital systems
that are actually being brought together.
I think they're really across the spectrum and they go from joining academic
practice as a sports medicine physician so that you can help build their sports
program to something more traditional, which would be like joining a spinal
cord injury unit and teaching in that realm. So I think it's a positive outlook.
Dr. Alice Hon:
What would you say are the benefits of academic medicine compared with
working in private practice?
Dr. Michael Boninger:
The key one is probably teaching and interacting with residents. I
think that keeps you young and it keeps you smart. The residents are always
teaching me and they're always challenging me. I think that challenge is one
that is – tell me about something or asking me a question and then I have to go
back and look at it, and so one benefit is this constant renewal that you get by
having a new set of people that are there looking to you for instruction.
I think another benefit is you're part of a larger group.
Most academic
medical centers aren't one or two docs. And being part of a larger group
means that this mentorship is just built into your system. There are always
people around who can help you, who have been there before, and so you get
the added benefit of a large group practice. I think that the other benefit of a
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large group practice is there usually is someone there who's handling the
business side of your career.
So I personally didn't want to get involved with worrying about billing, with
worrying about spreadsheets and enrolling in different programs. It turns out
as department chair you have to start learning that stuff, so I failed at my
attempts to avoid it altogether. But early in my career, I just didn't have to
think about that. I had to know how to code a visit, but someone else worried
about the business aspects and I was happy to have that be the case.
I think that there is this community of doctors across the country that have this
likeminded interest in pushing the field forward and helping to set the future.
I personally – this goes back to the whole engineering thing and my career
choice. I'm very thankful for the physicians out there that are happy seeing
one patient after another.
But that strikes me personally as somewhat
stagnant, and I think that the benefit of an academic career is also career
advancement.
If you go into research and you're successful – I just got back from Montreal
where I was asked to give a talk. I'm going to Valencia in a couple of weeks.
And so you get travel and that can be really fun. And so there's multiple
different benefits, depending on the career choice that you have. And I
certainly have been happy with that choice.
Dr. Alice Hon:
What do you see is the future of academic medicine and physical medicine
rehabilitation?
Dr. Michael Boninger:
We have to be very active in the transformation of medicine as it
exists right now. Most people would tell you hopefully—and I think the
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2015
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educated people would tell you—that medicine is rapidly changing. We have
high deductible plans, so people are seeing doctors less.
There's these
accountable care organizations or payer provider models that are making it so
that we're talking about quality over quantity. And U. S. healthcare has been
really about quantity, seeing more patients, and definitely much less about
quality than it should have been.
So there are these dramatic changes happening at health centers across the
country. And I think what academic physical medicine and rehabilitation has
to do is help define that future and talk about PM&R's role in that future.
So I see the future of academic PM&R being that we become more and more
prominent in health systems because one of the titles you read off for me was
the fact that I am now the Senior Medical Director for post-acute care. And
what we know is that care is going to be shifting into the community into
lower cost settings. And I think that rehab has a wonderful story to tell. So
we can help people stay at home, we can help them participate in a population
health or community-based health. That's exactly what you want.
My thought is that we're going to continue to grow as a specialty, that we will
become very integrated and integral to large health systems that are trying to
help people stay at home, and that it's our job to create that future.
Dr. Alice Hon:
Thank you for this insightful discussion on academic medicine career
opportunities. On behalf of the Association of Academic Physiatrists, we
would like to thank you for listening to this podcast.
For more information on the podcast and the American Journal of PM&R,
including the Journal iPad app, can be found on the AAP website at
www.physiatry.org.
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2015
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This concludes today's program. Thank you.
THE END