Academic Medicine and the Structure of Hospitals

[sandg]

Hey All,
I hope you don't mind an ignorant pre-med asking some basic questions, but I wanted to pick the brains of those working in the system now.

First, could someone provide a good definition of academic medicine? I have yet to see one. What are the duties of an academic physician?

Secondly, how is patient care ordered in hospitals, specifically teaching hospitals? I might be wrong (see the first question), but if academics are mostly involved in research, who carries the bulk of the patient care? What is meant by tenure-track vs. clinical facutly?

Lastly, what are the career options for someone who does a fellowship after residency? This question comes about because it seems that some of the most selective subspecialties (e.g. peds surgery, interventional radiology, etc.) require a research background and are only available at the big university programs. What if one wants to do clinical work in these areas but has no interest in research?

Well, I realize that is a lot to tackle. Any and all information or opinions are appreciated.

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[Seaglass]

First, could someone provide a good definition of academic medicine? I have yet to see one. What are the duties of an academic physician?

Academic medicine is probably best defined by a medical practice within some sort of institution of higher learning. This could be a teaching hospital, public institution (IE CDC) or other group. It is the alternative to private practice. It may or may not involve some sort of research or teaching.

Secondly, how is patient care ordered in hospitals, specifically teaching hospitals? I might be wrong (see the first question), but if academics are mostly involved in research, who carries the bulk of the patient care? What is meant by tenure-track vs. clinical facutly?

In teaching hospitals services (Cardiology, Medicine, Surgery) are run by attending physicians who may rotate on services, and may spend time doing research or teaching when off service. Much of the nuts-and-bolts are done by residents who work under the supervission of the attending physician. Some attendings may never see patients, some only see patients. Attendings generally have some flexibility to set up how much (or little) research they want to do. Additionally, many many faculty are involved in clinical research (as opposed to bench work) that may not require as much time away from patients.

Lastly, what are the career options for someone who does a fellowship after residency? This question comes about because it seems that some of the most selective subspecialties (e.g. peds surgery, interventional radiology, etc.) require a research background and are only available at the big university programs. What if one wants to do clinical work in these areas but has no interest in research?

It depends on the fellowship. Those you quote usually use research as a way of narrowing down the field of applicants since interventional rads especially is a really hot field right now. Most fellowship trained people go into private practice after their fellowship.

Casey