In this month’s Chair’s Column, we surveyed clinical associates who are currently working at any of the U of T fully-affiliated teaching hospitals. We asked them about their practice and how the clinical associate role fits in with their career goals. In addition to this survey, we also asked a group of clinical associates to talk a bit more about their role, including why they became a clinical associate and what advice they have to offer anyone else who is thinking about the clinical associate position after their training. This is what they had to say:
Why did you take on a clinical associate position?
Dr. Alyse Goldberg, Endocrinology & Metabolism: As a clinical associate at Sunnybrook, I have the privilege of working within a multi-disciplinary team to treat patients with gestational diabetes. Additionally, I am one of the presenters for the interdisciplinary obstetrics and endocrinology teaching rounds. Working with residents in clinic or while covering the consult service allows me to continue clinical and bedside teaching.
Dr. Ariel Lefkowitz, General Internal Medicine: I have clinical associate positions at four different hospitals. As a clinical associate, I have the flexibility of working at more than one place, working as much or as little as I request (I tend toward more!) while completing my Masters of Education at OISE. Working as a clinical associate also affords me the opportunity to continue honing my clinical skills, teach and mentor trainees, and work shoulder-to-shoulder with other staff who could potentially become long-term colleagues.
Dr. Zoe Lysy, Endocrinology & Metabolism: When I finished my clinical fellowship at the University of Toronto, I wanted to take time to do a Master’s degree. A clinical associate position gave me the exact flexibility that I needed for this. I could increase my clinical load when I was not in school, and while I was away for my studies, I could reduce it. It also allowed me to stay in close association with my colleagues and the clinical environment with which I was familiar and enjoyed, so this was a perfect fit. I found that I was well supported to balance my clinical work and studies.
Dr. Kieran Quinn, General Internal Medicine: I am presently working to complete my PhD in Clinical Epidemiology and Health Care Research as I work toward becoming a successful independent clinician-scientist at a leading academic institution. Working as a clinical associate ensures that I continue to hone my clinical skills and offers the additional opportunities to engage in clinical teaching and leadership. It keeps me connected to key individuals in leadership roles and to my clinical mentors who provide ongoing guidance in my career development. No matter where I end up working, being a clinical associate in the Department of Medicine allows me to develop a broad range of skills that will benefit me on my path to becoming a thoughtful and qualified physician, researcher and clinical leader.
Dr. Raffi Rush, Rheumatology: When I look back on my own residency training, I feel incredibly grateful to the attendings who gave their attention and experience to help make me into the physician I am today. I can never directly repay them. The most I can do is pay forward some small amount of what I received as an attending physician myself.
Being a clinical associate is a wonderful opportunity to work closely with trainees, teaching and learning from them, as well as continuing to learn from the cumulative experience of more senior faculty as I develop as a clinician, researcher, and writer.
Dr. Nathan Stall, Geriatric Medicine: I took on a clinical associate position to maintain my clinical skills, generate teaching evaluations, maintain 'relevance' within the hospital setting, and increase my earnings all while completing my PhD training in clinical epidemiology.
Dr. Jonathan Zipursky, Clinical Pharmacology & Toxicology: The clinical associate position gives me the opportunity to maintain my clinical skills and build upon my clinical interests while I am pursuing a PhD in Clinical Epidemiology and Health Care Research. It also provides an excellent transition from trainee/fellow to faculty as I continue my graduate work as part of the Clinician Scientist Training Program. The position allows me to maintain a connection with the clinical divisions at U of T and gives me the exciting opportunity to continue to teach and mentor trainees. It also allows me to work at different sites/hospitals to learn more about the clinical divisions and research environments within the Department of Medicine.
What kind of work do you do as a clinical associate?
Dr. Goldberg: I am fortunate to participate with the gestational diabetes population as this is connected to the reproductive endocrinology interests of my community practice. The clinical associate position has allowed me to combine academic elements to an otherwise clinical-based career, and maintain connection with supportive colleagues and mentors.
Dr. Lefkowitz: I am mostly doing clinical work as a clinical associate, as staff physician on the clinical teaching units, on the hospitalist services, and attending on medical consults. I am also involved in the creation of an exciting new clinical project and teach as a lecturer for undergraduate and postgraduate medical education at U of T.
Dr. Lysy: As a clinical associate I mainly do clinical work and teach. I see patients as part of a General Endocrine clinic but also have had a chance to create a niche within the Osteoporosis program at Women’s College Hospital. I work with residents and medical students in most of my clinics and teach as part of the formal program of our division as well as occasional undergraduate teaching or rounds.
Dr. Quinn: As a clinical associate, the bulk of my work is clinically oriented, supervising patient care and trainees on the Clinical Teaching Unit, the Medical Consults Service and the Palliative Care Unit. As time goes on, I have found opportunities for involvement in hospital working groups to help shape the clinical care processes that I use every day, to learn important management skills from the clinical leaders who are part of these experiences, and to engage in discussions on improving trainee experiences on our clinical services.
Dr. Rush: My work as a clinical associate is primarily clinical, attending on the clinical teaching unit or supervising trainees in the internal medicine clinic. When I'm not doing clinical work, I'm busy developing rheumatology and internal medicine services in the post-acute care setting, participating in studies and quality improvement initiatives focused on those patients, or writing.
Dr. Stall: I attend on the inpatient Geriatric Medicine Consultation Service and on the Internal Medicine Clinical Teaching Units at Mount Sinai Hospital. As a requirement of the Eliot Phillipson Clinician-Scientist Training Program and as preparation for a career as a clinician scientist, my clinical service is limited to approximately 10 weeks a year. I participate (when available) in divisional meetings for both geriatric medicine and general internal medicine at Mount Sinai Hospital. I teach a maximum of four ICE seminars per academic year in geriatric medicine (formally ASCM).
Dr. Zipursky: I am currently a clinical associate in Internal Medicine and Clinical Pharmacology and Toxicology at Sunnybrook Health Sciences Centre and the Sinai Health System. The majority of my time is devoted to graduate courses and research related to my PhD. My clinical work is mainly comprised of team medicine (CTU), the medical consult service, and outpatient general medicine clinics. I also work as a consultant on the Clinical Pharmacology and Toxicology service at Sunnybrook seeing cases related to adverse drug reactions, drug-drug interactions, and medical toxicology. I get to teach trainees while on service, and do formal clinical pharmacology and toxicology teaching at Department of Medicine academic half days and hospital-based noon rounds.
What advice do you have for residents and fellows thinking about a clinical associate position?
Dr. Goldberg: My advice to graduating residents and fellows is to pursue clinical associate opportunities in fields that excite them and with colleagues who they strive to continue to work with and learn from.
Dr. Lefkowitz: Talk to the division directors and department heads about the needs of the institutions, and tell them you are thinking about doing work as a clinical associate. If they are looking for eager and talented newly-minted physicians to fill their schedules, then you might be their knight in shining armour. Think about where you might want to work long-term – working as a clinical associate is an excellent opportunity to collaborate with colleagues across the city and find out what practicing medicine is like at different hospitals.
Dr. Lysy: This is a fantastic opportunity for anyone who wants to pursue a postgraduate degree while continuing to see patients in an academic environment. It is a great way to start a clinical career while pursuing research or degree, or even trying to see if there is a particular area of your field that you want to develop expertise in. For me, this is has been a very positive experience. It is a great way to transition to a more permanent academic career or give yourself some time in practice to see in which direction you want to take your practice.
Dr. Quinn: The best piece of advice I received when I was considering coming on as a clinical associate was to think about how this role would facilitate my career, and to guard my time as if it were my life. It is easy to say yes to the multitude of exciting opportunities that come up in a place like U of T, but learning to say no is of paramount importance (and using your clinical mentors to say no for you is a very effective means!). My principle goal is to complete my PhD and to be successful in the research that I do. Clinical work can easily become a distraction, but finding the right balance between my clinical and academic work supports my long-term goal to become a leading clinician-scientist in my field of research.
Dr. Rush: Find a mentor – or better yet, more than more – as early as possible. Learn from everyone. There's a wealth of experience just waiting to be discovered in the Department of Medicine at U of T.
Dr. Stall: My advice is to ‘do your homework’ and ensure that your expectations for the role as a clinical associate (including the potential for future hiring) are commensurate with the division or department's expectations. Furthermore, think carefully about the type of clinical work you take on, especially if you are concurrently pursuing graduate training. Committing to a regular outpatient clinic may be difficult, and I have found that working around concentrated two-week blocks of inpatient attending is much easier to coordinate with my research activities.
Dr. Zipursky: I would highly recommend using the clinical associate position as a ‘bridge’ or transition while you pursue advanced training in research, teaching/education, leadership, and/or specific clinical skills. The position allows for flexibility early on in one’s career in order to devote time to building an academic portfolio prior to taking on a faculty position.
