A Letter to Today’s Academic Generalist Mentor

Mentorship in academic medicine is associated with promotion, scholarly productivity, and career satisfaction.¹ We recently surveyed our Division of General Internal Medicine (DGIM) faculty on mentorship experiences, preferences, and barriers as a needs assessment for our mentorship program. We presented our findings at the 2023 Society of General Internal Medicine Annual Meeting.² The literature review informing the survey revealed an unexpected gem: a survey of mentorship needs performed by our DGIM colleagues more than 20 years ago.³ Differing survey methods prevent a direct comparison of survey results, but discovering our colleagues’ prior work on mentorship offered an opportunity for reflection: how has mentorship for Academic Generalists changed in 20 years?

The 2023 authors invited the 2003 authors to discuss what has changed in faculty mentorship since their work published. We referred to our latest survey results for comparison and discussion. Despite the informality of our conversation, several cohesive themes emerged: the profound (and unpredictable) changes in the clinical work of academic generalists, the diversification of non-clinical opportunities for academic faculty, a broadened perspective of what mentorship means, the persistence of inequities in advancement and promotion, and a growing recognition of the desire of junior faculty to derive meaning and satisfaction from work. We share these reflections with the hope that they will stimulate further conversations on the state of mentorship in academic GIM.

The scope of what it means to be an “academic generalist” has evolved over the past 20 years. Since Chew et al. described their findings on the junior clinician-educator mentorship needs, our division has seen enormous growth, especially in the proportion of full-time clinical faculty, who spend most of their time in patient care and clinical teaching rather than scholarship or research. This trend is also seen nationally across academic medical centers. Clinical GIM faculty are not subject to publication requirements and may have more freedom to develop innovative niches and focus on filling critical roles in quality improvement and patient safety, transitions of care, education, and diversity, equity, and inclusion. The demands of the clinical workload have also changed due to increased asynchronous work with the electronic medical record, greater emphasis on RVUs, and higher need to maximize access to care. Consequently, many senior faculty feel ill-equipped to mentor the growing numbers of this new phenotype of academic generalists, or even understand what their mentorship needs are.⁴

We believe that mentors 20 years ago were considerate of career satisfaction, and that junior faculty were interested in meaning and satisfaction. Nevertheless, reflecting on the past 20 years, it seems to us that junior faculty are more willing to express the importance of meaning and satisfaction in their work and to eschew traditional metrics of success.⁵ In 2003, incoming junior faculty were paired with mentors with the implicit objective of focusing on achieving goals for promotion. The expected outcome of successful mentorship was publication, which was expected to lead to eventual promotion. Promotion was expected to result in job satisfaction. In 2023, the word mentorship connotes a much broader function; mentors may be asked for guidance on projects, reflection on the pursuit of job satisfaction, help to decide which opportunities to pursue, and advice on work/life balance.⁵

Therefore, it is not surprising that the contemporary understanding of mentorship is more expansive than a traditional dyadic relationship between a more experienced mentor and the protégé mentee. Twenty years ago, the authors already suspected that linking senior and junior faculty would be insufficient to meet the career needs of all junior faculty across academic tracks.³ Now, it is widely appreciated that effective mentorship must take many forms and include many variations including coaching, sponsoring, and advising—qualities we hoped would organically evolve when mentees worked with their professional mentors. Furthermore, there is greater awareness of the benefits of employing a variety of mentorship structures, including mentorship networks (or “committees”), peer mentors, and connectors to support varied career paths.

In 2023, women are still more likely to report ineffective mentoring compared to men.^{1, 3} The authors of the 2003 report joined an increasing number of mid-career women faculty and women in leadership positions; yet, the progression of a generation of women faculty has not sealed the “leaky pipeline.” Women now represent nearly half of medical school graduates; however, only 21% of full professors and 18% of department chairs are women.1 Women who have risen through the ranks carry a significant “gender tax”—the expectation that they will be the primary source of mentorship for a growing number of junior women faculty. Addressing these gender differences in mentorship is crucial for improving equity in advancement and promotion.

Despite a steady increase in racial and ethnic minoritized populations in the United States, our Division does not reflect local or national diversity. At the time of their publication, the authors of the 2003 report were two of a handful of racial and ethnic minoritized faculty in our Division. Their mentorship assessment did not examine underrepresented in medicine (URiM) or minoritized junior clinician-educator perspectives. In our recent survey, only 6% of Division respondents self-identified as URiM and only 18% of faculty identified as minoritized, not underrepresented. Nearly all URiM faculty and more than half of minoritized, not underrepresented, faculty are full-time clinical faculty—the promotion track most lacking in mentorship. What has changed in 20 years? We now appreciate that intentional efforts to support mentorship and sponsorship specifically for minoritized faculty and across all identities are needed for our Division to represent and serve our entire community.

Based on these reflections, we propose four principles for future work in developing mentorship programs in Academic GIM:

• We must dispose of the notion that “mentorship” today should uphold the same process and outcomes of 20 years ago, or that these processes and outcomes should remain the most valued today.
• We must learn how to support this generation of academic generalists. Relying on traditional mentorship structures is inadequate. Mentors may need to learn or re-learn how to mentor, coach, and sponsor through active skill development.
• We should focus on what outcomes faculty are trying to achieve and how to best achieve them instead of settling on “lack of mentorship” as the foil for all types of career dissatisfaction.
• We should examine whether the “scholarship” imperative that mentorship was meant to support 20 years ago is still relevant today and consider more expansive definitions of scholarly work. Will it make the world a better or worse place if academic generalists are more fulfilled, more impactful, more oriented to serving their communities … but with fewer peer-reviewed publications?

The landscape of General Internal Medicine has changed greatly in the past 20 years. Mentorship and mentors must also evolve to support successful career development for the next generation of academic generalists.

Acknowledgements: The authors would like to thank Dr. Geetanjali Chander for her review of the article as well as Drs. Helene Starks, Paul Cornia, and Lauge Sokol-Hessner for their work on the 2022 mentorship survey.