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Academic medicine: who is it for?
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     EDITOR—Abbasi's four pillars of academic medicine—research, implementation of evidence, teaching, and improved delivery of healthcare—correspond closely with my perception of academic medicine as it was when I took up my first academic post 20 years ago.1 As a result, to be a clinical academic was regarded as a privilege. What's more, for those who made the grade, it was enjoyable.

    But, at least for the United Kingdom, Abbasi has the tense of the verb wrong when he says that this is what academic medicine is about. It was, but no more. The two pillars of academic medicine are now getting large research grants and publishing papers in journals with a high impact factor. These two may or may not be relevant to his first pillar, but they are pretty irrelevant to the other three. For example, teaching is devalued unless it is turned into an academic specialty in its own right, spawning educationalists who have research grants and publish papers on teaching. Actually doing the teaching is of far lower value.

    How can these new two pillars be made to support all four of Abbasi's pillars? I don't know. So I have recently and with great sadness abandoned a 20-year academic career for a substantive NHS post, and I know of many colleagues who are doing or at least contemplating doing the same.

    All the talk about improving recruitment to academic medicine is completely pointless unless these issues are addressed and being a clinical academic once again becomes a privilege, and fun. There was no shortage of bright, keen applicants for academic posts when I was newly qualified. But at that time, academic medicine had Abbasi's four pillars, not just the two of the research assessment exercise.

    Peter N Furness, consultant histopathologist

    Leicester General Hospital, Leicester LE5 4PW pnf1@le.ac.uk

    Competing interests: None declared.

    References

    Abbasi K. Editor's choice. The four pillars of global academic medicine. BMJ 2004; 329. (2 October.)