During a year when frontline healthcare providers have seen excessive trauma and loss, taking care of patients has never seemed so vital. But despite the importance of patient care during the COVID-19 pandemic, practitioners who work solely in clinical settings say that their work is often not as valued as research.
Jennifer Leah Goetz, MD, a psychiatrist at Johns Hopkins School of Medicine in Baltimore, who cares primarily for adolescents with eating disorders, shared a tweet this week that sparked discussion around a long-standing issue: the value of patient care in academic medicine.
"I 'just take care of patients,'" Goetz wrote on Twitter. "The sickest of the sick. I'm not publishing. I'm not giving talks. I'm doing my best to show up and give my all everyday on the psychiatric front lines."
"To those showing up with me, thank you," she continued. "I wish our work was as valued as others."
Goetz described an enduring sentiment among clinicians who primarily work in clinical care. Many feel that if they are not writing, publishing research, or presenting new findings -- they are less appreciated.
"Research is often the prize," Goetz said in an interview with MedPage Today. "The currency is sort of like, how many grants do you have, and how much money is being brought in for the institution."
Academic institutions have three primary missions, Goetz said: patient care, teaching, and research. All three are important, but patient care and teaching are often underappreciated because institutions expect that they will happen.
"I think that there's a lot of feeling that, especially in academic medicine, people who solely focus on clinical care can be at times overlooked and underappreciated," said Gavin Harris, MD, an assistant professor of medicine at Emory University in Atlanta.
He added that the sentiment that clinical providers are "just taking care of patients" is troubling. "That word 'just' is a little bit unsettling, because taking care of patients is the art of medicine."
Harris told MedPage Today that feeling overlooked can stem from several things, including the fact that clinical care does not generate a lot of revenue for academic centers and hospitals. Research, on the other hand, produces not only funding but also greater visibility for institutions when their clinicians publish breakthrough findings.
"Traditionally, institutions have looked to clinician researchers, who may not be spending that much time at patients' bedsides, but in laboratories," Harris said. Clinicians who provide patient care, he added, are often essential to an institution's research goals, as they provide a unique, on-the-ground perspective.
Goetz said that it is critical to remember why clinicians do research in the first place.
"Without patient care, without people doing the work on the front lines everyday, there is no one to translate the research," she said. "The research is great, but without a clinical setting to translate it into, it's irrelevant."
"It's not to say that clinical work isn't valued," Goetz added. "My wish is that there is more balance in how we value -- in academics and other places -- the three very important missions of teaching hospitals: education, research, and clinical care."
A way to acknowledge clinical work, Goetz said, is to change how promotions are granted. Traditionally, physicians are promoted based on publications and grants. But some facilities are adding a clinical educator track, advancing physicians based on their clinical and teaching work, which could spark cultural change.
Harris said that in times when he feels like he is not publishing enough or doing enough interviews, he remembers what he loves most about medicine: working with patients.
"It's a tremendous feeling when you are able to discharge or transfer a patient out of the ICU who has had COVID, or even before the pandemic when a very sick patient improves," he said. "It's at points like that when, yes, you might not always be appreciated by, say, the flash of the news. But you're appreciated by the patient because of how you made them feel."