Academic medicine already has effective tools for career development.

We have coaching models that work. Faculty development strategies with real evidence behind them. Clear data showing improvements in productivity, engagement, research output, and retention when support is structured and sustained.

And yet, most faculty never use these tools.

Not because they are ineffective.
Because of how we have positioned them.

In many departments, coaching still sits on the margins. It is accessed quietly, often late, and usually in response to a visible problem. Over time, that framing has created an unintended signal: coaching is for remediation, not growth.

As a result, some of the most powerful career-building resources in academic medicine remain underused, especially by high-performing faculty who assume they should already have things figured out.

Why Career Progress Stalls Even When the Work Is Strong

Careers rarely stall because people are not working hard enough.

They stall because the system assumes faculty will intuit a path that is rarely made explicit.

Most physicians are trained to say yes, show up, and deliver. I know that I was. 

And, early success reinforces this. Reliability is rewarded. Visibility increases. Requests multiply. Without a strategy, effort spreads.

Career development exists. BUT, the stigma around using it limits access.

When coaching is framed as a corrective measure, people delay it until they feel stuck. 

When coaching and faculty development are framed as infrastructure, people use it while growth is still flexible.

Why This Matters More Than We Admit

We all know that academic medicine is not a neutral environment.

Clinical work is urgent and visible. Teaching and service are socially reinforced. Research, leadership development, and reputation-building require long time horizons and protected attention.

Without structure:

• Reactive work crowds out strategic work.
• Faculty overprepare and overcommit to compensate for ambiguity.
• Promotion criteria feel vague until it is almost too late.
• Burnout is mislabeled as a personal resilience issue.

And faculty and departments absorb the downstream effects that include longer promotion timelines, increased attrition and watching some of the best leaders (or future leaders) walk out the door.  This reinforces the idea that faculty development programs and coaching are useful as reactive tools rather than strategies for intentional and proactive faculty management.

This is not a talent problem.
It is a design problem.

What Changes When Career Development Is Built In

When career development is treated as infrastructure, behavior shifts without forcing it.

Faculty gain shared language and clearer expectations. Decision-making improves. Coaching becomes a normal part of growth rather than a signal of trouble.

The most consistent changes look like this:

• Faculty evaluate opportunities based on alignment, not guilt.
• Time decisions are made with context, not panic.
• Career conversations happen earlier, when adjustment is easier.
• Coaching is used to prevent problems, not clean them up.

Not everyone receives the same input. This is personalized to your goals and challenges and systems.
However, everyone does operate within the same deliberate structure.

That distinction matters.

Different Career Stages. Different Problems. Same System.

One reason this approach works is that it respects how careers actually evolve.

Early-career faculty need systems for time, clinical efficiency, research integration, and boundary setting.

Mid-career faculty need clarity around what to stop, what still matters, and where to focus next.

Senior faculty and leaders need support navigating people management, influence, and legacy.

Treating coaching as remediation ignores this reality. Treating it as infrastructure aligns with it.

A Real Example of What Changes

One mid-career faculty member I worked with had done everything she was supposed to do. Grants. Committees. Teaching awards. She was respected across her division and routinely described as the “research engine.” And she was exhausted.

Funding felt elusive despite constant productivity. She had asked for a medical director role and been told no. Not because she lacked credibility, but because leadership already relied on her to keep the research work moving without formal authority or protected time.

She was mentoring students, teaching residents, submitting grants, and holding together multiple projects that depended largely on her after-hours effort. Much of the intellectual load of running the research program lived in her head. She began to wonder whether continuing to hope for the next big grant was enough to justify the time, energy, and mental bandwidth the work required.

When we stepped back and did structured career work, something important became clear. She did love the research. It aligned deeply with her values and the kind of academic life she wanted. The issue was not disinterest or burnout from the work itself.

The issue was misalignment.

Her effort was scattered across too many projects. Her national reputation was being leveraged without corresponding structure or support. The department benefited from her productivity, but the way the work was organized made it unsustainable and joyless.

Once that misalignment was visible, the work changed. Not because she worked less hard, but because she worked with intention. Projects were consolidated. Expectations were clarified. Boundaries were named. The research became something she could enjoy again, rather than something she carried alone.

Nothing about her capability changed.
What changed was how the work fit into her life and values.

The Financial Reality Departments Often Avoid

The math here is not subtle.

• Coaching a faculty member is relatively inexpensive 
• Losing a faculty member is extraordinarily costly (estimate at 1.5 to 2x annual salary)

Turnover brings:

• Recruitment and onboarding expenses
• Lost clinical revenue
• Disrupted research programs
• Increased workload on remaining faculty
• Cultural instability that compounds future attrition

Against that backdrop, structured career development is not generous.
It is rational.

The Mindset Shift That Actually Matters

This is not about working harder.
It is about working with a roadmap most of us were never given.

When departments invest in career development as infrastructure, they stop relying on individual heroics. They design environments where talented people can grow, contribute, and stay.

That is not generosity.
It is good systems design.

What to Do Now

• Listen to the podcast where I expand on how career strategy changes when development is built into the system.
• Talk to your department about Departmental Coaching (Check out the FERI program - www.medicalmentorcoaching.com/FERI