Author + information
- Arthur J. Moss, MD∗ ()
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
- ↵∗Address for correspondence:
Dr. Arthur J. Moss, Department of Medicine, Division of Cardiology, University of Rochester Medical Center, 265 Crittenden Boulevard, CU 420653, Rochester, New York 14642-0653.
In general, practicing physicians, including clinical cardiologists, end their clinical patient-care responsibilities when they are about 70 years of age, although some practicing physicians, especially surgeons, end their patient care responsibilities at an even younger age. Very little has been written about the academic clinical investigator and the duration of his/her research activity with aging. In general, the clinical researcher is allowed to continue academic work with pay so long as he/she is able to obtain research funding and continues to make contributions to the investigative field. I graduated from medical school in 1957 just before the rapid advances in clinical cardiology took place, and I have been involved in academic clinical research throughout my professional career. There are a number of challenges in continuing an academic clinical investigative career in one’s senior years that are rarely touched upon, and this topic will be discussed in this brief communication.
Physical and Mental Health
Aging can cause one’s physical mobility to be compromised in various degrees by any of a number of benign conditions, such as spinal-disc disorders, imbalance conditions, and so on, that do not involve a compromise of intellectual function. The relatively benign physical mobility disorders can compromise one’s ability to attend various professional meetings in the hospital and at a national or international specialty get-together. Serious compromise of one’s intellectual function for any of a variety of reasons, mainly cerebral vascular disease and Alzheimer’s disease, is a cause for ending one’s professional academic activities. Frequently, the physician-investigator is not aware of being limited, but colleagues may be the first to recognize the intellectual dysfunction in day-to-day interactions. The intellectual compromise may initially be subtle, but the intellectual limitations usually progress with further aging. Academic clinical investigators should be evaluated at yearly intervals by qualified physicians for evidence of any findings of dementia. Such yearly mental evaluations should be forwarded to the chief of medicine or an equivalent senior academic hospital administrator to be sure the aging investigator is fully competent to carry on his/her research career.
Much has been written about senior faculty mentoring of junior faculty, fellows, and medical students (1). It is standard practice for the senior physician to help junior colleagues in choosing a career direction, to provide networking opportunities, and to assist in selecting a research topic for investigation and in the specifics of the research studies, if the mentee is so interested. However, when there is a research group involving associate professors and professors who are devoting a good portion of their time to academic clinical research, the senior aging investigative professor needs to be careful not to usurp the innovative and creative activities of the faculty who will take over when he/she retires or dies. The field of investigation continually grows and takes on new directions that mostly involve the interests of the next generation of academic research faculty. At various institutions, I have frequently seen an aging academic professor dominate the investigative activities of the research group such that innovative and new research ideas do not mature, and growth is stagnant when the senior aging investigator departs.
Contributions to the Field by the Senior Physician
How does the aging senior physician continue to be involved in research activities without dominating upcoming faculty within his/her own institution? Collaboration with senior investigators from other institutions with whom one has worked previously in important areas of research is an excellent way to remain involved. I have had the good fortune of doing this, and it has been personally very rewarding. For example, I have collaborated with Dr. Frank Marcus, who is in my age range and very actively involved in clinical research, and we have worked together on inherited cardiac arrhythmia studies (2–4). In addition, we have written a joint editorial related to changing times in cardiovascular publications (5). In a similar way, I have worked with Drs. Helmut Klein and Stephen Heilman, both close to my age, on developing and testing the wearable defibrillator. I have also remained involved in leading our Multicenter Research Group, in which several members are in my age range, and we have continued to initiate and conduct randomized clinical studies and trials (6).
It is not very difficult to keep up with the specialty clinical research with utilization of Internet correspondence, Endnote, and access to the affiliated university medical school library for relevant full-content medical journal papers. There is certainly more medical cardiology data than one can review, so one has to be selective in one’s focus.
Before 1970, clinical research involved clinical medical reports that described a clinical disease entity. In addition, the leaders in the field wrote definitive clinical cardiology text books, mostly single authored, primarily describing clinical cardiovascular disorders: Heart Disease (1931) by Dr. Paul Dudley White, Clinical Heart Disease (1936) by Dr. Samuel A. Levine, Diseases of the Heart (1949) by Dr. Charles K. Friedberg, and Diseases of the Heart and Circulation (1950) by Dr. Paul Wood, to name a few of the more prominent earlier textbooks.
Since 1970, cardiology clinical research has exploded with randomized drug, device, diagnostic, and interventional clinical trials, often with involvement of basic scientists, that dramatically improved management of patients with hypertension, hypercholesterolemia, coronary heart disease, cardiomyopathy, heart block, risk of sudden cardiac death, heart failure, congenital heart disease, and genetic cardiac channelopathies. The field was advanced with increased cardiology research funding from the National Heart, Lung, and Blood Institute and by involvement of corporate pharmaceutical and device companies. During the past 50 years, leadership in cardiology has been dominated by editor-in-chiefs and the editorial board members of the major cardiology journals (including the JACC, Circulation, and European Heart Journal families), or by involvement in multiedited textbooks such as Braunwald’s Heart Diseases: A Textbook of Cardiovascular Medicine (1980) and Hurst’s The Heart (1966). These definitive cardiology textbooks are now in their 10th (2015) and 14th (2017) editions, respectively; these books are coedited by several distinguished cardiologists as well as by Dr. Braunwald and Dr. Fuster, respectively. These books, the established cardiology journals, and my ongoing research interactions with long-term investigative colleagues have helped me remain current and up to date in a broad array of relevant cardiology topics that are fundamental for continuing my clinical research involvement and activities during my senior years.
- 2017 American College of Cardiology Foundation
- Marcus F.I.
- Wilde A.A.,
- Moss A.J.,
- Kaufman E.S.,
- et al.
- Brun F.,
- Groeneweg J.A.,
- Gear K.,
- et al.
- Moss A.J.,
- Marcus F.I.
- Moss A.J.