Addressing the "Global Health Tax" and "Wild Cards": Practical Challenges to Building Academic Careers in Global Health

Abstract

Among many possible benefits, global health efforts can expand the skills and experience of U.S. clinicians, improve health for communities in need, and generate innovations in care delivery with relevance everywhere. Yet, despite high rates of interest among students and medical trainees to include global health opportunities in their training, there is still no clear understanding of how this interest will translate into viable and sustained global health careers after graduation. Building on a growing conversation about how to support careers in academic global health, this Perspective describes the practical challenges faced by physicians pursuing these careers after they complete training. Writing from their perspective as junior faculty at one U.S. academic health center with a dedicated focus on global health training, the authors describe a number of practical issues they have found to be critical both for their own career development and for the advice they provide their mentees. With a particular emphasis on the financial, personal, professional, and logistical challenges that young "expat" global health physicians in academic institutions face, they underscore the importance of finding ways to support these career paths, and propose possible solutions. Such investments would not only respond to the rational and moral imperatives of global health work and advance the mission of improving human health but also help to fully leverage the potential of what is already an unprecedented movement within academic medicine.

Figure 1

Graphic representation of an “expat” academic global health career. In the idealized traditional academic career, effort is commensurate with financial compensation via a full-time equivalency (FTE) contract, whereas in the expat academic global health career, effort is similar to that of other colleagues in academic medicine, but there is a gap in compensation generated by uncompensated work or unmet earning potential. The bars representing compensation show the proportion provided by each type of effort; where the traditional career’s compensation bar is clearly divided between majority and minority efforts because of the opportunities offered by compensated research, teaching, or administrative efforts, the expat career is often less clearly structured. As a result, the global health physician often needs to negotiate more variables and face greater uncertainty, and therefore is more prone to their career path being derailed by the listed “wild cards” (life challenges).

Figure 2

One of many possible “expat” academic global health career trajectories. Across the span of a global health career, professional activities can oscillate between domestic work and work abroad. The line represents one such pathway over time, showing how a sample physician transitioned from education to work abroad early in the career and back to domestic work as family-related responsibilities grew. This is not an idealized pathway, and physicians may follow many trajectories as they work to balance professional and personal opportunities with factors that enable them to achieve their goals and fulfill their responsibilities. The authors question how other career trajectories might be made possible.