In the past, academicians had an opportunity to take a periodic break from their ongoing responsibilities of teaching and research in order to refresh their thought process. Faculty of a certain rank or tenure could elect to take an extended leave of absence to fulfill some laudatory goal, in an interval known as a sabbatical.
The concept of a sabbatical is several thousand years old. It stems originally from an agricultural practice that required workers to take a year off from tending the fields once every seven years. The goal was to create a period of cognitive and emotional cleansing, which would result in revitalization of one’s career goals and life purpose.
Sabbaticals are not intended to be vacations. Those taking sabbaticals are often paid (in part or in full) with the intent that — when they return — they will have fresh energy, ideas, and dedication to their work.
So what does one do during their sabbatical in order to merit this incredible privilege?
Sometimes people travel to another laboratory to learn new methods. Many spend the time reading and writing, leading often to the publication of a book. A few give something back to society in underserved regions of the world.
Have I ever taken a sabbatical? From the time I entered academic medicine in 1978 until my move to Dallas in 2004, I worked continuously for 26 years in the discipline of heart failure. I was very proud to have built two major programs (one at Mount Sinai and one at Columbia, both in New York City), which helped to redefine the pathophysiology of heart failure, and led to major international trials of innovative new drugs. For a quarter-century, there had been no sabbatical.
Yet, at the peak of my career, I found myself doing the same thing year after year. I spent more time doing things than thinking about them. That bothered me. But most importantly, I needed to support my wife’s career.
In 2004, the opportunity for change came when my wife accepted a position at the University of Texas Southwestern Medical School in Dallas. I was the trailing spouse, but the school’s dean at the time, Dr. Robert Alpern, was motivated to find something special for me to do.
An obvious solution was to join the Division of Cardiology. But cardiology had excellent leadership, and Dr. Mark Drazner had already established an extraordinary heart failure program.
Furthermore, I had already been a division chief for 12 years, and I was ready for my next challenge. So Bob Alpern made a unique proposal. How about if you became a department chair? Would you want to do that?
I had honestly never thought that being a department chair would be a lot of fun. It sounded like a lot of unhappy administrative work, and my strengths lie in building new things rather than overseeing an existing structure. Additionally, the school already had outstanding leadership in the Department of Medicine. The legendary Dr. Daniel Foster had been chair for 16 years.
Bob Alpern’s proposal: You know how to develop clinical investigators in cardiology. What if you did that across all fields of medicine? The school could create a new department for you, and you could build it from scratch. You could do what you do best, but on a grander scale.
In a few months, Bob and I created a plan for a new Department of Clinical Sciences. Its mission: to develop and promote the careers of clinical investigators across all disciplines in medicine, including nursing and pharmacy. The faculty of the department would consist of both clinical investigators as well as experts in methodological sciences (biostatistics, epidemiology, behavioral sciences). Most of the faculty in the new department would be PhDs, and thus, the enterprise was classified as a basic science department.
What an extraordinary challenge! Could I do this? I had a deep commitment to methodological excellence, and I had learned a great deal in my role as a clinical trialist from many great biostatisticians who had served (and continue to serve) as my mentors.
But I had no idea what it meant to be the chair of a basic science department. I did not know how to promote the careers of PhD faculty. I had a vision and energy, but I needed resources to build the enterprise. These were not going to come only from the school. I needed to compete for extramural grants in a wide range of disciplines outside of cardiology.
On July 1, 2004, I started with a faculty of one: me.
When Dr. Al Gilman became dean shortly after my arrival, he embraced what I was planning to do, and made a substantial commitment to the new department.
Over the next 11 years, I recruited the best and brightest. I wrote dozens of NIH grants, and fortunately, most were funded. After more than a decade, the Department of Clinical Sciences had more than 70 people across a wide range of methodological disciplines. We were proud to acquire nearly $100 million in NIH grants on behalf of our own faculty and for faculty members throughout the school. We trained several hundred new clinical investigators across internal medicine, surgery, obstetrics, psychiatry, pediatrics, and many other disciplines, who successfully competed for grants in their own right.
We established a new curriculum, a new degree program, and a new culture. We protected the time of young investigators and faculty for research. To do so, I personally spent 100-150 hours a year in direct classroom teaching. And I mentored more than 40 faculty members each year.
The effort consumed my professional life. To be successful as a new department chair, there was no possibility of continuing my research activities in cardiology. My involvement in cardiovascular trials greatly diminished. I wrote continuously, but I wrote grants rather than peer-reviewed papers, and they were not focused on cardiology. I had little time to go to cardiology meetings.
In deciding to become a department chair, I had to shift my focus — away from my dedication to a research career — to assume the responsibilities of institutional leadership. It was a different world.
A decade later, the work of building the department was complete. The opportunities for rapid growth had diminished; the goal was to maintain its success. But I am not particularly wired for maintenance.
And I really missed my research career. I missed the excitement of cardiology and my commitment to the discipline of heart failure. I was ready to go back — but I needed a trigger.
The opportunity to return to cardiology presented itself in August 2014. With the success of the PARADIGM-HF trial, I made my first presentation at an international meeting in a decade. It was exhilarating. Memories about my career in heart failure flooded my brain. And I fell in love with cardiology all over again.
It was time to go back to my roots. It was time to start writing papers and leading large-scale clinical trials. It was time to come up with fresh ideas and introduce new frameworks of thinking. It was time to challenge conventional wisdom — just as I had done before.
In 2015, I stepped down as department chair, and I moved to Baylor University Medical Center (to my current appointment as distinguished scholar in cardiovascular science) to devote my full-time efforts (once again) to heart failure research.
In essence, I had taken an 11-year sabbatical from cardiology.
Was this 11-year hiatus a good idea? It was a wonderful idea, and it was an amazing experience.
After eleven years, I had a different perspective on medicine. I had learned so much about developing the careers of young investigators. I also understood the level of personal commitment that was required to effect change. If you really want to make a difference, you need to really fully immerse yourself in your determination to make a difference in the world.
Some people can take on institutional leadership positions and, at the same time, effect meaningful change in their research discipline. I am not one of them. To me, each requires a full-court press, an undiluted work ethic, and a total cognitive and emotional commitment.
After an 11-year sabbatical, I returned to cardiology with an entirely different vision for the field of heart failure. For the last 4 years, I have been writing constantly, but now, I am back to writing papers, rather than writing grants. I have returned to my love for debating new concepts and evidence at national and international meetings. I have renewed and strengthened relationships with friends whom I have known for 30 years or more. And I have made many new friends, and now, serve as a mentor to an even larger group of young, middle, and late-career investigators.
Fifteen years ago, I changed my professional life to support my wife in her career. The experience renewed my spirit, but it also reminded me how much I missed being home.
Packer recently consulted for Actavis, Akcea, Amgen, AstraZeneca, Boehringer Ingelheim, Cardiorentis, Daiichi Sankyo, Gilead, J&J, Novo Nordisk, Pfizer, Sanofi, Synthetic Biologics, and Takeda. He chairs the EMPEROR Executive Committee for trials of empagliflozin for the treatment of heart failure. He was previously the co-PI of the PARADIGM-HF trial and serves on the Steering Committee of the PARAGON-HF trial, but has no financial relationship with Novartis.