Jayshil J. Patel, MD; Michael J. Malinowski, MD; Manpreet S. Mundi, MD
WMJ. 2026;125(3):333. Published August 11, 2026.
To the Editor:
Aziz and Jarjour’s editorial, “When Everything Matters: Choosing What Truly Counts in Academic Medicine,” offers thoughtful guidance for academic physicians navigating increasingly complex professional lives.1 Their call for intentionality, prioritization, and aligning one’s work with a deeper sense of purpose will resonate with many faculty members.
We agree that academic physicians benefit from clarity about their “big rocks.” However, the essay largely frames the problem as one of individual choice. Many faculty are not overextended because they have failed to define what matters. The decision to pursue academic medicine reflects what matters most: generating and disseminating knowledge, educating future generations, and improving patient care.2 Rather, many are overextended by institutional expectations that exceed the limits of time, energy, and human attention.
Patient care is a clear example. Academic physicians are increasingly expected to maintain clinical productivity comparable to private practice colleagues while simultaneously fulfilling academic responsibilities. Yet much of modern care occurs outside traditional productivity measures through documentation, inbox management, patient messages, and regulatory requirements. A hospital-wide survey found that academic physicians spent 24% of working hours on patient-related administrative duties, with two-thirds reporting negative effects on their ability to deliver high-quality care.3 Much of this work remains difficult to measure but not difficult to feel.
The same is true for academic work. Teaching, mentorship, scholarship, program development, quality improvement, committee service, and contributions to professional organizations require substantial time and effort. Service contributions have been described as invisible labor that is systematically undervalued relative to research metrics such as citation indices.4 Despite progress in recognizing clinician-educator contributions, inconsistencies remain in how academic work is valued and rewarded.5 Scholarship often comes at the expense of personal time, as academic structures continue to reward work performed outside standard working hours.5
The familiar image of a jar filled with rocks, pebbles, and sand remains useful, but perhaps it no longer fully captures modern academic medicine. The jar itself has become larger and heavier. New expectations, expanding clinical demands, administrative responsibilities, and electronic work have enlarged the jar while leaving unchanged the finite hours available to fill it.
Clarity remains necessary. But clarity alone cannot solve problems created by misaligned incentives, insufficient protected time, and growing clinical and administrative demands. Perhaps the next question for academic medicine is why so many talented physicians struggle to devote time to what matters most…and whether we have designed the jar wisely in the first place.
REFERENCES
- Aziz F, Jarjour N. When everything matters: choosing what truly counts in academic medicine. WMJ. 2026;125(2):235-236.
- Bradley EA, Winchester D, Alfonso CE, et al. Physician wellness in academic cardiovascular medicine: a scientific statement from the American Heart Association. Circulation. 2022;146(16):e229-e241. doi:10.1161/CIR.0000000000001093
- Rao SK, Kimball AB, Lehrhoff SR, et al. The impact of administrative burden on academic physicians: results of a hospital-wide physician survey. Acad Med. 2017;92(2):237-243. doi:10.1097/ACM. 0000000000001461
- Mannix R, Bell MJ. Elevating service in academic medicine: the S-index. JAMA. 2025;334;(19):1707-1708. doi:10.1001/jama.2025.17221
- Chang A, Karani R, Dhaliwal G. Mission critical: reimagining promotion for clinician-educators. J Gen Intern Med. 2023;38(3):789-792. doi:10.1007/s11606-022-07969-5