Maxims And Birdhouses

For the past day or two I’ve been trying to remember who wrote an article with the word “maxims” in the title. I finally recalled “Simone’s Maxims.” The full title is “Understanding Academic Medical Centers: Simone’s Maxims.” I don’t recall how or why I first found this paper about the academic medical organizational culture by Dr. Joseph V. Simone, MD. However, it might have been during one of my two attempts to move from my Clinical Track faculty position in academia to private practice.

The first time, I left for Illinois. Colleagues and residents threw a little party. The chairman of the department at the time was Dr. Robert G. Robinson, MD, a powerhouse researcher, who gave me a birdhouse as a going away gift. At around that time, I was becoming immersed in consultation-liaison psychiatry and was rapidly forgetting one of my favorite pastimes–birding.

I’ve never used the birdhouse because it’s a work of art. I never bothered to look up the artist, Al Buss, until yesterday if you can believe it. He’s a craftsman in Wisconsin (did that presage the next departure?) who makes a variety of items in addition to birdhouses.

They gave me a little memory book in which they wrote very kind things. Dr. Russell Noyes, MD, who was a leader in many ways in the department and who also led the consultation service, wrote “You are the consummate consultation-liaison psychiatrist…” I’ve treasured that my entire career though I’ve always doubted I deserved it. I still have the book, the cover of which features a person crossing a footbridge spanning a wide river.

You’d think I’d learned my lesson when I returned a short time later. But I had not; I left again, this time crossing the bridge to Wisconsin. I was back again in short order. Dr. Simone is right about greener pastures. They’re not always as green as they look.

Although I cringe now when I think about those episodes in my career, I have to acknowledge that Dr. Simone’s remarks were right on target, and not just regarding job changes. He has spent most of his career improving cancer care for children. However, he once described himself in modest terms, not exactly as a “spear carrier” although not as a brilliant star either–which he certainly is.

I still think Simone’s Maxims are a more or less accurate description of academic medicine. I have not yet purchased the updated version in book form, Simone’s Maxims Updated and Expanded: Understanding Academic Medical Centers, published in 2012. The 160 page volume is just $15.

The maxims also remind me of my position as noted above, within the Clinical Track which is how the clinician-educator track has been identified at The University of Iowa. Dr. Simone obviously had in mind only the Tenure Track research scientist, which has in the past frequently been compared to the Clinical Track–with the latter not faring so well in the comparison. I don’t know what he would think about that issue. Maybe he mentions it in his book.

Historically at Iowa, I recall being perhaps the second Clinical Track faculty member hired in the mid-1990s although I could find one paper describing the role having its beginnings in the mid-1980s. This post is anything but a scholarly piece, but I found a little over twenty papers in PubMed using the search term “clinician educator.” I had thought about making this post more academic than it is turning out to be, which is more of a reminiscence.

That’s probably what it should be for a retiring academic psychiatrist. Maybe Dr. Simone would agree.

For now it’s enough to point out that the conflict between Clinical and Tenure Tracks is probably not the burning issue it was when I began my career. Nowadays, the literature is marked by papers describing ways to strengthen the role of clinician educators within academic medical centers and the attitude is hopeful. Many authors repeat the same advice, which is that being and finding a mentor is critical to the success of the next generation of doctors.


Simone, J. V. (1999). “Understanding Academic Medical Centers: Simone’s Maxims.” Clinical Cancer Research 5(9): 2281-2285.

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