For much of the 20th century, the academic medicine ideal was clear: a physician-researcher supported by NIH grants, publishing in high-impact journals, climbing a predictable ladder of assistant to associate to full professor. Research was formal, structured, and often slow. Productivity was measured in citations, and prestige came from peer-reviewed work and institutional affiliation. But that model no longer holds uncontested sway.
Academic medicine is undergoing a radical democratization driven by falling public research funding, the proliferation of alternative modes of scholarly communication, and the transformative influence of artificial intelligence (which, yes, did help me proofread this article). In this evolving landscape, junior faculty, clinicians, and nontraditional scholars can exert as much influence as tenured researchers with decades of conventional output. In some cases, they might even have more influence than their established counterparts. While this may be frightening to some, this shift holds tremendous promise for medicine, opening the door to potentially more inclusive and important contributions.
One of the most fundamental shifts reshaping the field is the steady erosion of public funding for medical research. For early-career physician-scientists, securing federal grants has become an increasingly difficult proposition. Despite rising costs of research, paylines for National Institutes of Health grants have stagnated. A growing share of academic biomedical research is now funded by private industry, philanthropic foundations, or hospital systems.
This has placed early-career faculty in an untenable position: simultaneously expected to maintain traditional output metrics while navigating a funding environment that no longer supports the breadth of inquiry it once did.
In response, many scholars are shifting their efforts away from basic research and toward forms of work that are more nimble, applied, and aligned with public or institutional needs: quality improvement, medical education, policy translation, digital innovation. These domains, once seen as peripheral to “serious” scholarship, are now leading areas of intellectual activity and influence. Crucially, they often rely less on multiyear grant cycles and more on embedded, iterative collaboration with communities, learners, or systems. This makes academic medicine more responsive to real-world needs—enhancing its relevance and impact.
End the unchecked growth of publishing fees and the overreliance on unpaid peer review
Dissemination, too, has been transformed. Traditional scholarly communication once involved years of study followed by months of peer review, culminating in a print journal read by a small, specialized audience. That model has not disappeared, but it has been joined — perhaps even overshadowed — by new channels of communication that bypass many of the bottlenecks of the past. Preprints, open-access platforms, and digital repositories allow scholars to share findings rapidly and reach global audiences without delay. Many academic clinicians now write public essays, host podcasts, or publish educational videos that reach tens or hundreds of thousands of people. The walls between “ivory tower” and “real world” have become porous. I’d rather discuss addiction with Dax Shepard on “Armchair Expert” than present at a national meeting if given the option.
Social media, in particular, has become a platform for knowledge dissemination and professional influence. On platforms like X (formerly Twitter), a well-crafted thread summarizing a clinical trial, policy issue, or educational topic can receive tens of thousands of views and generate lively discussion across disciplines. These outputs are ephemeral and informal, yet often far more impactful than conventional publications. For scholars working on underrecognized topics — stigma in addiction (my field), health disparities, patient experience — digital channels offer a way to build community, share work, and drive change that traditional academic journals might not prioritize.
This evolution in communication has also challenged long-standing hierarchies. It is now common to see junior scholars with modest CVs but substantial digital followings shaping public discourse more effectively than senior faculty. Influence no longer correlates neatly with tenure or H-index. A single widely read article in a venue like STAT, the Atlantic, or a respected blog can shape clinical thinking or public opinion as much as a systematic review. A researcher who builds a well-used open-source tool or publishes an accessible explainer video may make a more immediate contribution to practice than one whose work resides behind paywalls. The value of academic medicine is increasingly being defined not just by scholarly production, but by reach, clarity, and utility. This evolution empowers a new generation of scholars to lead with ideas that travel, not just titles that impress.
Technological change, particularly the rise of artificial intelligence, is accelerating these trends. AI tools like large language models, predictive analytics engines, and code-assisting platforms are fundamentally altering how scholars think, work, and publish. A researcher with minimal programming experience can now use AI to analyze large datasets, generate summaries, and even draft sections of manuscripts. Time-consuming tasks like literature reviews, figure generation, and table formatting can be streamlined. AI doesn’t just make research faster — it changes the nature of inquiry itself.
Just as significantly, AI is enabling new forms of scholarship. Scholars are now building clinical prediction tools, chatbots for patient education, and AI-enhanced simulations for training. These outputs often live outside traditional publication models, existing instead as apps, GitHub repositories, or embedded modules within learning management systems. Their impact is measurable not in citations but in users, downloads, or behavioral change. As AI becomes further embedded in medical education, diagnosis, and population health, the definition of scholarly contribution will need to adapt accordingly.
Yet these opportunities also raise important questions. Who validates the quality of this new scholarship? How do we distinguish between genuine innovation and superficial engagement? What constitutes authorship when a model like ChatGPT contributes to a manuscript? Maintaining high standards of evidence, transparency, and peer accountability remains essential.
What emerges though is a redefined idea of the academic medicine scholar. Today’s scholar may be a clinician who builds open-access curricula, a researcher who curates a public-facing database, a student who leads an AI-driven health equity project, or a physician who writes essays connecting lived experience to public health. These contributions are not side projects — they are scholarship. They create knowledge, foster engagement, and drive systemic change.
Traditional forms of scholarship still matter. R01-funded research and New England Journal of Medicine publications remain critical for advancing scientific frontiers. But they are no longer the sole ways to make a meaningful impact. Instead, the most influential academic physicians today will be those who can integrate rigor with relevance, science with storytelling, and discovery with dissemination.
This shift is happening faster than institutional structures can accommodate. Promotion processes, still tied to older models of scholarship, often fail to capture the full range of meaningful contributions. Educators who build transformative curricula, clinicians who develop innovative digital tools, and policy scholars whose work influences legislation may find that their efforts are discounted if they do not result in conventional publications. Universities must catch up — not by lowering standards, but by modernizing them to reflect the real contours of impact in 2025 and beyond.
The academic medicine scholar is not disappearing. They are diversifying, adapting, and reasserting relevance in a world where speed, accessibility, and creativity matter more than ever. As public trust in science wavers and health care systems strain, academic medicine must offer not only knowledge, but leadership — grounded in evidence, expressed with clarity, and shared in ways that make a difference.
Jonathan Avery, M.D., is vice chair for addiction psychiatry at Weill Cornell Medicine and NewYork-Presbyterian, where he leads clinical, research, and public efforts to reduce stigma and improve care for people with substance use disorders.