OR WAIT 15 SECS
I've been taught, "If you're not part of the solution, you are part of the problem." So, after a great deal of thought about this problem, I'd like to first list some of the reasons I believe young physicians are not pursuing careers in academics, and then, hopefully, provide some possible solutions for them.
The differences between the individual practitioner who wants to play an active role in problem-solving and the physician who would happily delegate the determination of those solutions to others may influence the type of practice setting most appropriate for each. For the physician who wants to be "involved," practicing as a solo practitioner or as a member of a small solo specialty group might be best. Conversely, the physician willing to delegate authority to others might be better suited for practice in a large multispecialty group or academics.
Take, for example, the problem of a patient who fails to keep two or three appointments without canceling. In some practice settings, the practitioner can take the necessary steps on his or her own to solve this type of problem. In a solo private practice, physicians may determine that under their policy this patient can be discharged from the practice. Trying to do that in most large multispecialty groups or academic centers would entail a pile of paperwork and myriad approval committees. Take if from me, that just doesn't happen - at least not quickly! So, depending upon personality types, one type of practice may be more appropriate than another.
Loss of autonomy
A loss of autonomy and increase in bureaucracy are inherent in most large medical organizations, but are especially prevalent, in my experience, in academic medicine. However, I'm not sure why this is the case. Perhaps it is due to the nature of academics, being a training ground for many different professions that are not normally part of medical training or practice.
Take the person with a Ph.D. in physics who serves on a Laser Safety Committee. He may know many things about how a laser operates, but have no experience with using lasers clinically, and therefore may develop and enforce rules that don't apply to the clinical setting. Or, consider the MBA candidate who is working at an academic medical center developing a model for operating a clinic at maximal efficiency. She may not have the necessary knowledge to know that her model may not work in all clinical settings with equal success.