The Dual Identity of Clinician-Teachers: Navigating Boundaries and Burdens

The Dual Identity of Clinician-Teachers: Navigating Boundaries and Burdens

Every clinician-teacher knows the feeling: one moment you are focused on patient care—managing a complex case, coordinating the team, navigating the electronic medical record—and the next moment, a medical student or resident is by your side, asking a question, eager to learn. In that instant, you are not only a physician but also a teacher, expected to explain, model, and inspire. This dual identity is both the beauty and the burden of academic medicine.

In recent years, there has been an attempt to examine more deeply what it means to live at the intersection of the clinician and teacher roles. A 2024 article in Medical Education by Alexandraki (1) highlights the tensions and opportunities that arise when these identities overlap. The author describes how clinical educators navigate role boundaries, often without explicit institutional support, and how these tensions shape both the quality of teaching and the satisfaction of faculty members. This got me thinking more about the pressures that our faculty are under.

The Boundaries of Identity

Clinician-teachers face constant negotiation of boundaries. On one hand, patient care demands efficiency, accuracy, and often rapid decision-making while on the other hand, teaching requires slowing down, making thinking visible, and creating space for questions. Some of the very qualities that make one an excellent physician—efficiency, decisiveness, independence—can conflict with the qualities that make one an excellent teacher—patience, transparency, collaboration.

The article notes that these boundaries are often blurred. Teaching can enhance clinical care by improving communication, reinforcing clinical reasoning, and engaging learners as team members. Yet, teaching can also slow workflow, reduce productivity, and create friction in systems that prioritize volume over value. An oft-quoted study by Vinson and colleagues (2) found that when a student was in their practice, a family physician sees less patients. In fact, their clinical productivity decreased from 3.9 to 3.3 patients per hour. Clinician-teachers are left to reconcile these conflicting demands, often without formal recognition or protected time.

Systemic Pressures

The challenges of dual identity are not just personal—they are systemic. In most practices and institutions, clinical productivity is measured in relative value units (RVUs), a measure of the work done in a patient encounter, while teaching contributions are harder to quantify. Dr Vinson (2) found that the amount of time the faculty physician spent working increased by 52 minutes per day. Another study by Denton, Pangaro, and colleagues (3) found that having a medical student working with a physician in the outpatient internal medicine clinic adds 32 minutes to a clinic session. Faculty may be praised for “going above and beyond” in teaching, but rarely are they rewarded in tangible ways. In medical schools, promotion systems often prioritize research and academic recognition while leaving educational contributions undervalued. As a result, clinician-teachers may feel like they are constantly falling short of their clinical expectations. Grayson and colleagues (4) surveyed preceptors and found that 61% reported a decrease in the number of patients seen.

This misalignment creates stress and, over time, may contribute to burnout. Clinician-teachers often report feelings of being pulled in too many directions, of their educational work being “invisible labor,” and of struggling to sustain enthusiasm in the face of mounting clinical pressures. These challenges may be compounded for women, underrepresented minorities, and international faculty, who may experience additional burdens related to equity, representation, and bias. 

The Rewards of Dual Identity

Yet, the story is not only about burden—it is also about joy. Many clinician-teachers describe teaching as the most rewarding part of their day. Educating the next generation of physicians provides a sense of purpose, continuity, and meaning. It reinforces one’s own knowledge, sharpens clinical reasoning, and fosters professional community. Learners can bring fresh perspectives, challenge assumptions, and remind faculty why they entered medicine in the first place. Dr Grayson’s survey of preceptors (4) found that: 82% felt more enjoyment of the practice of medicine, while 66% spent increased amount of time reviewing clinical medicine, and 49% had a desire to keep up with recent developments in medicine.

The dual identity, if well supported, can be profoundly enriching. It offers a professional life that integrates service and scholarship, mentorship, and practice. Clinician-teachers often become role models not only for clinical excellence but also for professional identity formation, showing learners how to balance compassion with competence, efficiency with empathy. 

Strategies for Support

How can institutions better support clinician-teachers in navigating these boundaries? 

1. Clarify Expectations – Institutions should clearly define the role of clinician-teachers, setting realistic expectations for clinical productivity and educational engagement. Without clarity, faculty are left to guess, often feeling like they are falling short in both domains.

2. Provide Protected Time – Teaching should not be an extracurricular activity squeezed between patient visits and after hours. Providing protected time for education signals that it is valued and essential, not optional.

3. Recognize and Reward Teaching – Promotion and tenure criteria must align with the real contributions of clinician-teachers. This means valuing curriculum design, mentorship, and educational leadership as much as publications and RVUs.

4. Invest in Faculty Development – Clinician-teachers need training not only in pedagogy but also in boundary negotiation, time management, and professional identity formation. Faculty development programs should explicitly address the dual identity challenge.

5. Promote Equity – Support should be distributed fairly, with attention to equity across gender, race, specialty, and career stage. Institutions should be intentional about mentorship and sponsorship for underrepresented groups. Finances should not just support the high dollar specialties. 

6. Model Integration – Leaders who themselves are clinician-teachers can model integration of roles, demonstrating how clinical care and teaching can enrich one another rather than compete.

Looking Forward

The future of academic medicine depends on clinician-teachers who can thrive in both roles. As medicine becomes more complex, the need for skilled educators embedded in clinical settings will only grow. If institutions fail to support this dual identity, they risk losing talented faculty and weakening the pipeline of future educators.

The challenge, then, is not to choose between clinician and teacher but to create systems where both roles are fully supported and mutually reinforcing. This requires intentional policies, cultural shifts, and recognition that teaching is not peripheral but central to the mission of academic medicine.

In the end, the dual identity of clinician-teachers is not a problem to be solved but a reality to be embraced. By acknowledging the boundaries, addressing the burdens, and celebrating the rewards, we can create an environment where clinician-teachers not only survive but flourish. And when they flourish, so too do the learners and patients they serve.

REFERENCES

1) Alexandraki I. Exploring the boundaries between clinician and teacher. Med Educ 2025; 59 (2): 136-138. doi:10.1111/medu.15586. 

2) Vinson DC, Paden C, Devera-Sales A. Impact of medical student teaching on family physicians' use of time. Journal of Family Practice  1996; 42 (3): 243-249. PMID: 8636675.

3) Denton GD, Durning SJ, Hemmer PA, & Pangaro LN. RESEARCH BASIC TO MEDICAL EDUCATION: A Time and Motion Study of the Effect of Ambulatory Medical Students on the Duration of General Internal Medicine Clinics. Teaching and Learning in Medicine  2005; 17 (3): 285–289. https://doi.org/10.1207/s15328015tlm1703_15

4) Grayson MS, Klein M, Lugo J, & Visintainer P. Benefits and Costs to Community-Based Physicians Teaching Primary Care to Medical Students. J General Internal Medicine  1998; 13 (7): 485-488. https://doi.org/10.1046/j.1525-1497.1998.00139.x