A common question is whether the research academic faculty spends enough time practicing medicine to maintain their clinical skills. Put another way, is a patient who sees a physician that spends the majority of their time doing research missing out on getting care by the best possible clinician?
First of all, as a scientist, I wish to note that I am not aware of any data on this topic, and I wouldn't believe it practical to obtain data. There are just too many covariates to do a meaningful study.
Second, I fully recognize that there are huge individual variations in how much time one needs to spend practicing at any given specialty to maintain ones skill.
Still, the question is important and as an academic who sees patients and provides medical care, I am obligated to evaluate whether I think I am maintaining my skills. Furthermore, this evaluation has relevance to a wide-range of issues in terms of part-time practice situations.
Since we are acknowledging that this is a personal, non-evidence based perspective, I will describe my time fraction spent clinically. Since completing my training about 2 decades ago, I have spent approximately 75-80% of my time doing research and about 20-25% of my time doing patient care. My research does not provide me with any particular patient experiences that are relevant to maintaining my medical care skills. I am not involved in surgery, but I do perform "procedures" in the clinical field. I continue to do medical procedures, both those I do and as the direct supervisor of trainees doing them. I work regularly both with academic physicians who have a schedule like mine and clinical faculty who spend a much greater percentage of their time on direct patient care. I also am very familiar with the practices and skill-set of non-academic physicians in my specialty.
In looking at the effects of a very part-time clinical practice, I would look at two main areas of competence. The first is that of actual procedure skills. Remembering that I am not in a surgical field, I still need to evaluate whether I can perform technical procedures as well as those who do them more often. Also, how is my guiding of trainees learning these procedures affected by my part-time practice?
The second area is that of clinical knowledge. That is, am I able to keep up on the latest treatments, diagnostic approaches and the like while focusing the majority of my time thinking about different research issues. How can I keep up on these when most of my time is not spent seeing new patients?
Well, with regard to the first, honestly, I don't see that as an issue at all. Again, I don't know how much time a surgeon must spend operating to keep their skills up, but in my area, involving some fairly precise skills, part-time is plenty. You just don't forget the things you learned in training and I've seen folks who hadn't done some procedures for a year or more go right at them with no problems. In general in academic medicine we are going to do fewer procedures ourselves as attendings because we are surrounded by trainees. Maintaining skills requires conscious effort, but, in my field this is not an issue at 25% clinical time (or thereabouts).
The second issue is much more difficult and requires more attention. Medicine is rapidly evolving and the fewer patients you see, the less aware you'll be of the latest care changes. The solution here is that one has to make a substantial effort to go to teaching conferences and even more so, to "case" conferences, morbidity/mortality conferences, morning reports, etc. Interact with trainees as they discuss new and difficult cases and what is being done. During ones clinical time, pay real attention to what the more clinically oriented folks are doing and whether it is a "fad" or really evidence based. Recognize that this is an issue and that just being a "professor" does not mean you are up-to-date on everything in your field.
Of course, reading the medical literature for the latest insights is important, but in many ways, part-timers and academics have as much or more time than primary clinicians for this. Many of us are also experienced at evaluating the statistics in scientific research and evaluating the quality of published research. What we have to make a greater effort to do is to pay attention to the actual clinical practices as they are updated and developed and to be a part of the committees and groups reviewing clinical practices in our area. This pulls from the research time, but is a must.
On the whole, I am comfortable with the idea that 20-25% clinical time in my specialty, and I believe, in most or all non-surgical specialties is adequate. Actually, I'm not convinced much more % time is needed for surgical specialties, but I would defer to a surgeon on that point. The effort must be made to make the clinical time worthwhile - see the sickest patients, follow what the trainees are being taught, and continue to attend as many conferences as possible.
In the future, whether for personal or academic reasons, part-time academic practice (and private practice) will become increasingly common. Debating the appropriateness of it is less important than teaching trainees the skills needed to make the most of part-time practice and ensuring that they maintain a full skill set.
to you. 
