Guidelines for promotion of clinician-educators

Many academic physicians in generalist divisions spend a large proportion of their time in clinical practice and teaching. A 1979 study by Friedman and coworkers reported that faculty in divisions of general internal medicine spent 48% of their time in clinical practice, 31% in teaching, 12% in administration, and 9% in research.1 Results were similar for academic pediatrics,2 and for emergency medicine3; current data on other disciplines are lacking. In many institutions, the growth of this group of faculty preceded the development of satisfactory academic policies regarding reappointment, promotion, tenure, and institutional commitment. In these institutions, the extent and quality of teaching plays little role in the decisions about promotion and tenure.4,5 As the number of full-time clinician-educators has grown,6 the need for improved policies has increased.6,12 In response to this growing need, an estimated 63% (N.M. Jensen and J. Stewart, manuscript submitted) to 83%13 of departments of medicine have established special promotion tracks for clinician-educators (current data are not available for other disciplines). Some of these tracks carry either prefixes or suffixes to distinguish them from the traditional tracks that have existed for medical researchers, and no two tracks are identical.6 Despite the existence of these tracks, many clinician-educators remained concerned about faculty rewards and advancement.14,15 Of eight valued reforms for medical education, “reward for teaching” received the strongest support in a 1989 survey of 1,369 American medical educators.15 Among medical school faculty and administrators responding to a 1992 survey, the most frequently mentioned problems concerned methods to evaluate and reward teaching.16 Among traditional rewards for medical faculty, promotion and tenure remain the most valued; most young faculty would like to attain the rank of full professor.11,17 Although it is important for medical schools to pay clinician-educators competitive incomes, higher salaries alone are not sufficient to attract and retain talented physicians.18 Promotion and tenure remain the utmost recognition of scholarship, even though many institutions are redefining their tenure privileges and have initiatives to reduce the number of tenured faculty.6,17,19 This scholarship, defined elsewhere,20 must satisfy two criteria: excellence (as judged by peers) and dissemination in the public domain.13 Excellence in patient care and teaching, including efficiency and availability, must be considered as part of this scholarship. It is essential to establish and maintain stringent criteria for the selection, development, and promotion of clinician-educators.7 Although many schools have these policies, they lack standardization across departments and universities.16 There is a need not only for widely accepted criteria by which clinician-educators may be fairly evaluated, but also for a reconsideration of how scholarship is defined.20 Expectations must be clear concerning how faculty are to spend their time, what they are to achieve, how they will be judged, and during what time frame.16 It is for these reasons that the Society of General Internal Medicine created the following guidelines for the promotion of clinician-teachers.21 We anticipate these guidelines will be useful to all academic clinical departments (with some discipline-specific adaptation).