Separate and Equitable Promotion Tracks for Clinician-Educators

MOST ACADEMIC MEDICAL CENTERS (AMCS) HAVE missions that aim for excellence in 3 areas: education, research, and patient care. For decades, “triple-threat” faculty members were able to substantively contribute to all 3. However, heightened competition for research grants, changes in the health care delivery system, more sophisticated instructional and evaluation methods, and increased requirements to account for time and productivity make it less feasible for individual faculty to significantly contribute to all 3. Instead, faculty members are likely to focus their efforts in 1 or 2 of these areas. Although exceptions exist, physician faculty members focus either on patient care and research or on patient care and education. The problem is that promotion and tenure systems work well for faculty members pursuing the former but not as well for those focusing on the latter. For instance, 1 report found that, compared with research faculty, the odds of holding a higher academic rank were 85% lower for academic clinicians and 69% lower for teacher-clinicians. In another report, faculty devoting more than 50% of their time to clinical care were more likely to be on a nontenure track and more likely to report slower career progress than those devoting less than 50% of their time to clinical care. In a third report, the time to promotion was significantly shorter for physician-scientists (with 80% designated research time) than for clinician-scholars (with 30% research time). If this issue is not resolved, AMCs run the risk that faculty charged with patient care and education will view their contributions as having limited value, which will decrease motivation and reduce incentives for future efforts. In this article, we briefly review the evolution and early promise of faculty promotion and tenure tracks. We explore ways clinician-educators are designated within academic promotion and tenure models, address the value of these faculty to the AMC system and the challenges they face, examine measurement and evaluation issues, and offer suggestions for change. History of Faculty Tracks