Issues and challenges of non-tenure-track research faculty: the UC Davis School of Medicine experience

Recent Trends in Faculty Promotion in U.S. Medical Schools: Implications for Recruitment, Retention, and Diversity and Inclusion

PURPOSE

Faculty promotion is important for retention and has implications for diversity. This study provides an update on recent trends in faculty promotion in U.S. medical schools.

METHOD

Using data from the Association of American Medical Colleges Faculty Roster, the authors examined trends in faculty promotion over 10 years. Promotion status for full-time assistant and full-time associate professors who started between 2000 and 2009 inclusive was followed from January 1, 2010 to January 1, 2019. The authors used bivariate analyses to assess associations and promotion rates by sex, race/ethnicity, department, tenure status, and degree type.

RESULTS

The promotion rate for assistant professors was 44.3% (2,330/5,263) in basic science departments, 37.1% (17,232/46,473) in clinical science departments, and 33.6% (131/390) in other departments. Among clinical departments, family medicine had the lowest rate of promoting assistant professors (24.4%; 484/1,982) and otolaryngology the highest rate (51.2%; 282/551). Faculty members who were male (38.9%; 11,687/30,017), White (40.0%; 12,635/31,596), tenured (58.7%; 98/167) or tenure-eligible (55.6%; 6,653/11,976), and holding MDs/PhDs (48.7%; 1,968/4,038) had higher promotion rates than, respectively, faculty who were female (36.3%; 7,975/21,998), minorities underrepresented in medicine (URM; 31.0%; 1,716/5,539), nontenured (32.5%; 12,174/37,433), and holding other/unknown degrees (20.6%; 195/948; all P < .001). These differences were less pronounced among associate professors; however, URM and nontenured faculty continued to have lower promotion rates compared with White, Asian, or tenured faculty at the associate professor level.

CONCLUSIONS

Promotion rates varied not only by faculty rank but also by faculty sex, race/ethnicity, department, tenure status, and degree type. The differences were more pronounced for assistant professors than associate professors. URM faculty members, particularly assistant professors, were promoted at lower rates than their White and Asian peers. More research to understand the drivers of disparities in faculty promotion seems warranted.

Full-Time Faculty in Clinical and Basic Science Departments by Sex and Underrepresented in Medicine Status: A 40-Year Review

PURPOSE

To assess the changing diversity of faculty in specific clinical and basic science departments, stratified by sex and underrepresented in medicine (URM) status, at all Liaison Committee on Medical Education (LCME)-accredited medical schools.

METHOD

In this retrospective, cross-sectional, observational study, the authors used data from the Association of American Medical Colleges Faculty Roster (data pulled in October 2019) to identify trends in clinical department faculty and in basic science department faculty by sex and URM status. They included full-time faculty at all LCME-accredited medical schools from 1979 to 2018. They compared the proportions of faculty across separate departments according to sex and URM status, and they used 2-independent-sample t test and simple linear regressions for statistical comparisons.

RESULTS

The number of full-time faculty increased from 49,909 in 1979 to 175,326 in 2018. The largest increase occurred in clinical departments, where the number of faculty increased from 38,726 to 155,677 (a fourfold increase). The number of faculty in basic science departments increased from 11,183 to 19,649 (a 1.8-fold increase). The proportions of faculty who were non-URM females (compared with non-URM males, URM females, and URM males) increased the most-from 14.4% (5,595 of 38,726) to 37.6% (58,478 of 155,677) for clinical departments, and from 14.9% (1,669 of 11,183) to 33.0% (6,485 of 19,649) for basic science departments. Growth was steady but slow among URM faculty, especially for Black males; the absolute number of male URM faculty remained low in both basic science and clinical departments. The proportions of females and URM faculty were highest in the departments of obstetrics and gynecology, pediatrics, and family medicine.

CONCLUSIONS

The substantial increase in faculty, especially in clinical departments, has led to greater diversity, but mostly among non-URM females. The rise of URM male and URM female faculty has been minimal.

Tenure Trends in Academic Emergency Medicine Departments in U.S. Medical Schools

OBJECTIVE

The objective was to assess the long-term trends in tenure status stratified by sex and underrepresented in medicine (URM) status among emergency medicine (EM) department faculty in U.S. medical schools.

METHODS

This study used the Association of American Medical Colleges Faculty Roster to study trends in tenure status of full-time faculty from 1989 to 2018. The numbers and proportions of faculty by tenure status were studied over the years and compared across sex and URM minority status. Two-independent-sample t-test and simple linear regression were used for statistical comparisons.

RESULTS

The number of EM faculty increased from 177 in 1989 to 5,237 in 2018, with the majority of increase in nontenured (from 120 to 4,485) rather than tenured (from 24 to 198) or tenure track (from 28 to 548) faculty. The proportions of tenure-line faculty increased briefly from 1989 (29.4%) to 1994 (32.5%) and decreased since to 14.2% in 2018. The decreases were greater among men (from 34.5% to 14.9%) or non-URM (from 32.7% to 14.1%) than women (from 24.8% to 13.1%) or URM (from 30.2% to 15.3%). Compared to other academic departments, EM departments had the second lowest proportion of tenure-line faculty in 2018.

CONCLUSION

Emergency medicine faculty size increased rapidly in the past 30 years, with the vast majority of growth in nontenured faculty, regardless of sex or URM status. This highlights the need to review career development and academic promotions for EM particularly among nontenured faculty.

Trends in Tenure Status in Academic Family Medicine, 1977-2017: Implications for Recruitment, Retention, and the Academic Mission

PURPOSE

Tenure status has important implications for medical school faculty recruitment and retention and may affect educational quality, academic freedom, and collegiality. However, tenure trends in academic family medicine are unknown. This study aimed to describe trends in tenure status of family medicine faculty overall and by gender and status of minorities underrepresented in medicine (URM) in Liaison Committee on Medical Education-accredited medical schools.

METHOD

Association of American Medical Colleges Faculty Roster data were used to describe trends in tenure status of full-time family medicine faculty, 1977 to 2017. Bivariate and trend analyses were conducted to assess associations and describe patterns between tenure status and gender, race, and ethnicity. Interdepartmental variations in tenure trends over the years were also examined.

RESULTS

Among family medicine faculty, the proportions of faculty tenured or on a tenure track dropped more than threefold from 1977 (46.6%; n = 507/1,089) to 2017 (12.7%; n = 729/5,752). Lower proportions of women and URM faculty were tenured or on a tenure track than male and non-URM faculty, respectively. But the gaps among them were converging. Compared with other clinical departments, family medicine had the highest proportion of faculty (74.6%; n = 4,291/5,752) not on a tenure track in 2017.

CONCLUSIONS

Proportion of tenure positions significantly decreased among family medicine faculty in U.S. medical schools. While gaps between male and female faculty and among certain racial/ethnic groups remained for family medicine tenure status, they have decreased over time, mainly because of a substantial increase in nontenured positions.

The Role of PhD Faculty in Advancing Research in Departments of Surgery

OBJECTIVE

To determine the academic contribution as measured by number of publications, citations, and National Institutes of Health (NIH) funding from PhD scientists in US departments of surgery.

SUMMARY BACKGROUND DATA

The number of PhD faculty working in US medical school clinical departments now exceeds the number working in basic science departments. The academic impact of PhDs in surgery has not been previously evaluated.

METHODS

Academic metrics for 3850 faculties at the top 55 NIH-funded university and hospital-based departments of surgery were collected using NIH RePORTER, Scopus, and departmental websites.

RESULTS

MD/PhDs and PhDs had significantly higher numbers of publications and citations than MDs, regardless of academic or institutional rank. PhDs had the greatest proportion of NIH funding compared to both MDs and MD/PhDs. Across all academic ranks, 50.2% of PhDs had received NIH funding compared with 15.2% of MDs and 33.9% of MD/PhDs (P < 0.001). The proportion of PhDs with NIH funding in the top 10 departments did not differ from those working in departments ranked 11 to 50 (P = 0.456). A greater percentage of departmental PhD faculty was associated with increased rates of MD funding.

CONCLUSIONS

The presence of dedicated research faculty with PhDs supports the academic mission of surgery departments by increasing both NIH funding and scholarly productivity. In contrast to MDs and MD/PhDs, PhDs seem to have similar levels of academic output and funding independent of the overall NIH funding environment of their department. This suggests that research programs in departments with limited resources may be enhanced by the recruitment of PhD faculty.

The 21st century faculty member in the educational process--what should be on the horizon?

One of Abraham Flexner's legacies was the concept of a professional faculty community responsible for teaching, scholarly work, and the creation and nurturing of the academic environment in medical schools. Dramatic shifts in society, health care, and educational practice have occurred over the century since Flexner's report, and these shifts have resulted in changes and challenges for medical school faculty. Fundamental principles that were articulated in Flexner's work remain relevant today: medicine is a profession, and as such is responsible for the education of the next generation of physicians; and the essential work of the medical school is the education of current and future generations of physicians. Medical schools must reconsider and restate the required characteristics and work of faculty members. Furthermore, we must develop a core faculty with primary responsibility for the educational program, the teaching of students, and the creation and nurturing of the academic environment. Enhancing the diversity of the faculty community, providing necessary faculty development, and further clarifying the forms of scholarly work in medicine are three ways that individual schools and national organizations can advance the educational mission through support of the faculty.