Tenure in the medical school

Academe

Volumn 82, Issue 1, 1996, Pages 40-44

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EID: 0029703997     PISSN: 01902946     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (17)

1. Much of the background section of this report has been adopted freely (and with thanks) from an earlier report by an Association Task Force on Medical Schools (May 12, 1994), but the present statement is the result of discussions subsequent to that report. The subcommittee acknowledges with gratitude the assistance or Robert F. Jones, associate vice-president for institutional and faculty studies, Association of American Medical Colleges, who has been a continuously helpful presence during the preparation of this report.
2. Abraham Flexner, Medical Education in the United States and Canada (Boston: Merrymount Press, 1910; Carnegie Foundation for the Advancement of Teaching, Bulletin #4); Lester S. King, American Medicine Comes of Age, 1840-1920 (Chicago: American Medical Association, 1984); Paul Starr, The Social Transformation of American Medicine(New York: Basic Books, 1982).
3. Abraham Flexner, Medical Education in the United States and Canada (Boston: Merrymount Press, 1910; Carnegie Foundation for the Advancement of Teaching, Bulletin #4); Lester S. King, American Medicine Comes of Age, 1840-1920 (Chicago: American Medical Association, 1984); Paul Starr, The Social Transformation of American Medicine(New York: Basic Books, 1982).
4. Abraham Flexner, Medical Education in the United States and Canada (Boston: Merrymount Press, 1910; Carnegie Foundation for the Advancement of Teaching, Bulletin #4); Lester S. King, American Medicine Comes of Age, 1840-1920 (Chicago: American Medical Association, 1984); Paul Starr, The Social Transformation of American Medicine(New York: Basic Books, 1982).
5. Our reference to "academic medical centers" at the beginning of this report is intended to designate those clusters of health professions education colleges (including dental medicine, pharmacy, allied health professions, nursing, and other units in addition to the school or college of medicine) which operate in conjunction with "teaching hospitals" or clinics, whether actually operated by the university or contractually linked to it for physician training. Medical schools may be private or public; some are still free-standing, but more often than not they are part of a university system, in which they may operate either in separate locations detached geographically and in governance from the "parent" campus, or as part of a campus that includes non-health-profession units of instruction, reporting to a common administrative officer and perhaps with the medical faculty participating in, e.g., a broadly based faculty senate. While the subcommittee acknowledged these distinctions early in its discussions, it is of the opinion that the fundamental policy questions remain the same no matter what the relationship of the medical school to any larger institution of which it may be part.
6. For example, schools of law, engineering, business, etc., do not generally have comparable systems in which income-providing clients, either as private payers or through third-party arrangements, offer practical experience to students and postgraduate trainees.
7. Robert F. Jones, American Medical Education: Institutions, Programs and Issues (Washington, D.C.: Association of American Medical Colleges, 1992), p. 4.
8. Robert G. Petersdorf, "It's Report Card Time Again," Academic Medicine 69 (1994): 175. For a more recent discussion of the complex of issues surrounding faculty status in medical schools, see Carole J. Bland and Richard L. Holloway, "A Crisis of Mission: Faculty Roles and Rewards in an Era of Health-Care Reform," Change (September-October 1995): 30-33.
9. Robert G. Petersdorf, "It's Report Card Time Again," Academic Medicine 69 (1994): 175. For a more recent discussion of the complex of issues surrounding faculty status in medical schools, see Carole J. Bland and Richard L. Holloway, "A Crisis of Mission: Faculty Roles and Rewards in an Era of Health-Care Reform," Change (September-October 1995): 30-33.
10. David Blumenthal and Gregg S. Meyer, "The Future of the Academic Medical Center Under Health Care Reform," New England Journal of Medicine 329 (1993):1812-14.
11. Jordan J. Cohen, "Academic Medicine's Tenuous Hold on Tenure," Academic Medicine 70 (1995):294.
12. The conclusion of Robert F. Jones and Susan C. Sanderson, "Tenure Policies in U.S. and Canadian Medical Schools" (Academic Medicine 69 [1994]:772-78), is that "medical schools have adapted tenure policies to allow themselves flexibility in meeting their academic and clinical missions. The forces driving schools to fashion unique faculty appointment arrangements are not dissipating. Tenure is likely to continue in the academic medical center of the future but to play a diminished role" (p. 772).
13. "In 1983, 30,856 clinical faculty were listed on the FRS [Association of American Medical Colleges Faculty Roster System], with 59 percent in tenure streams.... By 1993, the number of clinical faculty listed on the FRS had nearly doubled, to 58,607. Only 47 percent were in tenure streams: 26 percent with tenure and 21 percent on track" (ibid., p. 773).
14. Practices vary widely with respect to the percentage of clinical appointments that may be tenured, and in some cases the tenured portion may be so negligible as to be of little concern to the clinical faculty member. The situation has become much more complex since the time of the 1940 Statement, and its framers doubtless would not have envisioned the complexities that have emerged. We suggest using a basic science salary line as a guidepost for determining salary guarantees for clinical faculty members. The faculty of the particular school should be involved in arriving at a specific recommendation. Creative approaches not overly at odds with existing Association policy seem possible. Thus, one school represented on the subcommittee has adopted a commitment to support such a faculty member at the 50th percentile at his or her academic rank as reported annually by the AAMC, or the present salary of the individual, whichever is less.
15. Although dealing primarily with term contracts in the area of sponsored research, the Association's 1969 "Report of the Special Committee on Academic Personnel Ineligible for Tenure" (AAUP Policy Documents and Reports, 1995 edition, pp. 82-85) acknowledges a category of employment, "contract research teams," to which "traditional concepts of academic freedom and tenure do not apply." It also argues, however, that "whenever academic institutions designate full-time researchers as faculty members, either by formal appointment or by conferring the titles of instructor, assistant or associate professor, or professor, those researchers should have all the rights of other faculty members." In the case of faculty members whose title is modified by the designation "clinical," this issue now presents itself in a new light which we feel needs to be addressed here. More reluctantly, but with the awareness that the Association must nonetheless take account of changing realities. AAUP's Committee G on Part-Time and Non-Tenure-Track Appointments has developed, and the Association's Council (1993) approved, a document setting forth the basic protections that should be applied to non-tenure-track faculty: "The Status of Non-Tenure-Track Faculty" (AAUP Policy Documents and Reports, 1995 edition, pp. 72-81; see Statement of Policy below, point 2).
16. Although dealing primarily with term contracts in the area of sponsored research, the Association's 1969 "Report of the Special Committee on Academic Personnel Ineligible for Tenure" (AAUP Policy Documents and Reports, 1995 edition, pp. 82-85) acknowledges a category of employment, "contract research teams," to which "traditional concepts of academic freedom and tenure do not apply." It also argues, however, that "whenever academic institutions designate full-time researchers as faculty members, either by formal appointment or by conferring the titles of instructor, assistant or associate professor, or professor, those researchers should have all the rights of other faculty members." In the case of faculty members whose title is modified by the designation "clinical," this issue now presents itself in a new light which we feel needs to be addressed here. More reluctantly, but with the awareness that the Association must nonetheless take account of changing realities. AAUP's Committee G on Part-Time and Non-Tenure-Track Appointments has developed, and the Association's Council (1993) approved, a document setting forth the basic protections that should be applied to non-tenure-track faculty: "The Status of Non-Tenure-Track Faculty" (AAUP Policy Documents and Reports, 1995 edition, pp. 72-81; see Statement of Policy below, point 2).
17. In medical schools, the extent of the inclusion in departmental and faculty governance structures will depend on the extent to which the particular faculty member has responsibility for organizational or instructional matters which go beyond the specific, part-time instructional function for which he or she was appointed. For example, representation on a faculty curriculum committee by a part-time clinical faculty member who has been asked to organize student rotations in primary care physicians' offices might seem reasonable. Likewise, the inclusion of a full-time non-tenure-track researcher on a faculty research committee might be deemed appropriate.