Understanding and Preparing for Academic Promotion in Medical Schools

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Editor’s Note: The opinions expressed in this editorial do not necessarily reflect the opinions of the AAMC or its members. Academic promotion in medical schools serves to recognize the expertise, merit, and contributions of faculty members. Academic promotion decisions are made in the context of the academic and professional expectations for expertise, merit, and contributions associated with medical schools’ different faculty tracks. Promotion decisions may also rely on criteria regarding performance in institutional roles. Academic promotion is a demonstration of institutional integrity and fairness in acknowledging the work of individual faculty members. Receiving academic promotion may be accompanied by increased compensation, enhanced benefits, expanded leadership responsibilities, opportunities for professional development such as sabbatical time, and greater employment security such as longer appointment terms or tenure. For these reasons, understanding and preparing for academic promotion are vitally important to current and aspiring medical school faculty. Feedback from faculty regarding promotion criteria and processes was gathered by the Association of American Medical Colleges in the StandPoint Faculty Engagement Survey1 between 2021 and 2024. Full- and part-time faculty members (n = 14,511) from 21 U.S. medical schools participated in the survey study, with nearly 2,400 choosing to offer narrative comments on how to improve the clarity of promotion and tenure processes. Ensuring that criteria and guidelines are transparent and well defined (29%), expanding criteria and tracks to more fully recognize faculty contributions (15%), and improving communication (14%) were the most common recommendations. Applying processes and standards consistently (12%), addressing department-level issues (11%), providing additional mentoring and support (11%), and offering workshops and training (6%) were also suggested by respondents. Interestingly, in this analysis, relatively few respondents expressed concerns regarding the misalignment of expectations and criteria, administrative burden associated with promotion, and discrimination and bias in promotion and tenure processes (6%, 5%, and 3%, respectively). Moreover, positive comments regarding current approaches were mentioned by 12% of respondents, even though the question specifically asked for recommended improvements. These encouraging findings echo the results of a much earlier AAMC survey2 in which the majority of faculty respondents (n = 9,638) at 23 U.S. medical schools agreed that promotion expectations within different mission areas were clear and reasonable. Over the last 40 years, faculty tracks of medical schools and the faculty composition of medical schools have evolved. Among U.S. medical schools accredited before 1983 (n = 124), 93% had a tenure system for all faculty, 2% had a system in which only basic scientists were tenure-eligible, and 5% had no tenure system.3 Medical schools accredited between 2002 and 2020 (n = 31), on the other hand, were structured much differently, with one-third (n = 10) offering no tenure system at all.3 Adding to this complexity is the observation that some academically affiliated health systems in recent years have aligned with multiple medical schools, each with different faculty tracks and different expectations, and the health systems themselves can have additional promotion and career pathways.4 Some medical schools have developed different academic tracks for faculty engaged in clinical care, as well as tenure and nontenure research and education tracks. Each faculty track serves to support one or more institutional missions, and these faculty lines typically have different appointment and reappointment timelines and “clocks,” plus different promotion expectations. Some institutions allow for a faculty member to start in an “undifferentiated” faculty position and then formally declare a track, once their academic phenotype has become clear, and other institutions allow faculty to make a move from one track to another. Typically, the tenure line is the only “up or out” faculty track at most medical schools, although some institutions may allow a rehire to a different role. For many medical school faculty, by virtue of their clinically oriented roles, promotion criteria have shifted from a focus on scientific and scholarly impact to emphasize clinical contributions.5 Clinical contributions typically are assessed in relation to “quality” and “quantity,” relying on evidence of excellence (e.g., reputation, specialty or subspecialty certification or other demonstrations of expertise, and innovation) and of individual productivity and programmatic impact. These changes reflect the ever-increasing and valuable role of medical schools and academically affiliated health systems in providing patient care in the United States, but also have raised questions regarding scientific impact, organizational heterogeneity, intellectual freedom, job security, and retention for individuals who choose academic medicine over other employment settings.3,5,6 And some clinically engaged faculty may ask if clinical contributions receive too little or too much emphasis in the process of promotion. With respect to the faculty composition of medical schools, most (82%) medical school faculty members were early career, appointed in clinical departments, and serving on clinical tracks. Relative to the whole, very few—only 18% across approximately 200,000 faculty—were tenured or tenure-eligible.5 Further, a large number of faculty members at that time were part-time and primarily performing clinical teaching and clinical service duties in a wide range of settings, including community-based programs.5 Given this complicated picture, it is particularly important for faculty to be attentive and strategic as they plan their careers in academic medicine.7,8 Speaking with mentors, networking with peers, attending conferences, consulting the literature, and reading handbooks can be useful in this process.9–11 Below I will add a few of my own observations based on many years’ experience at different academic institutions. I have six “do’s” and just one (really big) “don’t” to offer in support of the success of faculty members seeking academic promotion. Things to Do Do learn everything you can about your faculty line at your institution. The faculty handbook will be your primary source. You should understand what the expectations are for your faculty role. What are the promotion criteria? How are expertise, merit, and contributions demonstrated, using qualitative and quantitative evidence? How does one substantiate national reputation and impact, for example? How do leadership roles such as serving as a medical director for a busy clinic or being the chair of a high-stakes committee figure into the evaluation of your performance? What is the timeline for reappointment or promotion? Are there events that can stop or accelerate your “clock”? Are you able to switch lines? Very importantly, are you on an “up or out” faculty line? And who evaluates your promotion file? Is the decision handled within the medical school alone, or does your file go to the university for review? The answers to these questions will greatly affect what, when, and how you prepare and position your promotion materials. Do learn everything you can about implicit or cultural expectations associated with promotion on your faculty line at your institution. Mentors, recently promoted near-peers, members of the academic affairs office, and colleagues in other academic units will have very helpful insights based on their knowledge and experience. Be careful not to overgeneralize from individual cases—instead, try to bring together information and discern patterns. Try to determine to the extent possible whether there are implicit “threshold” expectations, such as indications of success in independent “arm’s length” scientifi

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