Implications of Changing Institutions for Promotion in Academic Surgery

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Importance: Understanding and improving promotion and retention practices in academic surgery is crucial for enhancing academic success at both the individual and institutional levels. However, there is a paucity of data examining the potential association between faculty members changing institutions and their likelihood of academic promotion. Objective: To describe patterns in promotion rates of academic surgeons and the association of moving from one institution to another with faculty promotion. Design, Setting, and Participants: This cohort study used deidentified individual-level faculty data from 136 unique academic institutions and their associated academic programs obtained from the faculty roster of the Association of American Medical Colleges. Full-time surgical faculty who entered the dataset between 2000 and 2010 with a faculty rank of assistant professor or associate professor were followed up for 10 years. Data were analyzed from February 2025 to May 2025. Main Outcomes and Measures: Multivariable Cox proportional hazards regression was used to assess associations between changing institutions and 10-year promotion rates by academic rank, sex, race, and ethnicity. Results: A total of 6321 faculty (5024 male [79.5%]) were included in the analysis, and 896 faculty were included in both groups because these individuals achieved both ranks during the study period. Of these individuals, 21 (0.3%) identified as American Indian or Alaska Native, 244 (3.9%) as Black, 338 (5.4%) as Hispanic or Latinx, 68 (1.1%) as Native Hawaiian or Other Pacific Islander, and 4500 (72.0%) as White, with multiple choices possible. There were 4604 individuals in the assistant professor group and 2613 in the associate professor group. Overall, 606 of 905 assistant professors (67.0%) and 297 of 414 associate professors (71.1%) who changed institutions at least once over the study period were promoted within 10 years compared with 2230 of 3696 (60.3%) and 1243 of 2197 (56.6%), respectively, who were promoted and did not change institutions. Multivariable analysis revealed that changing institutions was associated with an increased likelihood of promotion for assistant professors (adjusted hazard ratio, 1.34; 95% CI, 1.22-1.46) and for associate professors (adjusted hazard ratio, 1.58; 95% CI, 1.39-1.80). Conclusions and Relevance: In this cohort study, changing institutions was associated with academic promotion at both the assistant professor and associate professor levels. Although further research is needed to understand the variety of reasons why academic surgeons change institutions, these findings underscore the need for deliberate institutional efforts to support the long-term career development of faculty and develop internal opportunities for advancement.

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