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Educating Physicians: Research Reports

Institutional Policies of U.S. Medical Schools Regarding Tenure, Promotion, and Benefits for Part‐time Faculty

Socolar, Rebecca R. S. MD, MPH; Kelman, Lesley S. MPH; Lannon, Carole M. MD, MPH; Lohr, Jacob A. MD

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Author Information

Dr. Socolar is clinical assistant professor of pediatrics and social medicine, University of North Carolina (UNC) at Chapel Hill School of Medicine. At the time the paper was written, Ms. Kelman was a graduate student in the Department of Health Behavior and Health Education, School of Public Health, UNC; she is now director, Women's Outreach Center, Oklahoma University. Dr. Lannon is clinical associate professor of internal medicine and pediatrics, and Dr. Lohr is professor and vice chair of the Department of Pediatrics, also at the University of North Carolina at Chapel Hill School of Medicine.

Correspondence and requests for reprints should be addressed to Dr. Socolar, C.B. #7225, Community Pediatrics, University of North Carolina, Chapel Hill, NC 27599-7225; e-mail: 〈rsocolar@med.unc.edu〉.

The authors thank Ruth Stein and Joseph Garfunkel for reviewing the manuscript and for helpful suggestions for revisions.

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Abstract

Purpose: To collect data on institutional policies regarding tenure, promotions, and benefits for part-time faculty at U.S. medical schools and determine the extent to which part-time work is a feasible or attractive option for academic physicians.

Method: In July 1996, the authors sent a 29-item questionnaire regarding tenure, promotions, and benefit policies for part-time faculty to respondents identified by the deans' offices of medical schools in the United States and Puerto Rico. Responses were analyzed using descriptive statistics and chi-square analyses.

Results: Respondents from 104 of 126 medical schools (83%) completed the questionnaire; 58 responded that their schools had written policies about tenure, promotion, or benefits for part-time faculty. Tenure. Of the 95 medical schools with tenure systems, 25 allowed part-time faculty to get tenure and 76 allowed for extending the time to tenure. Allowable reasons to slow the tenure clock included medical leave (65), maternity leave (65), paternity leave (54), other leave of absence (59). Only 23 allowed part-time status as a reason to slow the tenure clock. Policies written by the dean's office and from schools in the midwest or west were more favorable to part-time faculty's being allowed to get tenure. Promotions. The majority of respondents reported that it was possible for part-time faculty to serve as clinical assistant, assistant, associate, and full professors. Benefits. The majority of schools offered retirement benefits and health, dental, disability, and life insurance to part-time faculty, although in many cases part-time faculty had to buy additional coverage to match that of full-time faculty.

Conclusions: Most medical schools do not have policies that foster tenure for part-time faculty, although many allow for promotion and offer a variety of benefits to part-time faculty.

Nationally, 21% of women employees and 8% of men work part-time, while even more—one third of women and almost that proportion of men—have said they want to work part-time.1 At U.S. medical schools, only 6% of non-volunteer basic science and 15% of non-volunteer clinical faculty work part-time,2 whereas 36% of college and university faculty work part-time.3 Medical school faculty may desire the increased flexibility that part-time employment affords for a wide range of personal and professional reasons, but these faculty may not want to surrender reasonable academic options and benefits.

The increased flexibility of part-time work can benefit both men and women physicians, although the reasons for their choosing to work part-time seem to vary by gender: men are more likely to choose part-time work as a way to balance competing professional options, whereas women are more likely to choose part-time work to balance employment with family responsibilities. The only nationwide study of part-time medical school faculty found that in departments of internal medicine, men (63%) worked an average of 51 hours per week, dividing their faculty positions and private practices, and women (37%) worked an average of 35 hours per week, combining their careers and childrearing.4 The advantages of part-time status cited most often by these women faculty were increased involvement with children, more time for family, balance in life or work, and additional time for personal pursuits/development. For the men the advantages were satisfaction from teaching, keeping up with developments in the field, involvement with academic pursuits, and increased income from involvement with other pursuits. The disadvantages cited by part-time faculty were similar for both men and women, and they included lack of respect from academic colleagues and the medical community, and limited benefits or salary.

Policies regarding tenure, promotion, and benefits are crucial factors affecting the potential for faculty members to thrive in academic careers, including part-time academic careers. Change in time-to-tenure policies has been cited most frequently as the institutional change that would facilitate a part-time career.4 To foster the promotion of minorities and women from junior to senior faculty positions, the American College of Physicians (ACP) recommended that all medical schools develop flexibility in tenure and promotion procedures, in order to help faculty accommodate personal and family responsibilities while continuing academic work, and specifically advocated part-time work for faculty.5 A previous study found that 73% of U.S. and Canadian medical schools “provide for faculty who choose to work less than full-time but whose full professional effort is directed towards the institution.”6 We undertook our study to learn more about policies for part-time faculty at medical schools in the United States, and to provide data to facilitate future policy making with regard to part-time medical faculty.

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METHOD

In July 1996, we contacted the dean's office of each of the 126 medical schools in the United States and Puerto Rico by telephone to identify the person most familiar with policies about tenure, promotions, and benefits for that institution. The identified respondent was then mailed a 29-item questionnaire about institutional policies regarding tenure, promotion, and benefits. Questionnaires were mailed a second time to non-responders.

In this questionnaire, a part-time faculty member was defined as “someone who is employed by your institution more than 0.5 FTE [full-time equivalent] but less than 1.0 FTE, recognizing that for a medical school faculty member a ‘full-time equivalent’ usually means working more than 40 hours per week, and comparisons should be based on the expectation of a full-time faculty member at your institution.” The “tenure clock” was defined as “the time within your institution that is allowed before a decision is made about whether a faculty member gets tenure.”

The study was approved by the Institutional Review Board of the University of North Carolina at Chapel Hill School of Medicine. Informed consent was obtained via a cover letter accompanying the survey. Analyses were carried out using a statistical software package, and included descriptive statistics and chi-square analyses as indicated.

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RESULTS

Responses were received from 104 (83%) of the 126 medical schools' officials. In general, the questionnaires were filled out thoroughly, but across the items there were a few missing responses.

Respondents included deans (40%), staff administrators and secretaries (48%), faculty members (6%), and others. Thirty-seven percent of the institutions were private; 36% had total enrollments of >600 students, and 48% were from the eastern United States. Officials at 58 institutions reported that their institutions had written policies about the tenure, promotion, or benefits of part-time faculty. A total of 45 institutions had written policies pertaining to promotions, tenure, or benefits for part-time faculty as well as tenure systems, and their representatives reported whether it was possible to get tenure as a part-time faculty member. Of these policies, 15 were written by the dean's office or administration (eight allowed tenure of part-time faculty), 13 were written by faculty and administration (two allowed tenure of part-time faculty), ten were written by a governing body (one allowed tenure of part-time faculty), and seven were written by faculty (none allowed tenure of part-time faculty). Policies written by the deans' offices were significantly more likely to allow the tenure of part-time faculty than were those written by others (χ2 = 10.8, p =.01).

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Tenure

A total of 95 of the respondents reported that their medical schools had tenure systems. Of these, 27% allowed part-time faculty to get tenure; 32% of those that had tenure systems allowed part-time faculty to be on a tenure track (Figure 1). The size of the medical school and whether it was public or private were not related to whether tenure was allowed for part-time faculty. Tenure for part-time faculty was allowed at 18% of medical schools reporting from the eastern United States and 35% of those reporting from the midwest or west (χ2 = 3.4, p =.06). The average length of the tenure clock, without delays, was 7.4 years (median = 7 years; range = 3-21 years). At medical schools with tenure systems, 83% allowed the tenure clock to be slowed. Where the tenure clock could be slowed, 47% had no time limit. For those institutions with time limits, the mean maximum time for slowing the tenure clock was 3.0 years (median = 2 years; range = 1-30 years).

Figure 1
Figure 1
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Respondents indicated that the tenure clock could be slowed for various reasons (Figure 1). Part-time status was the least frequent reason for slowing the tenure clock, given by 23 respondents. Thirty-four of the respondents wrote in other reasons for slowing the tenure clock, including extenuating circumstances (16%), switching back and forth between tenure and non-tenure tracks (8%), leaves of absence (5%), and others (3%). Where part-time status was considered to be a valid reason to slow the tenure clock, the time limit was determined most commonly on a prorated or case-by-case basis.

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Promotions

Respondents from 84 institutions reported that it was possible for part-time faculty to have the rank of clinical assistant professor, 70 respondents reported this for assistant professor, 71 for associate professor, and 71 for professor.

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Benefits

The majority of medical schools offered retirement benefits, health, dental and disability benefits, and life insurance to part-time faculty (Table 1). Respondents from five medical schools reported that benefits varied by department. The minimum FTE required of part-time faculty to receive a given benefit was almost always greater than .50 FTE, but the majority of schools offered each benefit at less than .75 FTE. Thirty-nine percent of the institutions prorated the health insurance offered according to the FTE worked, so that part-time faculty had to buy coverage in addition to what the institution provided in order to be covered to the same extent as full-time faculty. The size, public status, and region of the institution were not related to the benefits offered.

Table 1
Table 1
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DISCUSSION

Tenure acquisition is an important component of a successful academic career, but the majority of medical schools in the United States do not allow part-time faculty to be tenured. Tenure systems continue to evolve, but at the time of our study 91% of respondents reported their medical schools had tenure systems, and only 27% of them allowed part-time faculty to get tenure. On the other hand, we found that part-time faculty could serve at a variety of ranks at the majority of institutions. And although limited (or no) benefits have been cited as a disadvantage by part-time faculty, we found that all benefits were likely to be offered to part-time faculty. Froom and Bickel6 found that 93% of the special sample of medical schools in their study offered health insurance to part-time faculty, which is similar to our finding.

There are arguments against part-time work for academics. For example, higher numbers of hours worked have been associated with higher academic ranks,7 and fewer hours worked might lead to lower quality of performance or commitment, or reduced satisfaction of patients and students. However, there is little evidence that these problems exist for part-time medical school faculty. One study suggested that quality of performance and patient satisfaction are the same for part-time and full-time academic physicians; when matched for severity of illness, this study also found no difference in lengths of stay and patients' satisfaction between the patients of part-time and full-time physicians.8 In academia, all faculty work part-time in a variety of professional areas—e.g., research, clinical service, and administrative duties. Thus, it may not be appropriate to impugn part-time work when all academic work is made up of various part-time responsibilities. Nonetheless, to perform a variety of tasks successfully may require a minimum time effort. It would be useful for institutions to define the minimum time effort required, if any, to meet institutional expectations. In addition, the range of advantages and disadvantages of part-time work should be considered, so that policies reflect well-thought-out institutional values and needs.

This study had several limitations. First, it is not possible to compare what we found out about policies for part-time faculty with policies for full-time faculty. Specifically, we found that 57% of the responding medical schools had written policies about tenure, promotions, and benefits for part-time faculty, but we did not determine what percentage had written policies for full-time faculty. Second, it is difficult to assess policies for promotion based solely on the titles of the positions.

Although part-time work affects both men and women, it has been considered to be a women's issue or a family issue. Part-time work and flexibility in time-to-tenure have been cited as important factors that show support of women in academic medicine9 and contribute to an increase in the percentage of women in senior faculty positions. However, increasing the percentage of women in senior faculty positions has been an elusive goal; the percentages of women full professors range from 8% to 18% in various departments and have actually fallen in recent years in some departments.10 One study found that women make up 24% of full-time medical faculty but they are also 60% of part-time faculty whose full professional efforts are directed toward the academic medical center.6 While both male and female physicians may need to balance career and family, women seem more affected by these issues. For example, approximately 80% of academic female internists were married or had been married, and 63% had children, but only 31% reported that they had role models whom they perceived to be successful in balancing career and personal life.9 A study of physicians' conflicts among career, spousal, and parental roles found that women were more than twice as likely as men to have made career changes for their children; the most common type of career change related to marriage or children was a decrease in work hours.11

As institutional policies toward part-time faculty evolve, it may be important to consider how these policies affect women faculty, and faculty with families, in particular. Ultimately, however, the perception that part-time work is solely a women's issue or a family issue will need to change, and be redefined as an issue of flexibility in any academic physician's life-course and of balancing his or her various professional and personal aspects of life.

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REFERENCES

1. Bond JT, Galinsky E, Swanberg JE. The 1997 National Study of the Changing Workforce. New York: Families and Work Institute, 1998.

2. Barzansky B, Jonas HS, Etzel SI. Educational programs in US medical schools, 1995-1996. JAMA. 1996;276:714–9.

3. Gappa J, Leslie D. The invisible faculty: improving the status of part-timers in higher education. Planning for Higher Education. 1994;22:35–7.

4. Levinson W, Kaufman K, Bickel J. Part-time faculty in academic medicine: present status and future challenges. Ann Intern Med. 1993;119:220–5.

5. American College of Physicians. Promotion and tenure of women and minorities on medical school faculties. Ann Intern Med. 1991;114:63–8.

6. Froom JD, Bickel J. Medical schools' policies for part-time faculty committed to full professional effort. Acad Med. 1996;71:91–6.

7. Kaplan SH, Sullivan LM, Dukes KA, Phillips CF, Kelch RP, Schaller JG. Sex differences in academic advancement: results of a national study of pediatricians. N Engl J Med. 1996;335:1282–9.

8. Fein OT, Garfield R. Impact of physicians' part-time status on inpatients' use of medical care and their satisfaction with physicians in an academic group practice. Acad Med. 1991;66:694–8.

9. Levinson W, Tolle SW, Lewis C. Women in academic medicine: combining career and family. N Engl J Med. 1989;321:1511–7.

10. Schaller JG. Women in academic pediatrics. Pediatr Ann. 1999;28:184–9.

11. Warde C, Allen W, Gelberg L. Physician role conflict and resulting career changes: gender and generational differences. J Gen Intern Med. 1996;11:729–35.

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