Morahan, Page S. PhD; Gold, Jennifer S. MA; Bickel, Janet MA
Since 1990, the Association of American Medical Colleges (AAMC) has held eight professional development conferences for medical school administrators responsible for a broad array of faculty issues. This informal group deals with faculty appointments, tenure, employment contracts, compensation, faculty reviews, legal issues, human resources, and professional or career development for teaching and related responsibilities. The medical school administrative offices handling faculty affairs or faculty development are some of the newest that have been formalized in medical schools. Although the management and development of faculty are increasingly complex and important,1–3 no centralized information has existed on how medical schools handle these responsibilities.
At the 1999 Faculty Affairs Professional Development Conference, a group of 13 participants discussed approaches to clarifying the functions of these administrative offices. A subgroup of conference participants proceeded with an iterative process of survey development and pilot testing, resulting in a survey of all U.S. medical schools.
Using the AAMC's faculty affairs group mailing list, we designated one representative from each of the 125 allopathic medical schools to receive the questionnaire in January 2000. The faculty affairs mailing list consists of faculty affairs professionals designated by medical school deans, as well as others requesting to participate in the group. We addressed the survey to the most senior administrator (based on title in the mailing list) at each school. Survey respondents included associate and assistant deans for faculty, academic, and administrative affairs; other administrators, such as directors of offices of faculty affairs and faculty development; and faculty, including chairs of promotion and tenure committees. The first section of the eight-page questionnaire asked respondents to indicate the office that handled a series of faculty-related activities, such as faculty policies, faculty governance, post-tenure review, faculty development, etc., at the school. Specific offices listed included office of faculty affairs, office of faculty development, another centralized office within the school of medicine, office(s) within the university, but not within the school of medicine, and department. The second section of the questionnaire posed a series of general questions about each office of faculty affairs and faculty development at the school. Questions focused on the age, origin, staffing, advising, funding, potential risks, and indicators of success associated with each office of faculty affairs and faculty development at the school.
Faculty affairs administrators from 76 medical schools returned completed questionnaires (61%); the schools were representative of all U.S. schools along the lines of geographic region and ownership.
The 76 respondents reported 117 different offices handling faculty affairs and faculty development functions. Of these, 93 primarily handled faculty affairs functions and 21, faculty development functions (three respondents decentralized these functions to the departmental level).
In addition to the “office of faculty affairs,” variations of names include clinical faculty affairs, academic affairs, administrative affairs, faculty administration or services, or medical school administration. No predominant title existed among the 21 offices that focused on faculty development. Office titles included faculty development, academic affairs, dean's office (no separate designation), variations on diversity (e.g., women in medicine, student and faculty advocacy, development and diversity, equal opportunity office), and variations on educational development.
Most offices of faculty development were established within the last decade, while most offices of faculty affairs had been established over ten years ago. About half reported some type of ongoing advisory group for their offices, for instance, executive committee or dean's advisory committee of department chairs, faculty council, faculty development liaison committee, academic senate committee on academic personnel, advisory committee for diversity, advisory committee for faculty development, promotion and tenure committee, and education or curriculum committees. Most survey respondents were senior-level medical school administrators. Over two thirds held titles at the associate dean level or higher, and held MD, PhD, or JD degrees.
The questionnaire listed 47 functions of these offices, and asked respondents to indicate whether the functions were handled by offices of faculty affairs, offices of faculty development, another centralized school of medicine office, or a university office; decentralized to departments; or not handled by either the school or the university. Respondents reported 11 functions were predominately housed in offices of faculty affairs, academic affairs, or administrative affairs (see Table 1). Five functions were predominately housed in other centralized offices within the school of medicine: databases for information on continuing medical education of faculty (55.6% of responding schools), technology such as telemedicine (54.3%), institutional review board staffing and support (49.4%), space planning (46.6%), and databases for faculty salary information (41.9%) (although 35% reported this function under faculty affairs offices).
Four functions were generally handled within a university office: retirement policies (52.3%), affirmative action policies and issues (45.8%), sexual harassment policies and issues (44.2%), and parental leave policies and issues (42.3%). The three latter personnel policies, however, were often handled by faculty affairs offices within the school of medicine (about 30%). Three functions were generally decentralized to departments: faculty goals and objective setting (56.7%), faculty career planning (43.0%), and faculty performance review or evaluation (41.3%), although 38.6% reported this function under faculty affairs offices.
Handling of the remaining functions varied considerably. Five functions were distributed relatively equally between faculty affairs and another school of medicine centralized office: departmental reviews, chairperson reviews, compensation guidelines, salary equity analyses, and educating committees about their roles. Four functions were distributed relatively equally among faculty affairs, another school of medicine office within the school of medicine, and a university office: international faculty issues such as visas, conflict-of-interest policies, scientific misconduct policies, and Web sites for faculty affairs or faculty development information. Sabbatical leave policies were distributed relatively equally among faculty affairs and university offices. Faculty affairs offices or departments handled post-tenure review, and 17% of the medical schools reported that neither the school nor the university addressed this function.
In contrast to faculty affairs functions, faculty development functions did not have a predominant locus (see Table 2), and formal faculty development offices still played a small role within medical schools. The four top functions among these offices were teaching skills, mentoring programs, leadership development, and programs for women and minorities. Even for these functions, faculty development offices showed minor involvement compared with other offices.
On the questionnaire the respondents also identified how they measured the performances of their offices (see Table 3). Both offices of faculty affairs and offices of faculty development relied on customer satisfaction and complaints or compliments received. Both also attempted to measure the recruitment, promotion, and retention of women and minority faculty. In addition to these measures, offices of faculty affairs tended to measure success in terms of faculty searches and retention of faculty. Offices of faculty development focused more on the use of services and mentoring. Other indicators reported included numbers of faculty compliant with conflict-of-interest policies, numbers of external peer review grants, increased numbers of publications by faculty, and improved standing on U.S. Medical Licensing Exam (USMLE) Step 1 scores. The relatively low response to this item likely indicates a lack of experience (compared with for-profit organizations) in evaluating success factors.
Finally, many respondents mentioned a risk factor of faculty affairs offices is that very few people—some of whom have been with the institution since the office was established and sometimes just one individual—have institutional knowledge. A loss of effectiveness and efficiency is predictable when individuals who have such knowledge leave. Additional risks mentioned included tensions arising from providing services to departments from a central dean's office, demonstrating the offices provide sufficient value, dependence on soft money and volunteered faculty time, a heavy workload for the personnel available, low staff pay, and high turnover. Staff retention was particularly cited because of their “unique knowledge and training required which cannot easily be found in the employment manual.”
This survey provides the first data on the organization of faculty affairs and faculty development functions within U.S. medical schools. Faculty affairs offices have more evolved administrative structures and responsibilities than do faculty development offices.4 Most medical schools have at least one office devoted to faculty affairs functions that has been functioning for over ten years. The nomenclature of these offices tends to be much less clear-cut than that of offices such as student affairs. The most common names are faculty affairs, academic affairs, and administrative affairs.
Only 20% of the total offices reported were devoted to faculty development; their responsibilities were generally limited to teaching skills, mentoring programs for women and minorities, and leadership development. A consensus does not yet exist about the relationship of centralized faculty development efforts with departmental chair responsibilities.5 No medical school had a comprehensive faculty development system, although a unified approach has much to offer.6,7 Technology and other industries competing for talent mount forward-looking initiatives to recruit and develop professional employees, including attention to work and life issues.8,9 Thus, from a leadership development point of view, academic medicine's lack of attention to human resources appears shortsighted.
Beyond customer satisfaction and numbers of people served, few offices have developed measures of effectiveness. It would be informative for medical schools to conduct cost—benefit analyses of these offices compared with the costs of replacing valuable faculty, legal costs of grievances, and lost productivity associated with turnover.
An under-recognized vulnerability of faculty affairs offices is that too often only one individual holds key information; schools need to consider succession planning in these offices.10 Increasingly, businesses require leaders to identify several people and groom them for advancement and possible succession.
Clearly “one size does not fit all” when it comes to faculty affairs and faculty development. Some configurations that have evolved merit re-examination in light of increasing demands, such as the rapid assimilation of newly recruited faculty, and pressures to enhance faculty productivity and retain the most talented.
While this study is limited by being a self-report from only 61% of medical schools, these results provide a baseline for future studies. The importance of faculty affairs and faculty development functions will only grow as academic health centers adapt to continuing competitive pressures to improve the design and delivery of medical education, health care, and research.