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Academic Medicine:
doi: 10.1097/ACM.0b013e31820ce51d
Promotion and Tenure

Evolving Workplace Flexibility for U.S. Medical School Tenure-Track Faculty

Bunton, Sarah A. PhD; Corrice, April M.

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Author Information

Dr. Bunton is research director, Organization and Management Studies, Association of American Medical Colleges, Washington, DC.

Ms. Corrice is research analyst, Organization and Management Studies, Association of American Medical Colleges, Washington, DC.

Correspondence should be addressed to Dr. Bunton, Association of American Medical Colleges, 2450 N St. NW, Washington, DC 20037-1127; telephone: (202) 862-6225; e-mail: sbunton@aamc.org.

First published online February 21, 2011

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Abstract

Purpose: The academic workplace has seen dramatic changes in recent decades, including growing faculty workloads, an increasingly demographically diverse faculty population, and changing expectations about workplace climate. Despite these significant changes, a typical medical faculty's career trajectory is often still quite linear and follows decades-old tenure policies. The authors describe the existence of flexible faculty policies related to tenure at U.S. medical schools to understand better the ways in which institutions are responding.

Method: Data primarily reflect responses from faculty affairs leaders at medical schools accredited by the Liaison Committee on Medical Education to a 2008 faculty personnel policies survey. These data are supplemented with results from the same survey fielded in previous years.

Results: The number of medical schools that have lengthened their probationary periods for faculty has increased over time, and, in 2008, nearly half of the institutions offered a probationary period length of eight years or more to faculty. Over three-fourths of the schools in 2008 had a tenure-clock-stopping policy available, and a third had a policy allowing faculty to work less than full-time while remaining on a tenure-eligible track.

Conclusions: Findings suggest that many medical schools have made progress in making policy additions and modifications that acknowledge the changing academic workplace culture by adding flexibility to traditional tenure policies. Despite those efforts, significant opportunities remain for continued adoption of flexible policies so that faculty can achieve productive academic careers while balancing work, life, and family, and institutions can continue to recruit and retain high-quality faculty members.

The academic workplace has changed dramatically over the past several decades. Faculty face growing workloads and responsibilities, are increasingly demographically diverse, and have changing expectations about the workplace climate.1 In academic medicine, in particular, the enterprise has grown significantly over the past few decades, and medical schools have seen a doubling of clinical faculty members, substantial changes to reimbursement practices, and increasing unprecedented competition for government research funding—all resulting in increased demands on faculty for research, teaching, patient care, and administration.2–4

As the academic medicine enterprise has changed, so too has the faculty workforce. Schools are seeing a growing number of female faculty at medical schools (35% of all full-time medical school faculty—a proportion that has grown by 6% in the past 10 years5,6). Also, faculty—especially the newer generation of faculty—are starting to emphasize a desire for more work–life balance or integration,7–10 where a complement of work and life activities is desired. Both of these changes have implications for institutions. Research suggests that because female faculty often have greater challenges in realizing work–life balance, they are more likely than men to endorse flexible personnel policies, such as part-time tenure tracks, at their institutions.11,12 Research also shows that work–life balance is important for the newer generation of faculty. For example, most junior faculty in a large medical school department indicated that they had too little time to spend at home, with family, and on hobbies.13 Also, a recent study of doctoral students across higher education institutions found that a high percentage of graduate students are opting out of faculty positions because these positions do not allow for work–life balance.14

Despite these noteworthy changes in the market and faculty workforce, a typical medical faculty's career trajectory is often still quite linear and lockstep. Many institutions have held on to faculty policies related to tenure for decades and have not adapted their policies to respond to these changes. Importantly, though, in this milieu, there are also increasingly more institutions that offer greater flexibility in their tenure policies. As recruitment and retention of faculty become increasingly important—as baby boomers retire in the coming decade15 and institutions are faced with significant human capital and financial costs of losing faculty16—the medical schools that have policies in place to offer work–life balance and flexibility to their tenure-track faculty may have a competitive advantage in attracting high-quality faculty. Indeed, unpublished research carried out by the Association of American Medical Colleges and the American Medical Association demonstrates that physicians under 50 years old value work–life balance over compensation and career advancement,17 suggesting that recruitment and retention measures that focus on work–life balance issues may prove to be effective with the next generation of physicians. Further, factors like the administration and workplace policies play a significant role in the extent to which faculty feel that their institution is a good place to work.18 Implementation and encouragement of faculty use of flexible policies may, therefore, increase faculty satisfaction and retention at academic institutions. An analysis of policies at high-achieving medical schools supports this conclusion with evidence suggesting that institutions that develop, implement, monitor, and reassess flexible work–life policies are at an advantage in attracting and retaining faculty while advancing institutional excellence.19

Our intent in this report is to describe the existence and frequency of use of flexible faculty personnel policies related to tenure at all U.S. medical schools in an effort to understand better the ways in which institutions are responding to the changes in faculty work, demographics, and preferences in recent years. We present data on policies that specify the length of the probationary period, tenure-clock-stopping policies, and policies allowing for less than full-time employment while remaining on a tenure-eligible track. These policies have implications for the future of the workplace culture at schools, and our data provide information that institutional leaders can use to assess their own institutional policies as they strive to address the needs of faculty.

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Method

Data in this article primarily reflect responses to a 2008 survey that we conducted on faculty personnel policies. All 126 U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME) participated (the number reflects the total number of fully accredited institutions at the time of the survey). The survey instrument consisted of questions about policies and procedures related to appointment and tenure structures for medical school faculty. Institutional faculty affairs representatives or designated staff members with expertise in faculty personnel policies completed the survey. For comparative purposes, data from the 2008 survey are supplemented with responses to the same survey fielded in previous years (the survey has been administered triennially since 1994). As we examine the tenure-related policies of each institution, descriptive statistics are provided in most cases by faculty type (i.e., by clinical faculty and basic science faculty). In addition to the survey data, we also referenced publicly available faculty handbooks and institutional policy documents at U.S. medical schools and engaged in personal communication with faculty affairs leaders at some of the institutions.

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Results

Of the 126 LCME-accredited medical schools that participated in the 2008 survey, representing a 100% response rate, 119 (94%) offered tenure for their basic science faculty and 111 (88%) offered tenure for their clinical faculty. The following results detail the tenure-related flexible policies that the schools with tenure systems made available to their faculty.

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Length of the probationary period

The number of schools that have lengthened their probationary periods for faculty has increased over time, and Table 1—reflecting our 2008 survey results as well as past administrations of the survey—displays these results from the years 1983 to 2008. For basic science faculty, just over one-quarter, or 26 of 99 (26%), of the schools that specified a length had probationary periods of eight years or more in 1983 (schools indicating that the length varies are not included in the denominator); by 2008, 53 of 119 (45%) schools did. Similarly, for clinical faculty, 25 of 95 (26%) schools had periods of eight years or more in 1983, and by 2008, 55 of 111 (50%) did. Further, the results of our survey suggest anticipated changes: In 2008, 12 of 114 (11%) schools indicated that they were considering lengthening the probationary period for their basic science faculty, and 11 of 106 (10%) were considering this change for their clinical faculty.

Table 1
Table 1
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Tenure-clock-stopping policy

Another institutional strategy that implies flexibility for tenure-track faculty is tenure-clock-stopping. This policy allows faculty on a tenure-eligible track to step off the tenure clock for a period of time, which, in effect, extends the probationary period. Results show that of the schools that offer tenure to faculty in 2008, 94 (79%) had a tenure-clock-stopping policy available. The number of schools with this policy has remained relatively stable since 2002, when 92 (77%) schools had a tenure-clock-stopping policy. Table 2 presents the reasons for which faculty members could use the tenure-clock-stopping policy at their institution in 2008. Child care (offered at 78 of 94 [83%] schools), caring for an ill family member (offered at 72 of 94 [77%] schools), and personal medical disability (offered at 75 of 94 [80%] schools) were the most common allowances for extending the probationary period in 2008, and the same pattern also held true in previous years. Just over half of the medical schools (49 of 94 [52%] schools) indicated an extension for faculty for “other” reasons, including “unique” or “catastrophic” events, events interfering with research or career progress, clinical load, and military service. Eight institutions offered clock stopping for all six reasons in our survey (shown in Table 2) and offered the policy to both their men and women faculty. Of the institutions that had a tenure-clock-stopping policy and that reported faculty usage statistics in 2008, 30 of 40 (75%) indicated that a total of zero to five faculty members used the policy in the 2006–2007 academic year, and 32 of 43 (74%) indicated the same for the 2007–2008 academic year.

Table 2
Table 2
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Less than full-time employment while on a tenure-eligible track

A third strategy that institutions use to increase flexibility in their faculty policies is to allow faculty to work less than full-time while remaining on a tenure-eligible track. Full-time faculty are typically employed with a 9- or 12-month appointment. The reported numbers of institutions to offer a policy allowing faculty to work less than full-time while remaining on a tenure-eligible track in 2002, 2005, and 2008 were 48 of 120 (40%), 37 of 119 (31%), and 41 of 119 (35%), respectively. These percentages suggest that the number of institutions with such a policy has remained relatively stable at roughly a third of the institutions over time. Of the 41 schools that offered this policy in 2008, 29 provided information on the minimum percentage of time worked that was allowed under such an arrangement. Of these 29 institutions, 27 (93%) defined less than full-time employment as 0.75 FTE or less. Of the institutions that had this policy and reported faculty usage statistics in 2008, 9 of 12 (75%) indicated that a total of zero to three faculty members used the policy in the 2006–2007 academic year, and 8 of 11 (73%) indicated the same for the 2007–2008 academic year.

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Discussion

Length of the probationary period

When the American Association of University Professors (AAUP) published the seminal Statement of Principles on Academic Freedom and Tenure in 194020 and recommended that the tenure probationary period be capped at seven years, most U.S. institutions, including medical schools, adopted—and have maintained—that policy. Debate has ensued about lengthening probationary periods, and a key argument against such extensions is that no evidence exists to suggest that longer probationary periods are associated with greater faculty achievement. Many feel that seven years is enough time to make an informed decision about one's performance.21 Others, however, have suggested that an increased probationary period provides the opportunity for faculty to fully establish and demonstrate their academic excellence in institutional mission areas, since research has become more interdisciplinary, funding has become more competitive, pressure to generate revenue is high, clinical practice complexities have increased, and some faculty face extreme service and education demands. All of these factors contribute to a much different work environment than what was in place almost 70 years ago. A recent American Council on Education study22 supports this need to create flexibility in tenure-track faculty career paths in order to attract and retain high-quality faculty.

Our results show that the percentage of medical schools that have lengthened the probationary period for tenure-track faculty beyond this traditional seven-year period has steadily increased over the past 25 years. This trend will likely continue as more institutions undertake actions to extend the probationary period as well. For example, faculty affairs leaders at the Indiana University School of Medicine recently published a white paper on this issue23 and are moving through the process of getting approval to lengthen the probationary period.24

Although many higher education institutions are considering extensions of the standard probationary period length,21 medical schools also seem to be willing to incorporate some degree of flexibility in their tenure policies as they strive to accommodate evolving workplace demands and a new generation of faculty. The attention to workplace flexibility in medical schools may be, in part, due to the unique work responsibilities of medical faculty, especially within clinical departments (i.e., demonstrating the promise of a clinical researcher amidst pressure to see patients, generate revenue, and support educational programs). In addition, it has become increasingly difficult for a basic science faculty member to quickly become an independent investigator in a time of great research funding competition (e.g., the success rate for being awarded an R01 grant has decreased over time,25 and the average age of investigators at their initial R01 award has increased over time26).

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Tenure-clock-stopping policy

Another innovation to modify the tenure guidelines as they were initially conceived is a tenure-clock-stopping policy, in which faculty are able to extend their probationary period. Our results indicate that about three-quarters of all U.S. medical schools offer such a policy. The most common allowance for extension of the probationary period is for child care. Despite the initial AAUP seven-year cap recommendation, a 2001 AAUP statement27 noted that faculty members should be allowed to stop the tenure clock for child care, because the tenure system was created when “it was assumed that untenured faculty—whether men or women—were not the sole, primary, or even coequal caretakers of newborn or newly adopted children.” The policies of most medical schools reflect this recommendation, such that the majority allow faculty to stop their tenure clock for this reason, and the number of schools adopting this policy has grown over the past several years. In addition, schools recognize other reasons that faculty may need to step off the tenure clock for a period of time.

Despite the existence of these policies, our results bring into question the acceptance of their use in the culture of academics. As the relatively small number of medical school faculty to use tenure-clock-stopping policies shows, many institutions may have developed flexible policies but implicitly or explicitly discourage faculty members from using them. Past research suggests that faculty members often do not use flexible policies even when it is appropriate or necessary to do so.28 In fact, some faculty members may fear retribution for using these policies despite their availability. For example, at Pennsylvania State University between 1992 and 1999, only 4 of 257 tenure-track faculty parents took any formal family leave.29

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Less than full-time employment while on a tenure-eligible track

Finally, our results reflect the use of a third mechanism to increase flexibility in faculty policies that also is a departure from faculty employment norms. Our results suggest that about a third of medical schools allow faculty to work less than full-time while remaining on a tenure track. Although the existence of this policy introduces flexibility for faculty members, some discourse30 and research suggests that such policies are not well known and cause faculty to fear less opportunity for advancement if used. For example, faculty surveyed at the University of California said that they would only use such a policy if there was strong support from colleagues; further, support for this policy was strongest among female faculty members with children, 74% of whom said that the policy would be useful for them.31 Here again, our results suggest that there may be a disconnect between the existence of the policy and faculty knowledge about or willingness to use it, which may reflect lingering employment norms.

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Conclusion

Our research suggests that many medical schools have made progress in offering family-friendly policies and making policy modifications that acknowledge the changing academic workplace culture by adding flexibility to traditional tenure policies. Further, although many higher education institutions are considering implementing flexible tenure policies, medical schools seem to be on the forefront of these issues and are making changes to their policies more quickly than at other types of schools. For example, research indicates that, in 2000, only 4% of higher education institutions had probationary periods that extended the traditional seven-year cap, and 3% granted tenure to part-time faculty.32 Although medical schools are on the forefront of this issue as reflected by policy changes, we did find that there were only 14 schools that had all three policies (i.e., a clock-stopping policy, a policy in place for less than full-time employment, and a greater than seven-year probationary period length) in place for their basic science faculty and 18 schools with all three policies in place for their clinical faculty. These numbers suggest significant opportunity for continued adoption of flexible policies for men and women tenure-track faculty throughout their career lifespan so that they can achieve a productive academic career while at the same time balancing work, family, and other responsibilities.

In addition to the continued evolution of policies themselves and resulting structural changes, schools may want to give greater consideration to cultural changes as well—that is, the support and encouragement of faculty use of flexible policies could improve their work–life balance and integration and offer a more supportive academic environment. For example, one proactive institutional measure to insert flexibility in institutional policies without faculty concern over using such policies is an automatic tenure-clock extension granted to new parents, as is the case at institutions like Harvard Medical School and Duke University School of Medicine, among others.19,33 Some researchers recommend a variety of measures for easing faculty hesitation in using flexible policies, including increased communication on availability of such policies, clarification of expectations of faculty who use these policies, and reminders for tenure review committees on the details of flexible policies.34

The aforementioned recommendations combined with the results of the current study, which provides information that institutional leaders can use to assess their own institutional policies, can help to guide the continued evolution of faculty personnel policies. As continued attention is given to these issues in the years to come and further research is done (e.g., to track and explore exactly how many people are using these policies at each institution and whether the increased probationary periods result in longer times in achieving tenure), increased use of a new flexible model and approach to tenure policies—instead of the traditional structure and approach to faculty policies—can serve the needs of the organization and the individual faculty member. These changes can also constitute a strategic and effective tool in recruiting and retaining high-quality faculty.

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Acknowledgments:

The authors acknowledge R. Kevin Grigsby, DSW, and William T. Mallon, EdD, for insightful feedback on earlier drafts of this manuscript and the many faculty affairs deans, administrators, and other medical school officials who generously contributed their time to complete the survey and to describe school policies.

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Funding/Support:

None.

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Other disclosures:

None.

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Ethical approval:

Not applicable.

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Cited By:

This article has been cited 1 time(s).

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