This article-based on a 2002 survey of 125 U.S. allopathic medical schools, reviews of institutional policy documents, and interviews with medical school leaders-explores and analyzes three trends in appointment and tenure policies for basic science faculty at U.S. medical schools. First, the percentage of full-time, nontenure track basic science faculty has increased, from 12% in 1980 to 20% in 2000. More dramatically, by the late 1990s, the percentage of new basic science faculty hired on a nontenure track surpassed the percentage hired on a traditional tenure-track line. This development stems from the tendency of some schools to appoint faculty to nontenure-eligible research scientists faculty tracks, to hire junior faculty on 100% grant funding, and to allow nontenure-track faculty to switch to the tenure track as their research career progresses.
The second trend is an alteration to the tenure financial guarantee. Historically, at most medical schools, it was assumed that tenure guaranteed total institutional salary for basic scientists. Schools have begun to redefine that commitment to less than full salary to protect against financial vulnerabilities and to provide a means to reduce faculty salaries, if warranted.
The third trend is increased flexibility to pretenure policies. Schools have lengthened probationary periods, revised up-or-out provisions, instituted stopping-the-tenure-clock policies and less-than-full-time appointments, and permitted faculty to switch between the tenure and nontenure tracks. These policy modifications recognize the increased professional and personal demands on faculty time.
For more than a decade, U.S. medical schools have been fighting financial battles on various fronts: reductions in clinical revenues in the era of managed care, cutbacks in Medicare payments to affiliated teaching hospitals, and decreases in state support for higher education in general and medical education programs in particular. Although many medical schools have achieved substantial gains in research funding over the last decade, they have also encountered increased competition for extramural awards and contracts. Schools have faced these situations while their costs for mounting successful education and research programs have continued to escalate.1-3
These problems point to a fundamental weakness of medical school financing that Korn4 described as the chronic and growing gap between academic medicine's seemingly insatiable demand for total resources and the supply of resources that society is willing to provide. Although medical schools have evolved into organizations highly dependent on soft money, until recently they continued to embrace traditional academic appointment, compensation, and governance models.5 However, as Nonnemaker and Griner6 stated, medical school organizational structures and policies that previously served the medical school well … may now be viewed as inflexible. Korn4 and Nonnemaker and Griner6 suggested that one probable solution of the tenuous underpinning of the financial model of medical schools would be a rethinking of faculty personnel policies. Policymakers and institutional leaders would need to reexamine how medical schools appoint, promote, compensate, and retain their faculty in an era of diminishing resources and financial uncertainty.
The need for new models of appointment and compensation has been most apparent with clinical faculty. With the high salaries of and the demands for increased productivity on clinicians, the expectations and requirements of a traditional tenure system seemed anachronistic. Therefore, schools made adjustments to the length of probationary periods and up-or-out provisions, devised new clinical-educator tracks and expanded the use of nontenure appointments, and made attempts to define the level of salary guaranteed to clinicians with tenure. Jones and Gold recently provided a cogent analysis of institutional policies governing clinical faculty appointment, tenure, and compensation in U.S. medical schools.7 In that report, the authors described a number of changes and trends, including an increasing differentiation of faculty roles into researchers and clinicians, the tightening of restrictions on tenure eligibility, a decline in the proportion of tenure-track appointments, and new limits on the financial guarantee associated with tenure.
Although scholars have attended to changes in policies and practices of clinical faculty appointment and compensation, we know less about trends for basic science faculty members. Historically, the policies regarding basic scientists did not greatly deviate from traditional practices as defined by the American Association of University Professors (AAUP). Basic science faculty typically encountered a tenure-track appointment, which, after seven years, led to an up-or-out tenure decision. It was assumed that tenure guaranteed the total salary of basic scientists, a modest figure compared with clinical faculty. In contradistinction to the salary support for clinicians, the majority of funding support for basic science faculty salaries was not dependent on external income but came from school funds.
In recent years, however, the external environment surrounding the basic sciences has been transformed, leading institutional leaders and policymakers to reexamine basic science faculty appointment policies. For many medical schools, the biomedical research enterprise is no longer a genteel academic pursuit but an underdeveloped strategic market opportunity. Biomedical research is considered a vast potential driver of economic development, entrepreneurial opportunities, and increased income streams. Most institutional leaders and department chairs are pursuing growth tactics for the biomedical enterprise in similar fashion to the unprecedented growth of the clinical arena after the passage of Medicare in the 1960s. As a result of increased extramural funding and changing institutional priorities, basic science faculty are under greater pressure to spend more time on research, win more extramural support, and recover higher percentages of their salaries.
Therefore, medical schools have also begun to alter many aspects of employment policies in an effort to mitigate their financial vulnerabilities yet still preserve tenure for the majority of basic science faculty in this new research environment. In this article, we describe three major trends for faculty in basic science departments at U.S. medical schools. First, nontenure-track appointments among basic scientists have grown over the last decade. Second, medical schools have been in the process of limiting the financial guarantee associated with tenure for basic science faculty. Third, schools have undertaken efforts to provide flexibility in some key areas of the tenure system to respond to the needs of their faculty members, especially junior and women faculty.
Data presented in this report come from the following sources: (1) results of the Faculty Personnel Policies Survey conducted by the Association of American Medical Colleges (AAMC) in Summer 2002, to which all 125 U.S. allopathic medical schools responded; (2) the AAMC Faculty Roster, a data system with key employment characteristics of approximately 95% of the full-time faculty in U.S. medical schools; (3) institutional faculty handbooks, bylaws, and other policies and procedures; and (4) telephone interviews and e-mail exchanges with medical school faculty affairs deans, deans of research, key faculty members, and principal business officers.