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Competing Risks Analysis of Promotion and Attrition in Academic Medicine

A National Study of U.S. Medical School Graduates

Jeffe, Donna B., PhD; Yan, Yan, MD, PhD; Andriole, Dorothy A., MD

doi: 10.1097/ACM.0000000000002441
Research Reports

Purpose Competing risk methodology was used to identify variables associated with promotion and attrition of newly appointed full-time instructors or assistant professors in U.S. MD-granting medical schools.

Method A national sample of U.S. MD-granting medical school graduates in calendar years 1997–2004 who received initial full-time instructor or assistant professor appointments from January 1, 2000 through December 31, 2012, was followed through December 31, 2013. Adjusted proportional subdistribution hazard ratios (aSHRs) measured the effects of demographic, educational, and institutional variables on promotion and attrition.

Results The final study sample included 27,219 full-time instructors (n = 10,470) and assistant professors (n = 16,749). In all models (entire sample and stratified by initial rank), faculty who reported all other (vs. full-time faculty) career intentions at graduation and were underrepresented racial/ethnic minority (vs. white) faculty had lower aSHRs for promotion and greater aSHRs for attrition, whereas research-intensive (vs. non-research-intensive) medical school graduates, faculty at schools without a tenure track, and mentored K awardees had greater aSHRs for promotion and lower aSHRs for attrition. In all models, faculty with ≥ $100,000 (vs. no) debt at graduation had greater aSHRs for attrition. Among instructors, women had lower aSHRs for attrition than men, but among assistant professors, women had greater aSHRs for attrition.

Conclusions This study adds new knowledge about career trajectories of academic medicine faculty initially appointed as full-time instructors. Career development interventions and research mentoring during and after medical school and debt reduction programs could help increase academic medicine faculty retention and promotion.

D.B. Jeffe is professor of medicine, Washington University School of Medicine, St. Louis, Missouri; ORCID: http://orcid.org/0000-0002-7642-3777.

Y. Yan is professor of surgery and biostatistics, Washington University School of Medicine, St. Louis, Missouri; ORCID: http://orcid.org/0000-0002-5917-1475.

D.A. Andriole was associate professor of surgery and assistant dean for medical education, Washington University School of Medicine, St. Louis, Missouri, at the time of this work. She is now senior director of medical education research, Association of American Medical Colleges, Washington, DC; ORCID: http://orcid.org/0000-0001-8902-1227.

Funding/Support: This study was supported by a grant from the National Institutes of Health National Institute of General Medical Sciences (R01 GM085350).

Other disclosures: None reported.

Ethical approval: The study was approved as non-human-subjects research by the institutional review board at Washington University School of Medicine.

Disclaimer: The conclusions of the authors are not necessarily those of the Association of American Medical Colleges, National Institutes of Health National Institute of General Medical Sciences, or their respective staff members. The National Institute of General Medical Sciences was not involved in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.

Previous presentations: Preliminary analyses were presented at the Association of American Medical Colleges Learn, Serve, Lead Annual Meeting, Boston, Massachusetts, November 3–7, 2017, and at the 10th Conference on Understanding Interventions That Broaden Participation in Research Careers, Baltimore, Maryland, March 2–4, 2018.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A595.

Correspondence should be addressed to Donna B. Jeffe, Department of Medicine, Washington University School of Medicine, Campus Box 8005, 4523 Clayton Ave., St. Louis, MO 63110; telephone: (314) 286-1914; e-mail: jeffedonnab@wustl.edu.

© 2019 by the Association of American Medical Colleges