J Thorac Cardiovasc Surg 2001;121:S17-S18
© 2001 The American Association for Thoracic Surgery
Developing the Academic Surgeon: A Symposium |
Getting promoted
Irving L. Kron, MD
From the Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va.
Address for reprints: Irving L. Kron, MD, University of Virginia, Box 800679, Charlottesville, VA 22908.
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Abstract
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Promotion is an active process. At the beginning of his or her academic career, the surgeon should begin planning for this process. Surgeons need to understand the promotion documents at their institutions and to have a timetable for achieving tenure at the appropriate time.
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Introduction
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To begin an academic career, you have to have a doable job. There must be a clinical niche to fill. You must have protection if academic work is required. This is particularly true if the expectation is to develop an independent laboratory and obtain extramural funding.
1 Most important is careful mentoring. You need a division or department head who is truly interested in your academic success. That person needs to understand the promotion process and to judge his or her success on how well you do academically. Finally, you need to understand what the focus of a starting academician should be. Should it be clinical work primarily or nearly full-time research? It may be some combination of both. You need to decide this before you start your career. The institution with which you affiliate must have the appropriate amount of clinical work for you, space if you plan to start a laboratory, and a document that allows a surgeon to be promoted at the same rate as a basic scientist.
Carefully analyze the promotion document at your institution. You need to know when you have to be tenured and how much you need to write. Most institutions say that a substantial number of publications may not be necessary. They tend to underestimate how much you need to write. You must be certain that you are on the right promotion track. Most institutions have clinical investigator and clinical educator tracks. If you are a clinical investigator, you will need to have an independent laboratory and extramural funding by the time you become eligible for tenure. If there is a clinical educator track, you still need to know how many publications you need, how much clinical activity you need, and the objective criteria for evaluation of teaching. Usually, you will acquire a teaching award in this track.
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Elements of an academic career
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The elements of an academic career include clinical activity, scholarship, research, teaching, administration, and extramural activities. Teaching speaks for itself, but there are not many objective goals in teaching. These include, most importantly, teaching awards and leading student clerkships and residency activities. From the standpoint of the school of medicine, residency activities are not nearly as important as medical school teaching activities. Clinical activity at one time was discouraged for an academic surgeon. Now it is increasingly important and provides the funding for most hospitals and medical schools. Clinical activity is rewarding and can be used as a criterion for promotion. However, you just cannot show up and go to work. You must be aware of terms such as relative value unit and be a leader in some aspect of your clinical program. Administration tends not to be academically rewarded unless you become chair of your division or department. It is certainly appropriate to do administrative work if you enjoy doing it, but remember that this will not likely mean much to the promotion committee. The most important aspects are scholarship and research.
Scholarship basically is a fair amount of publications and presentations. Publications are particularly important if they are peer reviewed. You need to publish in appropriate journals—those that are recognized as particularly scholarly. You need to know exactly how many publications are required to make it to the next level. If you need 15 publications by your fifth year, you cannot expect to have one article published in the first 5 years and then 10 papers in the sixth year. Even if you do not write a laboratory publication, it is possible to be published. You can conduct both retrospective and prospective clinical studies and present the findings at national meetings; such presentations are essentially published papers. A presentation without publication is not important. Presentations at national meetings are critical, but presentations for pharmaceutical companies provide no academic value.
Extramural activities are critical. These include work for various societies and editorial boards. This is the fun part of our specialty, and it is important to develop leadership at national and international levels. Work for our societies is work for our specialty and clearly needs to be encouraged. However, you must balance your time away from home working with your societies with the importance of developing your local reputation, clinical referral base, and publications. You also need to remember what your day job is.
It is important to understand the various promotion levels. One usually is hired as an assistant professor. You can be hired as a clinical instructor but this usually is a temporary position. It is important that the original appointment be on the tenure track. This puts you in a position to ascend the ladder. The rand of associate professor can be achieved 3 to 7 years after being hired. It is important to have a local reputation and some level of academic productivity. Ten to 20 publications usually are required for promotion to associate professor. Tenure usually occurs sometime after the rank of associate professor is achieved. It is possible but unlikely to be promoted to associate professor with tenure; tenure usually is achieved in 7 to 10 years. Tenure does not buy much anymore, but it is nice to have. Tenure does not guarantee a salary anymore, but it is difficult to lose a tenured position. Full professorship is the ultimate accolade in an academic institution. Most institutions require a national and international reputation and usually more than 40 publications. Various teaching awards, high levels of clinical activity, and often some administrative title are required.
To achieve the various levels, you need to know the composition of the promotion committee. Promotion committees vary from medical school to medical school. Some committees are linked to the undergraduate school, and some are composed solely of clinicians. At most medical schools, the promotion committee is a mix of basic scientists and clinicians. There is a perception that promotion committees tend to be antisurgical. That is not the case. It is important that the committee understand what you do for a living. Surgeons in general need clinical activity to keep their competence, and most promotion committees are used to dealing with basic scientists or clinician investigators who perform little, if any, clinical activity.
One of the most important aspects of being promoted is your promotion package. The promotion package is what the promotion committee sees. It is usually prepared by your mentor or division head. You need to have an active role in developing your promotion portfolio. This portfolio explains what a thoracic surgeon is and what you are doing that makes you deserving of a promotion. You need to explain what is unique about your research, your importance in the clinic, and your national reputation. You need to make sure that your chairperson is on board and be certain that the timing is right. It is always good to be promoted earlier than later, but if you go before the committee early you need to be able to accept being declined for promotion. I cannot tell you how many persons I know who left academics because they were denied a promotion. Be realistic about your chances and look at any negative reviews as objectively as possible. These reviews usually are not personal. Most important, you need to make it easy on your chairperson and the promotion committee by putting yourself in a good situation before promotion.
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Summary
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There are many rewards in academic surgery. There is a wonderful chance to develop new knowledge and teach residents and students. You can develop a large clinical practice with exciting and difficult problems to deal with. However, promotion is part of the package, and you must be prepared to deal with this from the day you enter an academic institution. Read the promotion document from your institution the day before you sign on. Begin preparing for promotion the day you arrive for work.
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Footnotes
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Read on April 29, 2000, at the Eightieth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada. 
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References
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- Kron, IL. Getting funded [review]. J Thorac Cardiovasc Surg 2000;119:526-8.
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Abstract
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