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Move to the Head of the Class


Sanjay Saint, MD, MPH

Moving up the ranks of academic hospital medicine—from instructor to assistant professor, and especially from assistant professor to associate professor—was covered in-depth by professors Scott Flanders, MD, and Sanjay Saint, MD, MPH, of the University of Michigan in Ann Arbor, and Stephan D. Fihn, MD, MPH, head of the Division of General Internal Medicine at the University of Washington, in the session “How to Get Promoted as an Academic Hospitalist.”

Choose a Track

Dr. Flanders said there are several tracks within hospital medicine in academia. They include:

Clinician-Investigator: This is usually a tenure-track position, where 60% to 80% of the hospitalist’s time is protected for research. Usually, you’ll receive at least partial salary support for about three years, after which you’re responsible for finding independent funding to cover most of your salary. Retention and promotion are based on academic productivity including publications, grants, and national recognition.

Clinician-Educator: With approximately 10% to 30% of their time protected for research, these professionals usually get indefinite salary support—although they’re expected to generate most of their salary through clinical work. Retention and promotion are based on teaching accomplishments and clinical skills and, to a lesser extent, academic productivity.

Clinician-Administrator: With any­where from 10% to 50% of their time protected for administrative work, these experienced hospitalists serve as directors, associate or assistant directors in a hospital medicine group, or in a clerkship role at a university. Retention and promotion are based on administrative skills, teaching prowess, clinical skills, and academic productivity.

Criteria for Promotion

Regardless of which track you’re on, when applying for a promotion you’ll be evaluated in these domains: clinical work, teaching, and administrative and scholarly work.

“These are universal to all institutions,” said Dr. Flanders. “You need to demonstrate excellence in each.” More specifically, you’ll need five to seven letters from impartial faculty outside your institution—preferably leaders in the field who hold at least the rank you are trying to achieve.

“Ask yourself as you get halfway between your associate and assistant professorship,” said Dr. Flanders, “who outside your institution knows you and your work.”

To earn a promotion, you’ll need to develop a regional and national reputation.

Steps for Promotion

Dr. Flanders offered advice on how to prepare for a successful career in academia.

“It helps if you develop a clinical niche,” he said. “Become the expert in one area in your group or institution.”

He also advised working toward giving clinical lectures to faculty and trainees in other departments, performing grand rounds in other departments, and speaking at neighboring institutions. To establish excellence in teaching, get feedback from students and work on improving your methods. Be innovative in your teaching and document your work in an education portfolio.

When focusing on administrative excellence, if you’re a director or an assistant director of a hospital medicine program, “make substantial contributions,” said Dr. Flanders. “… demonstrate that you’ve done leadership in … QI projects, and that this was important for your institution and more importantly, for other institutions.”

To generate scholarly work, write up your clinical cases as vignettes, case reports, or clinical problem solving; evaluate and disseminate your QI interventions; and establish connections with trained researchers.

“Ultimately, the goal is to have a national reputation,” Dr. Flanders reiterated. “It’s easiest if you’ve got 10 to 12 [articles in] peer-reviewed publications.”

Good Habits

Dr. Saint provided a list of seven habits of highly effective junior faculty members. They include:

  • Know the rules. Understand what’s expected of you and the criteria for promotion;
  • Develop expertise;
  • Learn how to diversify your portfolio. Balance the risk between high-, moderate-, and low-risk projects;
  • Find and utilize good mentors and collaborators;
  • Quickly demonstrate academic productivity;
  • Build a superb team. Hire the right research assistant; and
  • Manage your time wisely. Guard your protected time. TH

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