Valerie Lang, MD, MHPE, is a hospitalist at the University of Rochester School of Medicine in Rochester, N.Y., where she’s also a tenured professor of medicine, a major academic achievement that is particularly notable for a hospitalist.
But achieving that rank, she said, was anything but pre-ordained.
Dr. Lang
When she was an assistant professor and was applying for promotion to associate professor, she had to demonstrate achievements in scholarship. Her work involved the development of an interactive virtual patient curriculum used in the education of medical students across the country. But this kind of scholarship didn’t strike leaders involved in the promotions process as particularly important, Dr. Lang said. At one point, her work was described as a “case report,” she recalled.
Gaps Remain in Promotion Criteria
“It really wasn’t understood because the promotions criteria were interpreted through the lens of people who had made their clinical careers doing clinical or bench research, and, at that point, what counted were your grants and publications in peer-reviewed journals,” Dr. Lang said. “Those aren’t bad things—but it was very constricting.”
Since then, the promotion process has become more accommodating to hospitalists, with more appreciation of their entire body of work and recognition of a wider range of scholarship, Dr. Lang said. Years after her hard-fought promotion to associate professor, her promotion to full professor was a much simpler process. But a gap remains between the promotions criteria at most medical schools and the work that hospitalists do on a daily basis, she and others say.
“I’ve seen some enormous shifts in the promotions process,” Dr. Lang said. “But I think that even with shifts, there’s still some legacy of traditional approaches to the promotions process that still impact hospitalists a lot.”
High-ranking hospitalists and promotion-seeking hospitalists alike say that—even though it’s been about two decades since hospital medicine was first recognized as a medical subspecialty—the promotion process is still ill-fitted to their work, putting an added burden on hospitalists if they want to climb up through the academic ranks. Despite the challenges, they say, there are specific steps hospitalists can take to prepare themselves once the time for promotion comes around, with awareness and early preparation chief among them.
Dr. Migliore
Chris Migliore, MD, a hospitalist and assistant professor of medicine at Columbia University’s Vagelos College of Physicians and Surgeons in New York, said the promotions criteria, for the most part, predate the hospital-medicine field, and don’t contemplate the intense, day-to-day workload of hospitalists who usually have little time to do much else.
“The entire discipline was formed after many of these protocols for advancement for promotion were put into place,” said Dr. Migliore, who himself has been preparing for the promotion process to become an associate professor. “It’s such a unique role that those promotion processes didn’t even consider someone in that unique of a role where all we’re doing is taking care of patients.”
Too Many Variations
Sahar Rooholamini, MD, MPH, a hospitalist, assistant dean for faculty recruitment and retention, and associate professor of pediatrics at the University of Washington in Seattle, where she has long been involved in the promotions process, said the variation of the promotions criteria from medical school to medical school also poses a challenge for hospitalists preparing themselves for the process.
Dr. Rooholamini
“If you’ve seen one institution’s promotion guidelines, you’ve seen one institution’s promotion guidelines,” she said.
The University of Rochester’s avenues for promotion are just one example of the complexities hospitalists have to consider.1
There are professional titles—such as professor of clinical medicine—for which no national reputation or scholarship is required. And there are academic titles, such as professor of medicine. Some academic titles have a clinical and teaching component, which many hospitalists choose. These may require minimal scholarship, but do require a national reputation for promotion to associate professor, Dr. Lang said.
Some hospitalists pursue the scholarship component, with “scholarship” generally meaning a tangible product or platform others can build on, one that undergoes peer review and is publicly disseminated. The advantage of being promoted via this component is that these faculty are eligible for tenure and sabbaticals.
It’s important for hospitalists to understand these nuances,” Dr. Lang said.
Across medical schools, there are differences in the tracks that are offered, with different emphases depending on the track you’re in. But some threads seem to run through many medical schools’ promotion criteria.
Stumbling Blocks
Common stumbling blocks for hospitalists looking to be promoted from assistant professor to associate professor—often the first major promotion attempt undertaken by hospitalists— include requirements for a budding national reputation and publication requirements. Both of these require having time away from daily clinical demands in order to develop that part of the promotion portfolio.
At Columbia, promotion to associate professor with an “applied healthcare or public sciences” focus—often the track hospitalists would choose—requires a “strong regional reputation and emerging national reputation.”2
The criteria also include “authorship of book chapters, case reports, or membership in clinical or public health research as a site investigator for large multicenter trials or public health intervention disciplines.” There is a requirement for “development of guidelines/patient care or public health protocols.” Both of these, Dr. Migliore noted, involve a peer-reviewed publication component.
A look at a sampling of other medical school promotion criteria shows that many of them mention a scholarship requirement.
The Northwestern University promotions criteria for clinical associate professor call for “a local and regional reputation as an outstanding clinician and/or scholar in his/her area of expertise.” Clinical impact and recognition are measured in part by “development and implementation of clinical protocols and guidelines, clinical programs, and/or quality initiatives; demonstration of unique clinical expertise; and publication of original papers, case reports, reviews, editorials, and book chapters.”3
At the University of Washington, candidates for associate professor of clinical practice must have a “local or regional recognition for excellence.” They also have to demonstrate outstanding clinical care, professionalism, and teaching over a sustained period, and must have “participated meaningfully” in one of five scholarship domains, at least locally.4
Dr. Rooholamini said that the University of Washington—like many schools—lays out the promotions process online and tries to support hospitalists and all physicians in their promotions efforts.
“If we want to recruit and retain excellent people, they need to understand how they are going to progress in their career, how they’re going to be promoted, and what resources are available to them. We really try to help people thrive,” she said. “Each university is going to have a different structure for this, but we are trying … to provide a central place where people can go, at least to start asking questions.”
She said guidance on the promotions process should be highlighted at the time of hiring, though she acknowledged this sometimes can be easier said than done.
She said this period can be “like drinking from a firehose—it’s a lot of information, but ideally this would be part of onboarding.”
Dr. Westphal
Kathryn Westphal, MD, assistant professor of medicine at The Ohio State University in Columbus, said the university has been helpful in her pursuit of promotion.
“They have been supportive of my clinical work and areas of scholarship and education,” she said. “I am fortunate to have non-clinical time for these endeavors, which have helped me work towards the criteria for promotion.”
At Ohio State, in addition to teaching, mentoring, and clinical work, candidates for associate professor in the clinician educator pathway must show “contributions to scholarship, a portion of which should be peer-reviewed journal publications either focused on the pedagogy of education or based on their clinical expertise.”5
Dr. Migliore said hospitalists are not usually very proactive in tracking their progress to promotion because there is often little time or incentive to do so.
“They will have to choose—am I going to spend this time writing two papers and doing research, making sure that I can become an associate professor, versus, am I going to continue to see patients in clinic and rack up my RVUs to meet my clinical compensation targets so I can get full bonuses?” he said.
“I just don’t believe the incentives are there,” he said. “If you’re going to compete on publications and length of stay, length of stay wins.”
In the course of a hectic day, it’s very easy for hospitalists to pay little attention to the promotion process, especially if it is difficult to navigate, he said.
“We are so busy taking care of patients that when we are confronted with these complex or Rube Goldberg-type systems, a lot of people are like: ‘Is this required?’” And when the answer is “no,” he says, the hospitalists respond with, “I’m ignoring it.”
Dr. Lang has done research showing that hospitalists are less likely to seek out promotions if they see the criteria as not dovetailing with their identity as a hospitalist.6
“How hospitalists identify themselves is part of the challenge,” she said. “If they see that their professional identity doesn’t align with what the criteria value”—or if the criteria aren’t practiced in the way it appears they should be—“then you get a lot of distrust and a lack of motivation.”
She also found that hospitalists seeking promotion might have a hard time with the national-reputation requirement.
“That trips a lot of people up. Partly because if they’ve been focused on investing their work in the institution and less on traveling to conferences and networking outside the institutions, they sometimes can’t meet that criteria,” she said. “Reputation’s very vague, it’s nebulous. There’s a lot of concern that it’s wrought with bias, especially depending on the niche that you’re working in.”
Dr. Migliore said that academic institutions themselves can benefit from hospitalists being motivated to pursue promotions.
“Promotion for a hospitalist would lend credence to the field of hospital medicine when looked at by an outsider, or within a particular institution,” he said. “If more hospitalists are at advanced ranks, this may increase their academic clout at an academic institution.”
As it stands, though, he said, he works with more than one hospitalist at the assistant professor rank who “will likely never be an associate professor, but they are the best inpatient doctors I know.
Tips from the Trenches
These hospitalists—speaking from different ranks and perspectives but all of whom have thought about or studied the promotions process—offered several suggestions for navigating the process:
Understand the promotion criteria. Medical schools tend to publish their criteria online. They are often dozens of pages of dry reading, but hospitalists should read and have a good understanding of the criteria very early in their career so that they can begin preparing as soon as possible.
Dr. Rooholamini said that early-career hospitalists, when applying for jobs, tend to ask about things like call schedule, compensation, and education opportunities, and not about how the promotions process works. They are, she said, “happy to contribute and do the work but have very little context about what the scaffolding (is), what track they’re on, what they need to do to get promoted.”
They need to understand which tracks are available, whether clinical, education, or research-focused; which track they should choose; whether it’s possible to switch tracks; how that switch might take place; and the timing of everything.
In other words, they should take charge of the process, she said.
“For people having gone through all this training and all this work, I would not assume someone is going to tell you when you’re ready for promotion,” Dr. Rooholamini said. “And instead, be proactive about it on the front end.”
Dr. Migliore said he was only somewhat exaggerating when he said the promotions process is “100 percent opaque” to most early-career hospitalists. Instead of taking an interest in the process, there is “indeterminate optimism where we just expect good things for no reason.”
“Promotion is one of those things where we just expect people to figure it out—and that’s just not how that works,” he said.
Seek a mentor. Dr. Lang said that seeking out a mentor is important because mentors can help early-career hospitalists understand the nuances of the promotions process at that particular institution. Even though the criteria are written out in detail, how they are interpreted and put into practice—such as which criteria might be given more weight than others—varies from place to place.
“You really do need to have somebody who understands the local context and the local culture,” Dr. Lang said.
Dr. Rooholamini said that if finding a traditional mentor is not possible, then you could ask two or three people whose opinion you value, and who have diverse experiences, to get together a couple of times a year to offer advice to hospitalists who are seeking it.
“You can form your own career development committee,” she said.
Dr. Migliore said he has been meeting with a mentor to review his portfolio as he prepares to seek promotion to associate professor. Mentors also can help new hospitalists understand the process when they are first starting out, he said.
Track your progress. Dr. Westphal said she has created a document for this. “I personally have created an Excel sheet with the criteria for promotion on my pathway to track my activities, roles, and publications,” she said. “This makes it easy for me to see where I have gaps and where my strengths are, as opposed to going through my CV, which is more tedious.”
Dr. Westphal has also helped create a database of faculty who have expressed willingness to write external letters of recommendation.
Seek time for research. Dr. Westphal said she has protected non-clinical time for scholarly work, but not all hospitalists do. She said it depends on your track and your positions. But she sought it out from the beginning, she said.
“Completing a pediatric hospital medicine fellowship allowed me to establish a pattern of productivity that could be continued if given the time as faculty, which the division and department supported with my initial contract,” she said.
Get involved with societies. To prepare for promotion to associate professor, being involved with societies—such as the Society of Hospital Medicine or the Society of General Internal Medicine—can help develop the often-required “emerging national reputation,” Dr. Migliore said.
“It is amazing, if you do really good work, how fast these spots open up,” he said. “It does snowball into a national opportunity.”
That, he said, is “what I have found to be the most effective—and, to be honest, the fastest— way to get national recognition, is to do really good work with a society.”
Tom Collins is a medical writer based in South Florida.
References
1. Promotion on the “at CUMC” faculty track. Columbia Vagelos College of Physicians and Surgeons website. https://www.vagelos.columbia.edu/about-us/explore-vp-s/leadership-and-administration/academic-affairs/faculty-professional-development-diversity-inclusion/academic-appointments-and-promotion/cumc-track/promotion-cumc-faculty-track. Accessed October 27, 2025.
2. Information guide for appointments, promotions, and tenure (APT). Northwestern Feinberg School of Medicine website. https://www.feinberg.northwestern.edu/fao/docs/admin-general/Information-Guide-for-APT.pdf. Published February 20, 2025. Accessed October 27, 2025.
3. Appointment and promotions guideline clinical practice track. UW Medicine website. https://faculty.uwmedicine.org/wp-content/uploads/2024/12/Medicine-Clinical-Practice-Track.pdf. Published December 2024. Accessed October 27, 2025.
4. Regulations of the faculty. University of Rochester School of Medicine & Dentistry website. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/smd/academic-affairs/documents/faculty-regulations/Faculty-Regulations-July-2014-revision-10-13-2017_2.pdf. Published October 2017. Accessed October 27, 2025.
5. Appointments, promotion and tenure criteria and procedures for The Ohio State University College of Medicine. The Ohio State University website. https://oaa.osu.edu/sites/default/files/links_files/Medicine-APT-rev-11-2023.pdf. Published November 15, 2023. Accessed October 27, 2025.
6. Lang VJ, et al. Academic hospitalists’ views on promotion through the lens of professional identity. J Hosp Med. 2025. doi: 10.1002/jhm.70139.