Taking the next step. From medical school to intern year. Working your way through residency, choosing your fellowship, and starting your first attending position. Moving from observer to assistant to leading the operation. Our professional lives are marked by achieving the next step.
What does that mean when you are a junior attending? Working towards promotion.
As an Acute Care Surgeon at an academic medical center, I am on the clinical educator track. I have been fortunate to have mentorship both inside and outside of my institution that has provided guidance in this process. Preparing to write this piece, I found additional resources which I wished I had reviewed earlier in my career. I have cited a few below, but one I recommend everyone read during their first year as an attending is an article written by Dr. Hasan Alam simply titled “Promotion” . It provides an excellent guide to successfully set yourself up for the next step. Through this post, I wanted to share the things I wish I knew earlier and a few things I have done right!
Let’s start off with the Who, What, When, Where, and Why of Promotion.
Who: Promotion impacts all academic surgeons.
What: Promotion is the process of moving up in the academic ranks from Assistant to Associate to Full Professor. There are different tracks for clinical educators versus those with a major research focus including different metrics and timelines with options for tenure.
When: Most move from Assistant to Associate professor in 5-7 years. Promotion to full professor usually takes an additional 5-10 years.
Where: Promotion occurs within a medical school through a promotions and tenure committee.
Why: Prestige, reputation, financial, personal, increased opportunities
First, find out what your institution’s requirements are for promotion and do this within the first couple of months of starting at a particular program. Although each school has a set of unique requirements, many measures for promotion are universal and are centered on four main arenas – clinical work, teaching, scholarship, and service . Clinical work involves your patient care and clinical productivity. Teaching of medical student, residents and fellows is assessed by the hours of dedicated time and trainee evaluations. Publications, presentations, advanced degrees, and external funding for research projects are key elements of scholarship. Service is marked by your contribution to the hospital, medical school, community, and professional societies by working on committees and leading initiatives. You will be asked to demonstrate significant achievements in all these areas.
A second part of the promotions packet are letters of evaluation/recommendation. You will be asked to provide 2-4 letters from authors that are at the same rank or above the rank you are applying for. These authors should be able to address your clinical work and service but not have been a former mentor or advisor, commonly referred to as “arm’s length” letters. Most intuitions also stipulate some or all letters be from physicians at outside institutions.
Second, talk to those who have recently been successfully promoted. They can give specifics regarding the timeline, departmental support, and contacts to help smooth the way. They may make you aware of institutional biases and difficulties navigating the process. There has been significant focus on gender and racial disparities at the higher levels of academic medicine and current research is working on understanding how the promotion process may contribute to this issue .
Third, keep your CV up to date and inclusive of all activities you have participated in. This seems like a relatively easy task, but don’t be fooled. Promotion committees will often require a specific format with your achievements listed in particular categories. On a monthly basis, I encourage you to update your CV with every student you mentored, lecture you gave, abstract accepted and paper presented, every committee you have served, and taskforce you lead. At this time, also take inventory of areas you want to bolster and supplement. As junior faculty, we are encouraged to say yes to opportunities to get involved, but ensure these activities are being counted and strengthen specific areas of your professional package.
So, it seems like a lot of work, and you may be asking why am I doing all of this? There are many reasons to pursue promotion. Academic salaries are set based on your level with increasing pay scales from Assistant to Associate to Full Professor. Gaining promotion early will increase your overall earning potential . Oftentimes, administrative and leadership positions are offered to those at higher ranks. Gaining a regional and national reputation for your skills and work support your promotion and further enhance your standing within the surgical community.
In summary, start early, get informed, and be prepared. Knowing what is needed to take the next step makes it much easier to navigate promotion!
- Alam HB. Promotion. Clin Colon Rectal Surg. 2013 Dec;26(4):232-8. doi: 10.1055/s-0033-1356723. PMID: 24436683; PMCID: PMC3835443.
- Cochran A, Neumayer LA, Mellinger JD, Klingensmith ME, Scott DJ, Dunnington GL, Brasel KJ. Career Advancement for Surgeon-Educators:Findings from a Modified Delphi Process. J Surg Educ. 2022 Jan-Feb;79(1):173-178. doi: 10.1016/j.jsurg.2021.06.018. Epub 2021 Jul 20. PMID: 34294571.
- Murphy M, Callander JK, Dohan D, Grandis JR. Women’s Experiences of Promotion and Tenure in Academic Medicine and Potential Implications for Gender Disparities in Career Advancement: A Qualitative Analysis. JAMA Netw Open. 2021 Sep 1;4(9):e2125843. doi: 10.1001/jamanetworkopen.2021.25843. PMID: 34542616; PMCID: PMC8453318.
- Baimas-George M, Fleischer B, Korndorffer JR Jr, Slakey D, DuCoin C. The Economics of Academic Advancement Within Surgery. J Surg Educ. 2018 Mar-Apr;75(2):299-303. doi: 10.1016/j.jsurg.2017.08.016. Epub 2017 Sep 1. PMID: 28870711.