For those who are not familiar with academia in general or academic medicine specifically, it’s important to begin with some basic definitions and descriptions. Among university faculty, there are four ranks; in order of ascending seniority, they are clinical instructor, assistant professor, associate professor, and (full) professor. Clinical instructors and assistant professors are “junior faculty.” Associate professors and full professors are “senior faculty.” Some institutions offer tenure to their senior faculty. Promotion from junior to senior faculty or from assistant to associate professor is a major career event. Therefore, the goal of getting promoted or tenured is likely to shape your entire junior faculty career.

In academic medicine, there are many different career tracks or paths, the details of which vary somewhat by institution. Physicians in academic medicine are either on a clinical promotion track or an academic promotion track. Physicians in clinical promotion tracks can be either volunteer clinical faculty or core clinical faculty. Volunteer clinical faculty are physicians who are not primarily employed by a medical school or a university. They are usually doctors in private practice who enjoy teaching and so work with trainees, either medical students or resident physicians, in a variety of clinical settings such as their own offices, emergency rooms, or hospitals.   Core clinical faculty are those physicians who are either partially or completely employed by a teaching hospital or university. Their primary responsibility is to generate revenue via direct clinical care. They may do some teaching as well. Clinical faculty do not typically have significant academic responsibilities such as writing grants and papers.

Academic physician faculty are usually employed by an institution such as a medical school, a university, a hospital, or a specialty foundation. They serve as clinicians but also have significant roles as educators, researchers, and/or administrators. Academic physicians can pursue one of several different promotion tracks depending on both the policies of their institution and their individual interests. For example, the primary focus of a faculty member in a “teacher-scholar” track is medical education and, to some extent, medical education research. In contrast, the primary focus of a faculty member in a “research” track is either clinical or bench research. Research faculty will be expected, at some point in their careers, to generate either partial or complete salary support for themselves with grant funding. Although the exact names of these various tracks vary slightly by institution, the basic principles are relatively uniform across universities. Many institutions have what is referred to as an “up or out” policy for their academic faculty, regardless of track. “Up or out” means that unless you meet the criteria for promotion within a certain period of time in years, you may not be able to stay in your current job.