When It Comes to Hiring Faculty Physicians, Money Talks

Difficulty Filling Vacancies Not Always Tied to Reasons Given for Leaving

July 11, 2019 04:08 pm Michael Devitt

You'd think that understanding why a physician educator unexpectedly left an academic position would help you figure out how to recruit someone to fill that void, right?

[Physician in white coat shaking hands with new faculty hire]

If, for example, a faculty physician said she left her job at a residency program because patient care demands took too much time away from teaching and left her feeling burned out, or a physician faculty member at a large medical school said he threw in the towel because the mountain of administrative tasks he faced every day meant he wasn't able to eke out enough time to pursue his research interests -- you'd make it a point to provide protected time for those activities when trying to fill those vacancies, wouldn't you?

According to a new study from investigators at the Saint Louis University School of Medicine in Missouri, that strategy isn't likely to be helpful in recruiting to fill the position, because the factors that lead to burnout and attrition among faculty members aren't the same factors that contribute to challenges in hiring new faculty.  

Story Highlights
  • A survey of family medicine department chairs has provided new details about the factors associated with successfully filling vacancies for physician faculty positions.
  • Researchers asked department chairs general questions about the number of vacancies and vacancies filled in the previous 12 months, along with more specific questions about the most recent position filled.
  • Family medicine departments that offered higher salaries and signing bonuses filled vacancies considerably faster than departments that did not.

Their research,(journals.stfm.org) published in the June issue of Family Medicine, revealed some surprising -- and other not-so-surprising -- reasons behind how (and how soon) faculty vacancies are filled.

Study Design

The researchers emailed an electronic survey to 149 U.S. family medicine department chairs identified by the Association of Departments of Family Medicine. They received 75 responses.

Questions on the survey asked about the number of vacancies each department had in the previous 12 months, the number of vacancies filled during that period and the number of months the longest vacancy was open.

The survey also asked specific questions about each department's most recent position filled, including the position's rank, first-year salary, the number of months it was open, whether a signing bonus was offered, and the position's full-time equivalent allocation for clinical, research, teaching and administrative time.

Results and Analysis

Survey respondents reported having an average of 3.9 vacancies for full-time clinical faculty physician positions and 1.6 vacancies for part-time positions during the previous 12 months. Of those, departments filled an average of 2.5 full-time vacancies and 1.1 part-time vacancies within that time span.

On average, the longest vacancy for a full-time faculty position was 13.4 months, while the longest for a part-time faculty position was 10.1 months.

Most departments -- 81% -- offered protected time for teaching, 49% gave signing bonuses to new hires, and 28% offered protected time for research.

Aggregated details about departments' most recent full-time vacancy filled were as follows:

  • The position was open an average of 9.5 months.
  • 87% of departments hired the faculty member at the assistant professor level.
  • The average first-year salary was about $186,600.
  • Slightly more than 46% of departments offered a signing bonus.

Surprisingly, departments that did not offer protected teaching time filled a higher percentage of vacancies (85%) than departments that did (61%), the authors noted. However, these departments did not fill vacancies any more quickly than departments that offered protected teaching time.

Regarding the most recent faculty hire, results were essentially the same: The researchers reported no association between how long a faculty position was vacant and the FTE for teaching, research, clinical or administrative time.

"We had hypothesized that the FTE would be associated with difficulty filling a position given prior findings that dissatisfaction with the balance of clinical, research, teaching, and administrative effort was associated with quitting," the authors wrote.

Instead, they found that "a higher salary and a signing bonus were associated with positions being filled more quickly." In particular, family medicine departments that offered a signing bonus filled their vacancies considerably faster than departments that did not (7.5 months versus 11.2 months).

AAFP Expert Offers Insight

Karen Mitchell, M.D., director of the Academy's Medical Education Division and former president of the Association of Family Medicine Residency Directors, told AAFP News she was surprised at the low starting salary offered to faculty physicians in the study. "This would indicate to me that the faculty positions would be more attractive to new residency graduates over more experienced family physicians," she said.

Mitchell also found it surprising that only 81% of family medicine departments offered protected time for teaching. She pointed out, though, that the survey did not clearly define teaching time and noted that because faculty members often are teaching students while providing clinical services, some departments may designate that time as "clinical" rather than "teaching." That could explain why an offer of "designated teaching time" may not be a significant factor in helping fill faculty positions.

For family medicine department chairs and residency directors concerned about faculty recruitment and retention, Mitchell offered some advice:

"It is important to pay faculty at rates competitive with other options available to family physicians. Also, as new family physicians develop to gain clinical experience and confidence, it is likely that 'protected' teaching and research time becomes more important later in their careers. As long as salaries remain competitive for the work environment, the designation of protected time may be more important in retention than in recruitment."

It's also important to keep in mind that there are other educational avenues for family physicians who want to pass their knowledge and experiences on to the next generation of FPs, she noted.

"The need for clinical preceptors in family medicine remains high," Mitchell said. "Family physicians do not need to be full-time academicians in order to be involved in the teaching and precepting of students."

Related AAFP News Coverage
News From AMA Annual Meeting
AAFP Delegation Stands Up for Residency Teaching Faculty
(6/19/2019)

Family Medicine for America's Health
Workforce Tactic Team Sets Stage to Increase Ranks of FPs
(3/4/2019)

More From AAFP
Family Medicine Faculty

Teaching, Physician Responsibility

Physician Health First

Additional Resource
American Journal of the Medical Sciences: Tenure and the Faculty Physician(www.amjmedsci.org)
(February 2017)