Abstract
BACKGROUND AND OBJECTIVES
Doctoral trained faculty educators increase faculty physicians’ skills and capacities by implementing training and mentoring programs in academic primary care departments. The purpose of this study was to describe the characteristics, roles, challenges, and satisfaction of faculty educators working in departments of family medicine and to report perceptions of their work environment.
METHODS
The data for this study derive from a 2009 national survey of all full-time doctoral-level faculty members, including educators, working in US academic departments of family medicine. Items included demographics, roles, research output, financial support, and perceptions of the work environment. Descriptive statistics including means and percentages were used to compare public and private institutions.
RESULTS
Twenty-five full-time faculty educators responded to the survey. Median age was 57 years; median years worked was 17, with 52% holding the rank of associate or full professor. Differences were observed between public and private institutions in terms of how time is spent, sources of funding, rates of tenure, and number of grants and publications. Job-related perceptions were mostly positive, indicating a good fit of training and job responsibilities. Areas of dissatisfaction included feelings of being over committed and increased job stress.
CONCLUSIONS
As senior faculty educators retire, it is important to assure that the torch is passed to new faculty educators who can meet the professional development needs of future generations of family physicians.
Academic medical centers are at a crossroads in training faculty physicians. Due to the graying of American faculty 1 and increasing clinical demands on faculty physicians,2 there is a critical need to develop the capacity of faculty physicians to adapt to health system change 3,4 through training programs and active mentoring. Within academic primary care departments, doctoral-trained educators are employed to coordinate and conduct professional development and mentoring programs for the faculty.5–7 The purpose of this study was to describe the characteristics of full-time doctoral trained faculty educators in departments of family medicine, their roles, perceived challenges, satisfaction, and perceptions of their work environment.
Methods
The data for this study derive from a 2009 national survey of all full-time doctoral-level faculty members working in academic departments of family medicine. The survey contained demographic items, perceptual questions, and open-ended questions regarding types of research currently being done, roles in the department, number of authored journal articles, number of hours worked, number of grants, sources of financial support, and annual salary. Surveys were mailed to all nonphysician doctoral faculty members employed in academic family medicine departments at all public and private universities in the United States. The study was approved by the University Hospitals of Greater Cleveland Institutional Review Board.
Nonphysician doctoral-level faculty members were identified through family medicine department websites, attendance rosters from conferences for national professional organizations, eg, the Society of Teachers of Family Medicine, and other Internet searches. A total of 307 nonphysician doctoral-level faculty members were identified and mailed the survey. Second and third mailings to nonrespondents were sent approximately 3 and 6 weeks later, respectively. Remaining nonrespondents were contacted by email and offered the opportunity to participate. Means and percentages were computed for demographics variables. Because of the small study sample size, when comparing public and private institutions, effect size 8–9 was emphasized rather than P values. Effect size was estimated as a proportion of a standard deviation for continuous variables and by differences between percentages for categorical variables.
Results
Out of the total sample of respondents, 25 full-time faculty educators returned a survey. Because the number of faculty educators in all US departments of family medicine is not known, a response rate cannot be reported. However, the response rate for the total sample of participating nonphysician doctoral-level faculty members was 68%.
Demographic descriptors of the full-time faculty educators are shown in Table 1. Of interest is the median age of faculty educators (57), the median number of years (17) worked in academic family medicine departments, and their academic rank (52% were professor or associate professor). This profile describes a group of mostly senior faculty members.
Table 1.
Demographic Description of Full-Time, Doctoral Trained Educators Working in Departments of Family Medicine (n = 25)
| Age | Median: 57 |
| Range: 41–68 | |
| Years in Department | Median: 17 |
| Range: 2–35 | |
| Hours worked/week | Median: 55 |
| Range: 40–80 | |
| Annual Salary | Median: $90K–$110K |
| Hard Money | 70% Covered 100% |
| Gender | 56% Female |
| Joint Appointment | 32% Yes |
| University Type | 68% Public |
| Race | 88% White |
| 8% African American | |
| 4% Asian | |
| Academic Rank | 33% Professor |
| 29% Associate Professor | |
| 38% Assistant Professor/Instructor | |
| Tenure Status | 28% Tenured |
| 20% Tenure track | |
| 52% Not on tenure track | |
| Time Allocation | 7% Research (median) |
| 20% Teaching (median) | |
| 50% Administration (median) |
Table 2 contrasts faculty educators working in public versus private academic institutions. Interpreting only those differences considered a medium or large effect size,8–9 public institution faculty educators had more years of service and thus were more likely to have higher salaries, to be tenured, to have more time for research, to have more funded grants as a co-investigator, and to have more publications. In contrast, faculty educators at private institutions were more likely to have a higher percentage of their salaries covered by institutional funds versus grant support, spend a greater percentage of their time on administration, and devote more time assisting on grant proposals but not as principal investigator or co-investigator.
Table 2.
Description of Educators Working in Public vs. Private Institutional Settings
| Public n = 15 |
Private n = 7 |
|
|---|---|---|
| Age (Median, SD) | 54 (8) | 57 (9) |
| Years in the Department (Median, SD) | 17 (10) | 10 (8) |
| Hours worked/week (Median, SD) | 55 (9) | 55 (15) |
| Race (% White) | 87% | 86% |
| Gender (% Female) | 47% | 57% |
| Academic Rank (% Senior) | 60% | 57% |
| Salary (% >$90K) | 79% | 50% |
| Hard Money (Covered 100%) | 64% | 83% |
| Tenure (% Yes) | 33% | 14% |
| Joint Appointment (% Yes) | 27% | 43% |
| Time Alloc. for Research (>10% Time) | 71% | 29% |
| Time Alloc. for Teaching (>25% Time) | 57% | 43% |
| Time Alloc. for Administration (>50%) | 57% | 86% |
| Funded Grants as PI (% any in 3 years) | 71% | 57% |
| Funded Grants as Co-I (% any in 3 years) | 80% | 43% |
| Grant Proposals Assisted (%>1/year) | 43% | 71% |
| Publications (% >1/year over 3 years) | 50% | 29% |
Eighty percent or more of responding faculty educators moderately or strongly agreed that they enjoyed their work and that family medicine was a good fit for them. Seventy percent or more agreed that they were an integral part of the department and would recommend work in family medicine to other educators. More than 60% believed that they were valued by the physician faculty.
The most cited negative perception (76% moderately or strongly agreed) concerned the need to “reinvent” themselves from time to time. Two other perceptions with greater than 50% endorsement included feelings of being over-committed in their job and that their job has become more stressful over time. One quarter to one third of respondents felt that they needed to prove themselves to departmental physicians, felt they were treated as hired hands or second-class citizens, and felt isolated from their own discipline.
Discussion
This national survey of faculty educators working in academic departments of family medicine describes a group of senior faculty members with significant responsibilities in administration, teaching, and research. There is substantial contrast between public and private settings with respect to how time is spent, sources of funding, rates of tenure, and numbers of grants and publications. This information should prove useful to educators considering employment in primary care departments. Job-related perceptions of faculty educators were predominantly positive, indicating a good fit of background training with job responsibilities and roles. Negative perceptions, although less frequently endorsed, indicate areas of dissatisfaction and may be helpful to department chairs in recruiting new faculty educators.
It is important to note that this group of faculty educators is rapidly approaching retirement age at a time when their experiences may be most needed in family medicine. Faculty educators are likely to play an important role in building research capacity and in integrating the principles of the patient-centered medical home into the teaching of faculty, residents, and medical students.10–11 They also bring skills that are important in teaching adaptation and integration in areas such as practice redesign, collaborative health care teams, the integration of electronic health records, and changes in the health care system.12
Family medicine policy makers should be made aware that a demographic shift in the faculty educator workforce is occurring. At this time of transition, it may be important for departments to take steps to assure that qualified junior faculty educators are present to inherit the hard earned institutional knowledge base in professional development that has been built over many decades.
The relatively small sample size of this study is a major limitation. Moreover, although the response rate for the total sample was a respectable 68%, it is unknown whether the response of faculty educators was higher or lower.
Conclusions and Implications
The national cohort of US family medicine faculty educators is rapidly approaching retirement age. The profession’s age demographic necessitates the preparation of a new generation of faculty educators who will have critically important roles in training family physicians to successfully adapt to the demands of an ever-changing health care environment.
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