Clinical-Track Faculty: Making Them Count in Public Health Education

Public health education must continually adapt as it trains practitioners to address the dynamic public health landscape. New criteria from the Council on Education for Public Health underscore the importance of public health practice in public health education, requiring candidates in some degree programs to work with practice partners to graduate.¹ Tenure-track faculty, often focused on obtaining grant funding and publishing, are generally not well positioned to teach practice-based concepts. Clinical-track faculty, often focused on practice-oriented work and held to different expectations for scholarly productivity than tenure-track faculty, have the potential to fill practice-oriented curricular gaps. To optimize clinical faculty contributions to the public health curriculum, we need to better understand their presence and roles. A deeper understanding of the clinical track will illuminate the value those faculty bring to their institutions and, in institutions without clinical faculty, whether it is worth starting a clinical-track line.

At our own institution, the University of Michigan School of Public Health, the number of clinical faculty hired in the past five years grew substantially. In our setting, clinical faculty work in each of our six academic departments hold leadership roles in creating new academic programs, drive accreditation efforts, participate in teaching, work with community practice partners, and conduct research. Yet the extent to which other schools of public health employ clinical faculty and the duties of clinical faculty in these environments are not well documented. To begin to understand the presence of clinical faculty in public health education, including their roles and potential value to the field, we must first document basic information about these faculty in schools of public health.

ENUMERATION OF CLINICAL FACULTY

Currently, the Association of Schools & Programs of Public Health (ASPPH) does not enumerate clinical faculty in a separate category in their annual reports of faculty.² In an attempt to bridge this knowledge gap, our team conducted a Web site review of all accredited US schools of public health for faculty with “clinical” in their title, excluding clinical instructors and lecturers; visiting, emeritus, and adjunct clinical faculty; and clinical faculty with joint appointments in which their primary appointment was nonclinical or outside public health.

Our review demonstrates that clinical faculty have a significant presence in US schools of public health. Just over half (33 of 60) of schools had at least one clinical faculty member. In total, there were 321 clinical faculty members across these schools. Collectively, among schools of public health with clinical faculty, 10% of faculty members were clinical (321 clinical faculty/[321 clinical faculty + 2743 other faculty]). The clinical faculty count is from our Web review; the other faculty count is from ASPPH, which includes tenure- plus research-track faculty who teach. As the denominator does not include research faculty who do not teach, the percentage of clinical faculty may be an overestimation. Conversely, we may have missed faculty who serve in roles similar to clinical faculty but whose titles reflect only rank. At individual institutions, the percentage of clinical faculty ranged from 1% to 77%. Clinical faculty were especially prominent at research-intensive institutions; nearly two thirds of research-intensive institutions with a Carnegie Basic Classification of R1 (very high research activity) and R2 (high research activity) included clinical faculty, whereas institutions without a focus on research had far fewer clinical faculty.

EXPLAINING PATTERNS OF APPOINTMENTS

Why are we seeing this pattern? We can speculate. Tenure-track faculty at research-focused institutions must prioritize research, as most are merited on research dollars and activities rather than practice activities. Clinical faculty may have been hired at these types of institutions to provide a connection to practice, or they may have been hired to teach core and competency-focused courses, as teaching has been a traditional role of clinical faculty.³ The need for additional faculty to teach in new and expanding programs may also drive clinical faculty hires. Data published by the de Beaumont Foundation in partnership with ASPPH show a 300% increase in the number of graduate public health degrees conferred between 1992 and 2016.⁴ Data from this same report show that, during this same period, the number of academic institutions awarding public health degrees quadrupled. Similarly, the number of graduates and degree programs offering a bachelor’s of public health swelled in the past three decades.⁵ Faculty are needed for nontraditional public health education, including online education, and clinical faculty may play an outsized role in schools and programs of public health to meet this demand.

QUESTIONS THAT NEED ASKING AND ANSWERING

The absence of data on the role of clinical faculty prompts a number of questions on how this track functions across academic public health institutions. There is a large disparity between clinical- and tenure-track faculty in rank, with many more clinical faculty at lower ranks than tenure-track faculty. In our sample, more than half (53%) of clinical faculty were at the assistant level and only 16% were full professors; tenure-track faculty were much more balanced (Figure 1). Reasons for this differential in rank distribution should be studied, with specific attention to differences in hiring practices, contract lengths, promotion criteria, and other factors that might lead to a disproportion of assistant-level clinical faculty.

FIGURE 1—

Distribution of Ranks for Clinical Faculty and Tenure-Track Faculty in US Schools of Public Health: 2019

This disparity in rank could also be attributable in part to the credentials of clinical faculty and how they relate to their ability to succeed. Most (88%) clinical faculty in our sample had a doctoral degree, but for about 10% their highest degree was at the master’s level. Without a doctoral degree, it may not be possible to advance through the ranks. Additionally, 14% of clinical faculty in schools of public health were physicians. Physicians and other clinicians may be more likely to see patients in addition to their academic activities, precluding the focus that may be required to advance in an academic institution.^6,7 Exploring this disparity, and how it may affect the sustainability and ultimate quality of the clinical line, is imperative.

The very name of the clinical track should be reevaluated: whether and how it serves faculty and whether it should be revised. The word “clinical” has been used appropriately for other applied health professions, such as medicine and nursing, but has little connection to public health and may not serve our clinical faculty well. Because we do not know what types of activities clinical public health faculty engage in, it is not clear what the most appropriate title would be.

Appraising teaching, service, research, and practice activities among clinical faculty across institutions is critical. Are there standard expectations for teaching and practice activities? How do formal expectations align with actual activities? What are the expectations for promotion? Another important question is how clinical-track activities align with or are shaped by funding sources. If clinical faculty are hired to teach heavy loads, they will probably be paid with “hard” (institution) funds. But at some institutions, tenure-track and clinical faculty may be expected to cover a portion of their salary. If this is the case for clinical faculty, they will be beholden to their own funding sources. If they are participating in public health practice through funded activities, what do these entail?

Clinical faculty work in the majority of US schools of public health, playing important roles in meeting the educational and practice missions of our academic institutions. We hope the questions we raised lead to more investigation, planning, and strategic thinking about clinical faculty contributions to academic public health.