The present and future of appointment, tenure, and compensation policies for medical school clinical faculty

The authors present data and information about appointment, tenure, and com pensation policies to describe how medical schools are redefining the terms under which they relate to their full-time clinical faculties. First, the authors note the increasing differentiation of clinical faculty members int o two groups, researchers and clinicians. The present-day competitive reali ties of both research and clinical enterprises have prompted this change an d the principles of mission-based management are reinforcing it. Second, th ey document the long-term tendency of schools to appoint new clinical facul ty members to contract-term (as opposed to tenure) appointments, as special non-tenure-eligible tracks for clinically oriented faculty proliferate. Th ird, they report on the policies of schools to limit the financial guarante es provided to clinical faculty members who are awarded tenure. For schools that have yet to address this issue, they discuss the various employment a nd pay arrangements that inform or confuse the question. Fourth, they descr ibe historic problems with clinical faculty compensation arrangements and i llustrate, with examples from ten schools, the characteristics of recently implemented performance- and risk-based compensation plans. While these trends in institutional policies and practices may initially co ncern faculty advocate groups, the authors argue that they may serve the lo ng-term interests of those groups. The terms of relationships between medic al schools and their clinical faculties are tied closely to the specifics o f organizational structure, which are currently undergoing review and chang e. The challenge all schools face is to define these terms in ways that all ow them to continue to attract high-quality clinical faculty while avoiding an insupportable financial liability.