For the past several decades, financial uncertainty, changes in health care delivery and reimbursement, and changing workforce needs have prompted medical schools to continually refine their appointment and tenure policies. Studies during the past 30 years have examined the nature of these faculty appointment and tenure policies in U.S. medical schools, and in this article the authors present data from a 2005 survey on faculty personnel policies to extend this analysis. For both basic science and clinical faculty in U.S. medical schools, the authors describe tenure systems, trends in the number and percentage of full-time faculty on tenure-eligible tracks, the financial guarantee of tenure, and probationary period lengths. They review the status of flexible policies and highlight two current faculty policy changes that many institutions have made or are actively contemplating: the recognition of interdisciplinary and team science, and a broadening view of scholarship. Results show that although tenure systems remain well established in medical schools, the proportion of faculty on tenured or tenure-eligible tracks has continued to decline over time. Changes in the financial guarantee associated with tenure have transformed the fundamental concept of tenure at many medical schools, and the percentage of schools that have lengthened the probationary period for tenure-track faculty has steadily increased during the past 25 years. Tenure-clock-stopping policies and part-time tenure policies continue to exist at medical schools, though results indicate low faculty use of the policies, suggesting a disconnect between policy and practice.

Despite the relatively unpredictable environmental challenges facing medical schools today, leaders have opportunities to influence and improve the workplace satisfaction of their faculty. Examples of opportunities include fostering a culture characterized by open communication and occasions for faculty input, and remaining vigilant regarding factors contributing to faculty burnout. Understanding what drives faculty satisfaction is crucial for medical schools as they continue to seek excellence in all missions and recruit and retain high-quality faculty.

Findings suggest that many medical schools have made progress in making policy additions and modifications that acknowledge the changing academic workplace culture by adding flexibility to traditional tenure policies. Despite those efforts, significant opportunities remain for continued adoption of flexible policies so that faculty can achieve productive academic careers while balancing work, life, and family, and institutions can continue to recruit and retain high-quality faculty members.

Mentored clinical faculty members have significantly greater satisfaction with their department and institution. This multi-institutional study provides evidence that fostering mentoring opportunities may facilitate faculty members' satisfaction and engagement, which, in turn, may help medical schools retain high-quality faculty staff committed to the multidimensional academic mission.

Research centers and institutes are a common mechanism to organize and facilitate biomedical research at medical schools and universities. The authors report the results of a study on the size, scope, and range of activities of 604 research centers and institutes at research-intensive U.S. medical schools and their parent universities. Centers and institutes with primary missions of patient care, education, or outreach were not included. The findings indicate that, in addition to research, centers and institutes are involved in a range of activities, including education, service, and technology transfer. The centers and institutes the authors studied were more interdisciplinary than those included in previous studies on this topic. Most research centers and institutes did not have authority comparable to academic departments. Only 22% of centers directly appointed faculty members, and most center directors reported to a medical school dean or a department chair. A small group of centers and institutes ("power centers"), however, reported to a university president or provost, and may have considerable power and influence in academic decision making and resource allocation. Two main types of centers and institutes emerge from this research. The first type, which includes the vast of majority of centers, is modest in its scope and marginal in its influence. The second type--with greater amounts of funding, larger staffs, and direct access to institutional decisionmakers--may have a more significant role in the organization and governance of the medical school and university and in the ways that researchers interact within and across academic divisions.

As institutions work to improve the satisfaction of full-time faculty, they should do the same for part-time faculty. Understanding why faculty choose part-time work is important in encouraging the recruitment and retention of the most talented faculty. The findings of this study indicate multiple opportunities to improve the satisfaction and engagement of part-time faculty.

Academic medicine's landscape is dynamically adjusting. The changes are accelerating and these alterations are impacting both the faculty workforce as a whole and individual faculty members. This article reviews workforce and institutional changes within academic medicine and supports the need for faculty members to adapt to this changing landscape. Resources to maintain an understanding of these ongoing changes are reviewed. A faculty life-cycle model is proposed as a context for developing a personal action plan. Career management steps are suggested to facilitate career productivity and satisfaction. Finally, we propose that psychologists, being human behavior experts, are well positioned to contribute within the transformation of academic medicine.

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