AAMC Reporter: November 2008

Medical Schools Assess, Advance Academic Workplace

Related Resources Faculty Forward AAMC-COACHE Medical Faculty Job Satisfaction Survey U.S. Medical School Faculty Job Satisfaction (PDF, 2 pages) Analysis in Brief, July 2008 Organizational Performance Improvement Faculty Development and Leadership

There was a time when medical schools tended not to pay much attention to how content their faculties were, or whether employees viewed the campus as a good place to work. As long as students were educated, research was conducted, and patients were treated, the medical school workplace was not often closely examined.

But in recent years, that has begun to change. As study after study pointed to personal job satisfaction and a healthy work environment as strong predictors of high performance across many professions, people began to take note—and, in many cases, came to realize that serious problems existed.

The medical school community was no exception. Major strides have been made in recognizing and addressing workplace issues, but some challenges still linger. An AAMC analysis of a 2007 faculty satisfaction survey jointly administered by the AAMC and the Collaborative on Academic Careers in Higher Education (COACHE) reported 62 percent of faculty were satisfied with their departments as a place to work—a slightly lower percentage than that of the overall physician community over the past decade. Medical school faculty reported high satisfaction with colleague interactions, a sense of belonging, and the autonomy level they had over their work, but lower satisfaction levels emerged on the issues of promotions, communication from school administrators, and a feeling of being appreciated for their efforts.

Moreover, dissatisfaction may be on the rise.

"There is evidence that the economics of the academic medical center—that is, the need for increased clinical and research productivity—is creating discontent among faculty," said Bill Mallon, AAMC director of organizational learning and research. "These professionals feel like they don't have time to teach or contribute to other academic pursuits. And this situation is exacerbated as Baby Boomer faculty members begin to approach retirement age and it becomes harder to find new staff."

Mallon noted that many other fields, including K-12 teaching, nursing, and IT, report higher levels of job dissatisfaction than medical school faculty. Faculty satisfaction is only one factor when evaluating the overall quality of a medical school workplace, but nevertheless may act as the proverbial canary in the coal mine by signaling deeper issues that could ultimately lead to lower productivity and staff departures.

"Satisfied faculty are more likely to be retained and are more likely to be maximally productive," said Hannah Valantine, M.D., senior associate dean at Stanford University School of Medicine and head of the school's Office of Diversity and Leadership, which oversees faculty satisfaction initiatives. "A satisfied faculty member is less likely to have higher manifestations of stress that can diminish performance. So there are morale issues, but there are also economic and even physical ones."

Identifying the importance of faculty satisfaction may no longer be the hard part. The challenge, Mallon said, may now lie in how best to assess faculty satisfaction and the larger workplace climate, and then do something about it.

"Many schools no longer want to take a laissez-faire approach to issues of faculty satisfaction and retention, because they know it can lead to high turnover and lost productivity. But you can't change what you can't measure," Mallon said. "Fortunately, there are multiple ways a school can address this. Doing a faculty survey is the easy part. The hard part is acting on it. A lot of times, these are entrenched cultures."

Oftentimes, certain aspects of a culture may be entrenched without the school realizing it. At the University of Texas School of Medicine at San Antonio, various faculty development programs were already in place or in the works. But after participating in the AAMC/COACHE survey, which covered everything from governance and operations to office culture, school officials found dissatisfaction in an area that surprised them.

"Our faculty is about 40 percent Hispanic," said Pedro L. Delgado, M.D., M.A., the school's associate dean for professional and faculty development. "You would think that they would view their advancement opportunities as being good, but they didn't. This stimulated a lot of efforts at the school and departmental levels. I think what [a faculty survey] does is help prioritize some of the issues you know about, and identify issues you didn't realize were a problem. This helped us to galvanize ourselves."

Issues of pay and clinical infrastructure also came to light during the survey, Delgado said. Changes are still in the development stages, but working groups in each department are dedicated to addressing these issues. "We wanted to do this departmentally, because each department is different," Delgado said. "You have big and small, research-intensive and less research-intensive, high-revenue and low-revenue."

Other medical schools have taken a broader approach. At Stanford, the leadership and diversity office was created in part as a central "way station" for all workplace-related initiatives. Once a problem area is identified, Valantine and her staff spring into action. "We wanted to have a sustained and centralized response to faculty satisfaction surveys and faculty satisfaction improvement programs," she said.

After Stanford faculty completed the AAMC/COACHE survey, three major perceptions emerged: uneven appointment and promotion procedures, inadequate child care policies, and difficulty in attaining solid performance feedback. Each of the three were noted more frequently by female faculty members.

Valantine's office has since established several new initiatives around each problem area. To help improve the appointment and promotion process, the school will now hold at least two annual workshops to outline advancement requirements. For child care, the office established a child care task force, which subsequently decided to financially supplement the cost of child care for eligible faculty, allot staff members with a certain amount of "back-up" child care time for weekend or travel situations, and even build two new child care centers—one just opened, the other will open in 2010.

"This will completely obliterate the wait list, which before was nine months to a year," Valantine said.

Stanford always had mentors to help with professional feedback, but "we had assigned mentors," Valantine said, "and that didn't work terribly well." Now, faculty members have multiple mentors, mentors and mentees alike are educated on how to get the most from the relationship, and a "definitive" training session on giving feedback is now offered.

In addition, Stanford instituted training programs to ensure that faculty members reach their full potential. One six-month course educates faculty on management tools such as negotiation and finances, and ends with a specific leadership project that carries tangible results— for example, reducing infections in the ICU. A novel program, called Faculty Fellows, guides about 15 midlevel faculty members who are on track for high-level positions through a series of group exercises and monthly dinner discussions with university leaders, which all culminates in the creation of a personalized career development plan. Each participant then works to implement the plan with his or her department chair or division chief.

Mentoring and leadership programs are two ways the University of Pennsylvania School of Medicine looks to increase faculty satisfaction through fostering networking or collaborative opportunities. Long recognized as a leader on workplace issues in the medical school community, Penn has been conducting faculty "climate" surveys for the past decade, which led to the formation of groups for women and underrepresented minority faculty.

"Through our gender equity council, we make our women faculty available to recruits for questions," said Victoria A. Mulhern, the school's executive director of faculty affairs and professional development. "Our committee for the underrepresented in medicine hosts social functions in large groups that then break out into faculty, student, post-doc, and resident groups. We want a collegial environment on our campus. Maybe in one of these groups, someone will spot an opportunity for collaboration, or maybe they will just make friends."

In terms of spotting dissatisfaction, Mulhern said the school takes a proactive approach.

"We try to anticipate reasons for faculty leaving and address them before they become problems," she said. "We try to keep our ear to the ground. And our dean is very receptive to hearing from the faculty on what works and where we could improve."

As medical schools pay more attention to their workplace environments, a new AAMC initiative may assist them in assessing challenges and working toward solutions. As part of the new Faculty Forward program, up to 30 participating schools in 2009 can have a national job satisfaction survey administered to their faculty; receive customized results, workshops, and site visits; and compare their own workplace benchmarks against those of other medical schools. Faculty Forward participants also receive information on strategies for making changes based on the evaluations, among numerous other benefits. The annual fee for the program is $25,000.

Change can take up to 10 years to fully take root, according to experts, but with the right tools, initiatives can begin making progress almost right away.

"Some people are finding some quick wins, and trying to pick off some low-hanging fruit," Mallon said. "A little caring goes a long way. Faculty members, like patients, want to know that people care about them."

—By Scott Harris