Part-Time Faculty in Academic Medicine: Present Status and Future Challenges

Methods

Because no list identifies part-time medical school faculty, the first stages of this project required formation of such a list. For the purposes of the project, part-time academic status was defined as a paid position for less than 1.0 full-time equivalent in a department of internal medicine in a U.S. medical school. A three-step procedure was followed to identify an appropriate sample. First, a letter was mailed by the president of the American College of Physicians (ACP) to the chairman of medicine in each U.S. medical school (n = 126) requesting the name, address, and percentage of full-time equivalent positions for all part-time faculty in the department of medicine. A second letter was sent to those schools not responding. Finally, the Association of American Medical Colleges (AAMC) requested the information from the identified faculty roster representative in each medical school. A total of 107 (85%) medical schools ultimately provided an appropriate list.

An initial sample of 705 part-time faculty were identified by their institutions. In January 1991, a 79-item questionnaire was mailed to these faculty. Approximately 4 weeks later, a reminder card was sent to those who had not responded. The questionnaires were coded to protect confidentiality.

A phone survey of a random sample of nonrespondents was done, 1 year after data collection, to determine whether the nonrespondents were eligible for the study and to record professional and personal demographic characteristics. The questionnaire was based on a survey instrument previously used by the investigator in a national study of full-time women faculty [6]. New items pertinent to part-time issues were pilot tested in a group of 25 part-time faculty. The survey items included information about personal and professional demographics, the advantages and disadvantages of part-time careers, and perceptions of relevant institutional policies. Satisfaction with particular aspects of personal life or career was measured by asking respondents to indicate their agreement with statements using a 5-point Likert Scale, with 5 indicating a positive sentiment or strong agreement, 3 indicating uncertainty, and 1 indicating a negative sentiment or strong disagreement.

Data from the respondents were tabulated, yielding descriptive measures for the above content areas. Chi-square analyses, t-tests, analyses of variance, and multiple regression analysis were used to assess the relationship between selected characteristics and responses. To measure satisfaction about part-time career choices, a principal components analysis using a varimax rotation was done on data derived from the 12 questions. The analysis yielded four factors, three of which were used as dependent variables in our further analyses: balance between roles (5 items), policy issues (3 items), and career satisfaction (2 items). The balance factor included statements such as I am satisfied with the way part-time work allows me to combine my career and my personal life, and I feel frustrated by the lack of time available to devote to my career. The policy factor explored opinions about the fairness of institutional policies and attitudes, including University policies related to tenure are fair to part-time faculty, Faculty who work part time are unlikely to be promoted, and Working as a part-time faculty member has a negative influence on my colleagues' opinions of my commitment to my job. The career satisfaction factor included the statements If I had it to do all over, I would have chosen a different career and I would encourage medical students to pursue careers in academic medicine.

Results

A total of 403 faculty (57% of delivered questionnaires) responded to the mailing by returning the questionnaire (296 faculty) or the follow-up card (107 faculty). Respondents considered ineligible included 66 full-time faculty, 48 not in a department of medicine, 10 with degrees other than MD, and 34 with other reasons (for example, retired, volunteer). Thus our results are based on 245 eligible questionnaires.

A total of 302 people did not respond to the questionnaire. A random sample of 40 nonrespondents (13%) were telephoned. For 39 who were contacted (8 women and 31 men), 25 (64%) were not eligible for the study (5 full time, 1 not in a department of medicine, 10 volunteer position only, 9 retired or no longer on faculty), and 14 were eligible (13 men and 1 woman). All of the men worked part-time in their faculty position and part-time in private practice, whereas the only woman did not work outside her faculty position. The mean age of nonrespondents was 48 years.

Based on the percentage of eligible faculty in the sample of nonrespondents, we estimated that 354 faculty work part-time in these institutions (109 eligible nonrespondents and 245 eligible respondents). Therefore our survey has a response rate of approximately 69%. Because 85% of medical schools provided faculty lists, we estimated that 416 faculty work part time in departments of medicine in U.S. medical schools.

Personal and Professional Characteristics

Of the 245 eligible respondents, 90 (36%) were women and 155 (63%) were men (Table 1). Most were white (83%) and married (91%). Women were more frequently married to physicians (57%) than were men (17%). Men were older, with a mean age of 49 years compared with 40 years for the women (P < 0.001). Approximately 89% of the respondents had at least one child; the mean number of children was 2.4. Men had more children than women (mean, 2.6 compared with 2.1; P < 0.001).

Part-time women faculty reported working an average of 35 h/wk compared with 51 h/wk for men (Table 2). The majority of men (78%) actually worked full-time hours ( 40 h/wk), and 65% worked in a private practice in addition to their faculty position. In contrast, 32% of women worked full-time hours, and only 11% worked in a private practice. Most of the faculty, both men and women, were board certified in internal medicine (86%), and approximately one half were also certified in a specialty (54%). Women working part-time reported a mean of 4.4 years in postgraduate training compared with 4.9 years for men respondents; this difference was not statistically significant.

Most men and women (86%) reported having a nontenure track position (Table 2). Men were more likely to be professors and associate professors, whereas the women respondents were more likely to be assistant professors or instructors (P < 0.001). Men had joined the medical school faculty a mean of 15.7 years previously compared with 7.6 years previously for women. Women were also less likely to have published articles in refereed journals (P < 0.001). Women's rank was lower than men's even when the effects of length of time on faculty and number of publications were controlled (P < 0.001).

Most faculty indicated that their time was dedicated primarily to teaching and patient care. The median time commitment to different activities included administration, 5%; teaching, 30%; patient care, 40%; and research, 0%. If they were to increase their time commitment in any of these areas, one third reported that they would choose to increase their research commitment. In addition, 24% of women indicated that they would increase their patient care and 24% would increase their teaching commitment, compared with 10% and 43% of men in these areas, respectively. More frequently, women indicated that they intended to pursue a full-time academic career in the future (32% of women compared with 13% of men). More than 70% of the men indicated that they were not planning to return to full-time academic careers.

Women indicated their choice for part-time work was due to childbirth/childrearing (76%), personal preference (33%), and private practice commitment (15%) (respondents could indicate more than one choice). For men, the most frequently cited reasons were personal preference (54%), private practice commitment (53%), and other (mostly retirement) (16%). Overall, the reasons for working part-time were related to family activities for women and to private practice commitments for men (P < 0.001). Faculty reported beginning their part-time status at different phases of their career: during residency, 7%; during fellowship, 8%; as a junior faculty, 42%; after promotion, 8%; always part-time, 22%; and other, 12%.

Institutional Policies

Sixty-four percent of women respondents compared, with 37% of men, reported developing the part-time position themselves (P < 0.001). Most faculty did not know about the availability of different institutional opportunities and policies, including policies related to promotion and tenure, procedures for part-time faculty, and parental leave policies (Table 3). Overall, men were more likely than women to believe that institutional policies were fair to part-time faculty. On the policy factor (a 15-point scale), male faculty had a mean score of 9.3 compared with 7.0 for women (P < 0.001). Forty-eight percent of women, compared with 12% of men, felt that working part-time has a negative influence on their colleagues' impression of their commitment to their job (P < 0.001). Multivariate analysis of variance showed that rank also influenced respondents' attitudes toward fairness of policies pertaining to part-time faculty, with higher-ranking faculty having more positive attitudes than lower-ranking faculty (P < 0.001).

Ninety-seven respondents answered the question What changes, if any, in institutional policies would facilitate part-time careers? Suggestions included a longer probationary period before tenure review (n = 17), a change in attitude toward part-time faculty (n = 16), clear criteria for advancement of part-time faculty (n = 15), job sharing opportunities (n = 10), and better benefits (salary, on-site child care) (n = 8).

Satisfaction with Career and Balance with Personal Life

Respondents were satisfied with their careers (mean score, 8.6 on a 10-point scale). Multivariate analysisincluding the respondent's rank, sex, and whether he or she had childrendid not show any relationship (P < 0.06), although women tended to be less satisfied overall with their career than were men. Academic rank, when analyzed alone, was associated with degree of satisfaction with career (P < 0.05). Sex and rank were highly correlated in these analyses.

Respondents expressed some dissatisfaction with the balance of medicine and their personal lives (average, 17.4 on a 25-point scale). Multivariate analysiswhich included sex, rank, and whether he or she had childrenshowed that values on this measure were associated with the respondent's academic rank (P < 0.001), with higher-ranking respondents reporting a greater degree of satisfaction than lower-ranking respondents. Univariate analysis showed that sex was also associated with the degree of satisfaction pertaining to this factor, with men being more satisfied than women (P < 0.05). Sex and rank were highly correlated. Despite the high degree of overall career and personal satisfaction, a substantial number of faculty (44% of men and 41% of women) were uncertain or would not encourage medical students to pursue academic medical careers.

In response to the question What are the advantages and disadvantages of working as a part-time faculty member? men and women had different responses (Table 4). Women most frequently reported that part-time work allowed them to balance family and personal concerns with work commitments. Men said the advantage was that part-time work allowed them to be involved in academic work and teaching. Disadvantages were similar for men and women, and they included lack of respect from colleagues and limited benefits or salary.

Discussion

We estimate that approximately 416 faculty work part-time in departments of medicine in U.S. medical schools. Most of these faculty (63%) are men. Men and women faculty choose part-time positions for different reasons. In our study, more than 90% of women respondents working part-time are combining childrearing with developing an academic career. These women are coping with the difficult questions of when to have children in their medical career [6], how long to stay away from work peripartum, and how to balance the time demands of young children with the intense pressures of patient care, teaching, and research [9-24]. In contrast, most of the men are combining their part-time academic career with part-time private practice, working a total of 50 h/wk or more. These physicians have the competing demands of these two different work worlds.

Part-time faculty have difficulty being promoted. Traditionally, universities have promoted academicians who are productive in research [7, 8]. More recently, most medical schools have adapted their promotion and tenure policies to reward academic physicians for excellence in teaching and patient care by introducing a clinical-teacher track [7, 25]. In our study, most of the part-time faculty were clinical teachers who did not devote any time to research. Thus, if part-time faculty seek promotion, they are likely to use these new, usually less prestigious career paths.

Furthermore, most university policies place limits on time allowed for promotion and tenure standards [7, 8, 25, 26]. Change in time-to-tenure policies was most frequently cited by respondents as the institutional change that would facilitate a part-time career. The American College of Physicians [8], in a recent position paper, Promotion and Tenure of Women and Minorities, underscored the importance of developing flexibility in tenure and promotion procedures to accommodate the personal and family responsibilities of faculty. The College recommended the development of alternate tracks allowing tenure deadlines to be modified according to the percentage of time a faculty member committed to academic work.

Another underlying obstacle for part-time faculty and part-time clinicians relates to negative attitudes of administrators and colleagues [27, 28]. In this study, almost 50% of women (and 12% of men) believe that working part-time negatively influences their colleagues' impression of their commitment. Women faculty are more likely to encounter negative attitudes because they devote their time to family responsibilities rather than to medicine, whereas the men actually devote 100% of their work time to medicine. A recent study [28] explored the impact of physicians' part-time status on inpatient use of medical care and patient satisfaction with physicians in an academic group practice. This study did not find differences between part-time and full-time physicians and concluded that their findings may contribute to more enlightened attitudes toward physicians who choose part-time status. With the increasing number of women entering medical school, residencies and faculty positions, a reevaluation of attitudes and negative biases is necessary.

Increasing numbers of practicing internists are working part-time and facing challenges similar to academic physicians. Problems include covering patient care responsibilities in off hours, lack of fringe benefits, lower status, and negative judgments about their commitment. However, many successful large multidisciplinary clinics and health maintenance organizations have recognized the importance of developing systems to accommodate the needs of part-time physicians. Given the changing work force, these large groups realize that attracting and retaining new physicians requires flexible provisions and that part-time physicians contribute advantageously to their institutions in terms of skills, creativity, productivity, and commitment. Often part-time professionals work more hours than they are paid for, and thus they increase the productivity of the group [29-31].

Faculty members considering part-time positions should carefully weigh the advantages and disadvantages. Informed choices enhance career and personal satisfaction and they minimize the frustration of unmet and unrealistic expectations. Women faculty in this sample found that the part-time career options enabled them to be more involved in the activities of their children and to have more time for personal pursuits outside medicine. Men enjoyed the satisfaction of teaching and staying involved in an academic career while continuing a private practice. On the other hand, the limitations of promotion, lack of financial and fringe benefits, negative attitudes, and conflicting time demands are the disadvantages of part-time work. Although overall career satisfaction of respondents was high, more than one quarter were uncertain about whether they would encourage medical students to pursue similar careers; 17% would actually discourage students. In fact, part-time faculty in this study were less likely to encourage medical students than were full-time faculty in a similar study [5].

The main limitation of this study relates to inaccuracies in the original list of part-time faculty. The list may have excluded potentially eligible respondents leading to an underestimate of the total number of part-time faculty. The phone survey found that approximately two thirds of the nonrespondents were actually ineligible. However, we do not believe that a systematic response bias impairs the interpretation of our findings.

Our study is the first to identify the views of both men and women faculty working part-time in departments of medicine and to examine barriers and opportunities associated with this work option. Most part-time faculty are men who divide their time between private practice and academic work. In contrast, the women faculty who work part-time typically work exclusively in their academic position. We found that most part-time faculty were satisfied with their career choice even though they believed that part-time status makes promotion more difficult and negatively influences colleagues' perceptions of them. Academic institutions will enhance medical education by developing and adapting policies that attract and nurture physicians with diverse skills, including faculty choosing to work part-time.