MEMBERS OF TASK FORCE: Brian Alldredge (SOP), Diane Dillon (VC Academic Affairs), Stanton Glantz (SOM), Arnold Kahn (SOD), Nelson Schiller (SOM), Margaret Wallhagen (SON), and Daniel Bikle (SOM), Chair.
The Task Force on the Future of Clinician Scientists at UCSF was charged by the Academic Senate with examining the success rate of clinician scientists pursuing their careers at UCSF. The Task Force considered current UCSF policies and practices that might be modified to enhance the academic success of the clinician scientist, while at the same time stimulating the interest of, and opportunities for, health science students, Housestaff, and fellows to pursue a career as a clinical scientist (Appendix 1). The Task Force defines a clinician scientist as a faculty member who by training, desire, performance and/or academic responsibilities pursues a career that includes both clinical activities and research. This report details the findings of the Task Force on factors that influence the success rate of clinician scientists and proposes recommendations to enhance the success rate of these faculty members. Although the focus of this report is on the Clinician Scientist, our observations and recommendations are germane to the faculty as a whole and should be interpreted as such.
The first step in the process was to gather information that would provide data on the actual success rate of Clinician Scientists. A survey was conducted that included questions regarding research support, mentoring, promotion, and balancing research, patient care and teaching loads (Appendix 2). The Office of the Academic Senate distributed surveys to all UCSF faculty members. Of the 319 responses 200 identified themselves as clinician scientists. The results of the survey are tabulated in Appendix 3.
In addition to the survey, over 80 faculty members participated in focus groups and offered personal experiences and suggestions on how to enhance their success as clinician scientists. These groups were encouraged to discuss issues of concern with respect to their careers as clinician scientists. A number of themes identified from the questionnaire served as a starting point for these discussions. These themes, in the form of questions, were handed out in advance and are found in Appendix 4. A summary of specific issues raised and solutions proposed during these discussions is found in Appendix 5.
MAJOR CONCERNS THAT EMERGED FROM THE QUESTIONNAIRE AND FOCUS GROUPS AT UCSF
- THE PERCEPTION THAT CLINICAL RESEARCH RECEIVES LESS RECOGNITION AND IS LESS VALUED THAN BASIC RESEARCH.
- THE PERCEPTION THAT COLLABORATIVE RESEARCH IS LESS VALUED THAN INDEPENDENT RESEARCH.
- THE FAILURE OF DEPARTMENT CHAIRS AND/OR DIVISION HEADS TO ARTICULATE CLEARLY EXPECTATIONS AND PROMOTION CRITERIA AND TO PROVIDE ADEQUATE RESOURCES TO SUPPORT RESEARCH.
- THE LACK OF MENTORING AND GUIDANCE.
- THE COMPETING DEMANDS BETWEEN CLINICAL RESPONSIBILITIES AND RESEARCH.
LESS RECOGNITION FOR CLINICAL RESEARCH
Many of those interviewed indicated that recognition is difficult for those who do not engage in basic research, defined as molecular and cellular biology. Of the respondents to the questionnaire, 83% believed that clinical research does not receive equal support, recognition and credit for promotion when compared to basic research. The focus group participants also raised concerns that the Mission Bay campus will draw attention away from clinical research at Parnassus, thus further decreasing University support for clinician scientists.
LESS RECOGNITION FOR COLLABORATIVE RESEARCH
A number of focus group participants raised the concern that being a principal investigator on an independent NIH RO1 (or equivalent) grant was essential for promotion, whereas participation in program project grants, serving as an essential collaborator in research with other PI s, or pursuing research supported by other mechanisms was less valued. Some participants expressed the concern that only first and last author positions on publications were counted for promotion purposes, again reducing the incentive for collaborative efforts. Departmental policies that discourage members from submitting grants through organized research units or functioning as co-investigators on grants of members in other departments contribute to this problem.
INADEQUATE AND INCONSISTENT COMMUNICATION REGARDING EXPECTATIONS AND PROMOTION CRITERIA
Many focus group participants felt they lacked relevant information critical to their success at UCSF. A number felt they had not received adequate orientation from department chairs or division heads upon joining UCSF on what was expected of them regarding clinical work load, promotion criteria, and meaningful advice for balancing clinical, teaching, administrative and research activities. Some participants were not well informed about the pros and cons of different academic series and the differences in expectations between the various academic series. Many had been recruited primarily to do clinical work, but were anticipating that they would be able to engage in research activities as well; the opportunities to do so were not provided to them. In some cases faculty were told that an NIH RO1 grant was required for promotion, and were discouraged from participating in collaborative research in order to demonstrate
"independence." A number of the focus group participants were unaware of sources of information for collaborative studies, research opportunities, core facilities, and administrative help for their activities.
LACK OF MENTORING
The results of the initial survey indicated that two out of three faculty members received no mentoring or inadequate mentoring. Mentoring was further discussed at each focus group, and from the comments it appeared that the majority of departments did not have mentoring programs, or if they did the quality varied. Inconsistencies between departments caused a disparity in the availability and quality of guidance for junior faculty. Many participants also emphasized that junior faculty require a different type of mentoring than faculty who have been at UCSF for several years. Because of the concern that grants are required for promotion, participants felt pressure to obtain grants. However, in many cases little assistance was offered on how to write a grant including having it critiqued by senior faculty members. Furthermore, administrative help in putting together the budget and front sheets was often not available.
Competing demands between clinical responsibilities, teaching, and research. According to the majority of focus group participants, the greatest liability to research efforts was lack of protected time. Many reported that excessive clinical responsibilities prevent them from working on grants and the projects funded by grants. These faculty expressed concern that departments demand more clinical work in order to sustain income for the departments, and that under these circumstances there is little time, financial incentive or support for research. In schools such as Pharmacy, the state mandated student:faculty ratio is 11:1, putting an additional teaching load on faculty juggling their research and clinical responsibilities. When asked to provide a preferred balance between research, teaching, patient care, administration and public service, respondents to the survey ranked research and teaching as their first and second most preferred activities, with expanded clinical responsibilities the biggest barrier to achieving this balance. One survey respondent accurately summarized the challenge of maintaining a dual clinical and research career:
"A successful clinician-scientist, measured as a prominent clinician and scientist, is a difficult task. Clinically, you are competing with full-time clinicians who are protecting their practices to sustain their salaries. Scientifically, you are competing with full-time scientists who are pushing as hard as they can to protect their grant support. In this atmosphere of highly polarized needs, it is a tall order to succeed on both fronts."
RECOGNITION OF CLINICAL RESEARCH
- Promote an environment that values and rewards a broad spectrum of research. This should be reflected in the diversity of campus funded grant awards (eg. Academic Senate grants, REAC grants, travel awards) and consistency in promotion criteria for all forms of creative activity across departments and schools.
- The selection of faculty lectureships should honor outstanding clinical as well as basic science investigators. This could be achieved by establishing a selection committee that is comprised of faculty who represent the full scope of research activities at UCSF, including clinical, basic, and social and behavioral sciences.
- Continue to select members of the Committee for Academic Personnel to represent the spectrum of academic pursuits on this campus, including clinical research. Emphasize to individual faculty and department chairs that the Committee for Academic Personnel considers high quality clinical research as well as basic research as acceptable evidence of creative activity for promotion in all series.
- Select members of the Committee on Research to represent the spectrum of research activities on this campus.
PROMOTE COLLABORATIVE RESEARCH
- Permit faculty to submit grant proposals through any department or ORU with which they are affiliated, based on the intellectual content of the proposal and the academic unit that provides the most logical intellectual base for the research. When investigators participating in the project come from different departments or ORU’s, the Chairs of those departments could develop a mechanism to share in the indirect costs, if they deemed such sharing as appropriate.
- Encourage collaborative research by removing the perception or requirement that being a principal investigator on a NIH RO1 (or equivalent) grant is an essential criterion for promotion.
- Incorporate into advancement packages a discussion highlighting contributions to collaborative research.
- Develop a mechanism such as a campus wide Academy of Clinician Scientists that would foster research collaborations across school and departmental boundaries and between clinical, sociological, behavioral, and basic scientists. The role of the Academy should include but not be limited to developing joint seminars, providing seed money for collaborative projects, and developing an information exchange to increase awareness of collaborative research opportunities. This should be a joint project between the Academic Senate and the Office of the Vice Chancellor for Research.
IMPROVE COMMUNICATION REGARDING EXPECTATIONS AND PROMOTION CRITERIA
- Require that offer letters for new appointments of junior faculty in all series delineate the expectations for clinical service and teaching, the amount of time for research, the allocated space, and start up resources. This letter should be reviewed by the Committee for Academic Personnel as part of the appointment package to ensure that the stated expectations are consistent with the series into which the faculty person is being recruited and that the resources (both in terms of time and financial resources) are available for the new faculty member to succeed. Although 1 year renewal term appointments are made at the assistant professor level in all series and at all levels for some series, these letters should generally outline a three year startup plan for new faculty.
- Develop an orientation program for new faculty that discusses promotion criteria in the different series; that provides training in grant writing; that identifies and promotes the use of campus resources including the library, relevant web sites including bulletin boards with grant opportunities, organized research units, core facilities, and administrative resources that are of potential benefit. This program could be developed by the Vice Chancellor for Academic Affairs in conjunction with the Vice Chancellor for Research and the Academic Senate.
- Establish a centralized mechanism to inform faculty members of research opportunities. This could be developed by the Vice Chancellor for Research in conjunction with the Academic Senate and coordinated with similar efforts by other campus groups such as the ORUs and Cancer Center.
- Require that the department chair or his/her designated division chief meet with the junior faculty person at the beginning of his/her appointment to detail the expectations he/she has for that faculty person, orient the faculty person to the resources within the department and the campus, and outline an expected career path. Criteria for promotion should be reviewed at that time. The chair should provide to the junior faculty member a written evaluation of his/her progress at the end of the first and third years, including any adjustments to the original plan. These letters should be included in the appraisal package subsequently submitted to the Committee for Academic Personnel after the fourth year.
- Establish consistent promotion criteria for the same series within different departments and schools consistent with the Academic Personnel Manual recognizing that the components of creative activity may vary across disciplines. The Committee on Academic Personnel could accomplish this.
- Develop a means to monitor the success rate of faculty with respect to promotion in the various series and seek to determine the reasons for lack of success. This could be the joint responsibility of the Vice Chancellor for Academic Affairs and the Academic Senate through its Committee for Academic Personnel.
- Require that the department Chair ensure that a mentor is selected to assist each new faculty person in fulfilling the obligations of the department, developing a research career, and meeting the milestones required for timely promotion. This selection need not remain fixed if another mentor is subsequently felt to be more suitable, but the Chair needs to ensure that a mentoring relationship with an appropriate senior faculty person is established.
- Establish a list of willing and available mentors to augment the departmental mentoring program for faculty who seek a non departmental mentor who may provide a broader UCSF perspective and be better able to address broader school, inter-school, or inter-campus issues. This could be performed by the Vice Chancellor for Academic Affairs in collaboration with the Academic Senate and the Committee for a Supportive Work Environment.
- Include in the stewardship review for department chairs and division chiefs, a section that clearly delineates the success rate of junior faculty in achieving promotions.
- Include recognition for mentoring among the criteria for promotion. This could be accomplished by incorporating a separate mentoring section in the CV and requesting letters of evaluation from mentorees.
COMPETING DEMANDS BETWEEN CLINICAL RESPONSIBILITIES, TEACHING AND RESEARCH
- Require that departmental loads, in terms of clinical responsibilities and teaching, allow for enough time to purse a productive research program consistent with a successful academic career. This balance needs to be reviewed annually by junior faculty with their mentors and chairs.
- Curtail departmental policies that only reward income generation through clinical activities without supporting less remunerative teaching and research activities. Incentive plans should be implemented at the division or department level rather than at the level of individual faculty. The Dean should review these plans to ensure that they adequately support the academic program.