What does it mean to be Faculty at UCSF?

Part I in a Series – What does it mean to be a faculty member at an UC-affiliated health care facility?

In recent years, UCSF has affiliated with a growing number of health care facilities throughout Northern California. While there had been a clear separation between the medical center and campus in the past, the strengthening of the clinical enterprise and its integration with the campus as UCSF Health has created a unified entity, with shared core resources and financial planning, and common goals. This shift can be seen as part of a much larger trend of consolidations and clinical expansions of Academic Medical Centers (AMCs) nationwide. In the Bay Area, UCSF has largely kept pace with its competitors by growing its network through affiliations and agreements.

At UCSF, the medical center also contributes substantially to the financial viability of the University, often accounting for the majority of its revenue. In FY 17-18, nearly 2/3 of the $7B revenue came from UCSF Health, and accounted for 2/3 of the net income. Increasingly, however, both UCSF Health and campus revenue are being impacted by cost-control measures such as the Patient Protection and Affordable Care Act. On the campus side, there have been reductions in state and federal support for medical education, and levels of research funding are stagnant. On the medical center side, conservative estimates of a four to five percent reduction in traditional revenue (some estimates predict as much as a ten percent decrease over the next decade) that would put most AMCs in the red1, which is leading to an even more rapid expansion of UCSF’s affiliated clinical network.

With this expansion comes the inclusion of new faculty and clinicians into the UCSF system. It is within this changing landscape that the Senate wishes to explore what it means to be faculty at UCSF, and how the expansion of clinical care impacts UCSF’s ability to support the academic careers of its faculty who primarily work at affiliates. For instance, will faculty at satellite facilities have access to enough trainees to fulfill the teaching requirements required for promotion? In order to explore this question and other related ones, it is useful to briefly review the Senate’s role in UCSF’s missions, and its ongoing support of faculty welfare and promotion.

A key part of the Senate’s charge is the maintenance of UCSF’s core academic missions, which include patient care, biomedical research, health science education, and community service. While the Academic Senate does not have authority over clinical operations, it does have purview over the educational mission and is an important consulting body, ensuring that the research and clinical missions are appropriately support by the Administration, while ensuring faculty welfare and high quality patient care. One concern, for example, is that an increased emphasis on clinical revenue could have a deleterious impact on the academic missions if UCSF faculty are increasingly encouraged to perform clinical activities while neglecting research, education, and community service. The latter components have traditionally not only contributed to UCSF’s high reputation, but have also played a major role in faculty members’ own ability to be promoted, depending, of course, upon the different faculty series2:

  • Adjunct Professor—Faculty in this series are focused on either teaching or research. University or public service is encouraged but not required.
  • Health Sciences Clinical Professor—Faculty in this series are predominantly responsible for clinical service and teaching (bedside, clinic, or classroom). Research is encouraged but not required.
  • Professor of Clinical X—Faculty in this series are predominantly responsible for clinical service and teaching. University or public service, and research is also expected.
  • Professor In Residence—Faculty in this series are responsible for teaching, research, and University and public service, and if applicable, clinical service to the same extent as those holding corresponding titles in the Professor series (below).
  • Professor (aka “ladder” or “regular” rank) – Faculty in this series are responsible for teaching, research, University or public service, and if applicable, clinical service.

In making the distinctions above, one should also note that there is a relatively new non-faculty series, the clinical associate, which is essentially a UCSF physician who primarily works at one of UCSF’s affiliates without formal teaching or research obligations. In all of the above academic series except “ladder rank, faculty must generate all of their salary through revenues derived from their clinical, research, and teaching activities.

As it is unlikely that there will be a significant number of faculty in the In-Residence or Ladder Rank tracks at affiliated institutions, teaching will be a major component of a faculty’s academic activity. However, will these faculty members have access to sufficient trainees to fulfill those teaching requirements? This past year, the Senate’s Committee on Faculty Welfare (CFW) and Clinical Affairs Committee (CAC) both explored this question, and determined that APM 210 stipulates that faculty must do some teaching of UCSF trainees; it does not specify the number of UCSF trainees. It does not say is that one does not get credit for teaching non-UCSF trainees. The key is that there must be some teaching of “UCSF trainees.” While the exact mix of UCSF and non-UCSF is an open question, the Senate will continue to push to ensure that all UCSF faculty at affiliates have access to at least some UCSF trainees to afford them the opportunities for promotion.

Another example concerns the support (e.g., research support) necessary to foster academic activities as UCSF faculty based at affiliates. As one example, there is concern that St. Mary’s-based UCSF faculty do not have equal access to internal grants sponsored by the School of Medicine as their UCSF medical-center based colleagues. This is an issue that CAC will pursue further, especially as UCSF continues to expand the number of its affiliates.

Future Discussions

As alluded to above, the Senate is concerned with the welfare of all faculty at UCSF and its affiliates. Indeed, many of these issues are being addressed by various Academic Senate committees and working groups, and some will be highlighted in future issues of A Slice of Pie.

If you would like to propose other topics related to the recent growth of UC-affiliated health care facilities that you think would be important for the Senate to explore, please email us at academic.senate@ucsf.edu.

1 Governing the University of California Health System: An Analysis of Issues and Options, RAND Health, Prepared for the Regents of the University of California (PR-1884-UC), June 2015
2 For more detailed information about the different faculty series, please refer to: https://www.ucop.edu/academic-personnel-programs/_files/apm/apm-112.pdf.

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