Medical schools must pay attention to the sources of faculty discontent. Bland has warned that "institutions can no longer take a laissez faire attitude [toward] faculty and institutional vitality, if they hope to retain faculty who are creative and successful in their work." [3
] As noted earlier, programs aimed at ensuring faculty vitality, productivity and institutional loyalty are likely to be far more cost-effective than continual recruitment and retraining [1
These data prompt several recommendations. First, medical school faculty and administrators should develop and conduct their own faculty needs assessments. Conducting a review of the "top ten" predictors of faculty discontent and intent to leave can assist medical schools to measure faculty vitality and sharpen the focus of their faculty development programs. Schools should regularly monitor turnover and attrition rates and compare these with national benchmarks. Periodic surveys can be conducted confidentially, rapidly and inexpensively using web-based technologies.
Second, the demographic trends are obvious. The junior faculty pipeline is increasingly filled with members of Generation X, men and women who define career success holistically and frequently take a longer view of their career trajectories [15
]. They are likely to benefit by attention paid to career and family balance, with more flexible schedules, more opportunities to work part-time, and relaxation of promotion or tenure clocks [1
Stronger mentoring and performance feedback by department chairs, and stronger networks of colleagues, can enhance faculty career satisfaction and retention. Chairs should be held accountable for holding regular meetings with faculty and providing constructive feedback and guidance regarding academic progress. Faculty also need release time to attend skill- and career-building workshops and seminars. According to Bland et al, "individuals' [academic] success depends on their knowledge, skills and motivation, but also hinges on the depth and breadth of support provided by their home institutions." [50
] That support typically includes effective mentoring programs, protected work time, substantive communication among colleagues and "brokered" faculty development opportunities, all of which are found routinely in successful research-intensive enterprises [50
Schools that have not already done so should consider revisions of academic promotion guidelines so that they recognize and reward faculty members for the jobs they are asked to do [5
]. In particular, faculty express a strong desire that high quality teaching and clinical service be recognized and rewarded, and not marginalized or subordinated to other traditional yardsticks, such as grant acquisition, peer-review publications or evidence of a national reputation [5
]. In our survey, one faculty member observed that, for clinician-educators, "excellent patient care and teaching should be more than enough to promote; it's our job."
Finally, there must be a strong emphasis on shared governance. This survey indicates that faculty members and the institution may benefit if faculty are provided with more tangible opportunities to participate in school-wide governance; such opportunities should include the means to influence decision-making, resource allocation and selection and evaluation of school leaders.
In a general sense, these results suggest the importance of an array of institutional features and faculty supports: Chairs who provide constructive feedback; institutional and departmental commitments to mentoring and career development; opportunities to interact with successful and influential colleagues; support and recognition for teaching and clinical service; and effective participation in institutional governance, including shared decision-making, evaluation of leaders, resource allocation and program planning. These steps will not only help empower individual faculty and aid them in their careers, but will also prove good for the institution, as they boost faculty loyalty and the institution's resiliency and leadership capacity [1