We surveyed academic hospitalists regarding mentorship, productivity and promotion. We found the majority of academic hospitalists lacked mentorship and this was associated with failure to produce publications and lead national teaching sessions. Many academic hospitalists had never presented a poster at a national meeting, published a manuscript, or presented grand rounds. The few academic hospitalists who had been promoted to the level of associate professor after seven or more years had been first author on an average of four to six peer-reviewed publications.
In academic medicine, mentorship has been positively associated with promotion,3
, job satisfaction,13
time spent on research,11
and publication success9
. Forty-two percent of academic hospitalists surveyed had mentors, consistent with the 19%–54% rate found in pervious studies of other select populations in academic medicine.3,8,9,11,17
The majority of hospitalists with mentors in our study met with them four or fewer times a year for less than an hour. We found clinician–investigators (CI) were more likely to have mentors available than clinician–educators (CE), consistent with other investigators who have suggested that clinician educators may be less likely to have mentorship than clinician investigators but that such mentorship may be especially important.14,18,19
Of all previous studies of mentorship and promotion, the prospective study of academic department of medicine faculty by Beasely et al. in 2006 likely represents the most similar study population to our own.3,20
The participants in their study were 35% female, 49% had >10% protected time, and 46% had a mentor. The participants in our survey were 46% female, 58% had >10% protected time, and 42% had a mentor. Their study identified three variables that were independently associated with promotion: 1) Working more than 60 hours per week, 2) Having a career mentor, and 3) being in the $130,000 to $149,000 salary bracket.
Seventy-six percent of hospitalists with a primary mentor rated the value of mentorship in academic career development as “excellent” or “very good.” Traits that hospitalists valued in mentors include “enthusiasm,” “ability to give career advice,” and “ability to inspire me.” These traits are similar to the attributes associated with excellent attending role models as identified by Wright et al. in 1998 which included spending more time with house staff, enjoying teaching, and building relationships.21
The least valued trait identified in our survey was “providing emotional support.” Beyond perceived value, we identified objective scholarly outcomes adversely affected by a lack of mentorship. In the multivariate analysis, a lack of mentorship had significant detrimental effects on production of both first-author peer-reviewed and any non-peer reviewed publications. Lack of mentorship was also associated with a failure to lead a teaching session at a national meeting. These findings are consistent with Steiner’s findings among primary care fellows that “influential and sustained mentorship” was associated with the outcome of academic productivity.11
Possible explanations for the lack of mentorship include the relative infancy of the field of hospital medicine, a lack of seasoned role models, lack of funding and competing clinical demands as identified by other investigators.22
Despite the challenges, creating a structured mentorship program has been shown to be a cost-effective way to improve education and research skills and retention of faculty in academic medicine.10
In comparison with increasing protected non-clinical time, establishing effective mentorship relationships may be less expensive way to help improve young faculty’s publication success and subsequent chances for promotion.
Academic hospitalists appeared to be slow to start scholarly production. Nearly half of academic hospitalists had not produced an abstract or poster or written a first-author paper and only a quarter had presented grand rounds at their institution. Academic hospitalists with 20% or more protected time from clinical duties and a better understanding of promotion criteria tended to be more academically productive, even after adjusting for the hospitalist’s career focus (e.g. research vs. clinician educator). As suggested by previous studies, we also observed that a better than average understanding of the criteria for promotion was associated with production of any peer-reviewed first author papers.20
This would suggest that the faculty members who understand what is required are more likely to produce what is necessary. Alternatively, it may be that those faculty members who are active and participating in the intellectual work of the university also tend to know the rules by which the system functions. It remains unclear why male academic hospitalists in our survey are more likely to produce peer-reviewed first author papers. Our data offer no suggestion of the origin of this gender difference. It is an unexpected result that suggests areas for further research regarding academic roles, gender, academic productivity, and promotion.
While it is difficult to assess “success” or “failure” with regard to promotion, we quantified first author publications by year and academic rank. At year seven and beyond, physicians who had been promoted to associate professor had produced on average four to six first-author peer-review publications. Assistant professors at the same stage had averaged only one or two—consistent with Beasley’s findings that the number of first authored papers is “the strongest independent predictor of promotion.”3
Expectations vary widely among institutions with respect to publications and promotion criteria although teaching skill and particularly teaching awards are among the most important elements for clinician educators.23
Curiously, mentoring is itself viewed by promotion committees as a valued contribution from a clinician–educator.24
In agreement with previous studies, our findings suggest that each academic hospitalist would be well served by requesting protected time for scholarly pursuits and making first-author papers their primary academic objective.25
There are several limitations in our study. In order to make this study feasible, the process of identifying our survey population required a number of steps. By consensus among the authors, we identified a convenience sample of 25 larger, well established academic hospitalist programs in the United States. We did not define strict criteria and thus there is potential for bias in this initial selection. More successful or higher reputation programs may have received attention while smaller programs were not included. Of the 25 group leaders contacted, only 20 agreed to participate and share the email contact information for their hospitalists. There may have been some element of self selection for larger or more successful groups. Our methods, though imperfect, allowed us to survey many academic hospitalists and achieve a high response rate. A database or hospitalist society-level initiative may allow future researchers to ask these same important questions of a larger study population.
Sixty-three percent of academic hospitalists surveyed are clinician–educators. Promotion committees use a wide variety of methods to evaluate clinician–educators including but not limited to written scholarship and clinical research.24
We elected to use the production of posters, abstracts and papers because it was a tangible objective measure of academic success. This is a narrow measure and ignores excellence in teaching, clinical, or administrative work, which is also used by promotion committees in evaluating physicians defined as clinician–educators and thus we may have missed relevant contributions. Hospitalist positions in academic medical centers are often staffed by two separate populations of young physicians; doctors choosing the field with intentions of a long career in academic medicine and recent residency graduates who spend a few years as hospitalists prior to beginning a subspecialty fellowship who are typically more transient within academics. Although we were able to differentiate between new faculty (less than six months on the job) and others, we were not able to separate out the hospitalists who were intending an academic career from those fulfilling a short-term staffing need. This may have biased our data with regards to academic productivity as the transient hospitalist may be less motivated to create academic publications than her career counterpart.
The leadership in academic hospital medicine would be well served to review and act upon the findings of this survey. Fewer than half of academic hospitalists surveyed had a mentor and a lack of mentorship is associated with a failure to produce quantifiable academic work. Facilitating the development of mentoring relationships among new and seasoned physicians may be an inexpensive way to improve academic success.