3. P&T with Alan Dalkin

I'm going through my first promotion cycle and...wow. We need to talk about this.

In this episode I discuss promotion and tenure with Alan Dalkin, Vice Chair for Promotion and Tenure in the UVA Department of Medicine. We talk about what the P&T process entails (and why), key lessons from his experience ushering DOM candidates through P&T, and future directions we should move towards to make P&T more inclusive and reflective of the work we do.

Topics
- Overview of the P&T process at UVA (02:15)
- "Promotion" vs "Tenure"  and the career tracks (03:38)
- How to get the most out of your annual review (06:35)
- Does tenure mean anything anymore? (11:33)
- The common hangups for faculty going through P&T (13:05)
- What should P&T look like going forward? (17:45)

Links:
- UVA School of Medicine P&T Resources
- Is it Time to Reimagine Academic Promotion and Tenure? JAMA 2020;1(2):e200164
- Follow Dr. Bell on Twitter

Transcript

3. P&T with Alan Dalkin

Intro

[00:00:00] Taison: Hello, everyone! You are listening to This Medicine Life. I'm your host Taison Bell, a Critical Care and Infectious Disease physician at the University of Virginia. And, if you're like me, you may love being an academic medicine, but it's hard, y'all! The goal of this show is to make that just a little easier through the power of connection. We're interviewing medicine faculty, both inside and outside of UVA. Our goal is to connect with each other, to share our stories, our tips for success, and - together - become the best versions of ourselves in life and career. 

Pre Guest Segment

[00:00:40] Taison: Okay, y'all we're going to talk about promotion and tenure. P&T. 

[00:00:46] What was the emotional response you have when I just said that? P&T stirs up a lot for us in academic medicine, which is why it's so important to talk about it. I'm going through the P&T cycle this year and, the question that comes to mind is, "What is happening?" All of a sudden there're all these deadlines approaching, I'm reformatting my CV, and all my annual reviews, which were basically, yeah, you're doing well" now become, "Maybe you should consider changing your track." 

[00:01:16] The reality is academic medicine has changed a lot, but the promotion and tenure process has not. And some of the advice we receive is either outdated, wrong, or it lacks the vision necessary to help us all thrive. 

[00:01:31] So to answer these questions, I sat down with Alan Dalkin to discuss P&T. He's Professor of Medicine in the Division of Endocrinology and Metabolism here at UVA and he's the Vice Chair for Promotion and Tenure here in the Department. Which means that it's better to hear his advice upfront rather than receive an unexpected call from him later. 

[00:01:50] We discussed as pointers along with the direction he would like to see P&T move towards in order to be more inclusive. So let's get right to Alan. 

Taison/Alan Conversation

[00:02:01] Taison: Alan, good afternoon. How are you doing? 

[00:02:05] Alan: I am Well, How are you, Taison?

[00:02:07] Taison: I'm good. How was clinic? 

[00:02:08] Alan: Busy as always, which is a good thing. 

[00:02:11] Taison: Reminds me of why I chose not to do clinic. 

[00:02:15] But let's go ahead and jump right in. This is near and dear to my heart because I'm going through the P&T process right now. But I guess we could first start by just going through the roadmap or an overview of people approaching the P&T process. What should we be thinking about? 

[00:02:30] Alan: It's an excellent first question. I'd like to start back a little bit earlier than when you're deciding to go up for P&T cause I really do think P&T should start when somebody is hired. You've got to have it. They need to be hired with the right job description. They need to be hired with a mentor who can help guide them along the way. People who can, who been there, done that and who can be a resource to the candidate because it isn't always up to the candidate when they think they're ready. It's sometimes it takes a an external view of the world to be able to decide what's the right time. 

[00:03:00] So. Historically. 20 years ago, everybody tried to be on the tenure track, whether it's the clinician, educator, or clinician investigator, our academic investigator track. And the other point I'd make is that that has really changed in the last couple of decades in that I would say the vast majority of faculty that are hired are now on the clinical faculty track. They are not a part of the tenure process at all, but so I want people to, I want the listeners to understand that that's probably the the majority of individuals and it is in no way, shape or form any different, better, worse, or otherwise. 

[00:03:38] Taison: realized that, um, I there's even some more basic questions that want to have answered. So I'm one of them is just, what is promotion versus tenure? And just a basic overview of the um, that, The three main tracks that are tenure are academic investigator, which is for PhDs, the clinician investigator, which is for an MD and the clinician educator, which is also generally an MD, their MD tracks. The two investigator tracks are meant for people with a focus on science. On research. And the main criteria for the first step in their promotion and tenure-- that is going from assistant professor to associate professor-- is excellence in research and that's getting grant funding. Now in the world of team science, it may not be that you're the only person on the grant. But essentially excellence in investigation is the only pathway to success for the first step for those two tracks. Thereafter, they have a second step. That is the award of tenure. That step requires excellence in a second area, which is patient care or medical education. 

[00:04:48] Alan: And then from that comes the third step, which is promotion to professor. And that requires sustained excellence. That means that you continue to do excellent work in those two areas that you've identified when you got tenure. There's timing differences between some of the tracks, but that's the gist of those two. 

[00:05:07] And the clinician educator track is also the same three steps. Assistant to associate. Associate to tenure. Tenure to professor. But the areas of emphasis in that track are usually patient care and medical education. Although there are many clinician educators that develop grant supported programs, research operations that are very significant and will have excellence in research. The other track, the other half of the world or now probably 60, 65% of the world for the Department of is clinical faculty track. Now that is not a so there is one last step. There are only two promotion steps. 

[00:05:45] The first step is to go from assistant professor to associate professor. And that requires excellence in one of the three areas, and it's almost invariably patient care. But it can be education as well. Investigation would be unlikely because if you're doing enough work to have excellence in investigation you're on the wrong track. Your job description, isn't going to match your efforting in terms of where it, where you're spending your time. 

[00:06:09] So clinical faculty go from assistant to associate professor and then associate professor to professor. And, and again, the word sustained applies to becoming a professor, which is that you then have to show that you have grown in your area of excellence, grown in your development of the impact of your work. 

[00:06:26] Those are, those are the big ones. There are some, there are some other associated tracks. I'm happy to meet with anybody to discuss them, but I think for your audience, that covers the vast majority of 

[00:06:35] Taison: Sure. Okay. So how about these reviews that we're supposed to do annually with our division chief? How are we supposed to be using those in this process? 

[00:06:44] Alan: The annual reviews, the other part of this is that the annual reviews that are done with faculty members and their division chiefs are critically important. 

[00:06:52] Again, historically, they oftentimes are for a check the box, make sure everybody is alive and breathing, going to clinic and doing whatever, but I think in recent years, they really are meant to answer the question, "Am I on track?" Am I doing the things that I need to do to fulfill the job description for which I was hired to. Things that make me better as a academic physician and the accomplishments that are going to get me recognized for the skilled individual that I really am. The flip side of that is to make sure that people aren't overextending themselves, that they aren't getting involved in too many different activities that otherwise could draw them away from what's the reason that they're here. 

[00:07:28] Taison: All right. So let's say we've done our annual reviews. We've done exactly what we're supposed to be doing. And now it's finally time to get our portfolio together. So what does this look like? 

[00:07:39] Alan: That the process, the roadmap we're going through P and T is really. The year that they're going to go up. Starting probably over the course of the winter. They really do have to start pulling together a whole array of information that has to do with your clinical product. That is where the patients come from. How many patients that you see, what are the diagnoses? 

[00:07:59] What is the role that you play in a very specific niche that allows you to be an expert in that area? To be able to get the patient satisfaction scores and the area of education. Course evaluations, teaching evaluations. Other,scores that you may have gotten from giving lectures and other educational opportunities. So, when the time arrives, to be submitting the beginning parts of your portfolio. Which is essentially a CV that has to be in the format that the School of Medicine and the University requires. A personal statement about what makes you tick and what makes you excited to be here, and then a letter (a list, sorry) a list of, potential outside and inside referees who can evaluate the quality and the quantity of your work. That happens pretty much in the spring or April- May timeframe. From there then comes to putting together of the full portfolio, which is a pretty extensive process as you have figured out, there is a lot of moving parts. There's a lot of information that's needed. Those things are in binders for a reason. They're not just in a folder. It's a, it's a... 

[00:09:00] Taison: Physical binders, I saw mine. 

[00:09:02] Alan: Yeah. Yeah, they are. They are everything you could want and more. So it, it requires and putting them together requires some time and some thought and some strategy with your division chief. What are the things that are most important to me? What are the things that I feel like I have really had the biggest impact? Whether it's an education, whether it's in research, whether it's in clinical practice. All those things matter. So that, then is due sometime at the end of the summer then the department of medicine committee gets together in September, where we review on a one by one basis, every single portfolio. There's a primary reviewer that's assigned to that and a secondary reviewer that's assigned to an individual. They each have their own report out. We meet as a group. We all vote. There's. Somewhere between. 10 and 15 faculty members on that committee. We make a decision. If there's a yes then the portfolio is going to be moved forward to the School of Medicine. 

[00:09:58] If we vote we need more information then oftentimes I, as the committee chair, get hold of the candidate. And we have a division chief and we try and get all the information together and then the committee will re-vote and if the answer is no, that's often because of the need for clarification of information. Somebody needs to pull together a different aspect, a different viewpoint on their portfolio, but we really do try to pull everybody that's going up to the next step if at all possible, unless there's something that they're just not ready for, in which case then that's the responsibility of the committee chairman to meet with the candidate, to meet with the division chief and to work through that. 

[00:10:33] Taison: So it sounds like you're the kind of person that we should talk with when we're getting prepared. But after we submit, we actually don't want to hear from you. 

[00:10:40] Alan: No, that's the guy right. I am, I am behind the, "Don't talk to the man behind the curtain." No, no, I think. I think that, one of the resources that's available is the chairman of the promotion tenure committee for the Department. I probably meet with half or more of the candidates at some point before they submit their portfolios. Help read the personal statements to look to the CVs, to look through the letters of nomination that have to come from the divisions because I think they're critically important how they're crafted. And not tooting my own horn, but I've read hundreds of them. I've written dozens and dozens of them and it does matter that some time and energy and thought is put into those. They don't just flow out of the, the pen, off the typewriter, off the keypad instantaneously. 

[00:11:24] So I, it takes some time, but I'm always, it's a good question. I'm always available. Even as the process is ongoing to meet with people and help rearrange and craft the way it should look. 

[00:11:33] Taison: Quick question, cause I remember when I was told, when I first came here in 2017, when it comes to physician faculty, there's really no benefit to having tenure. True or false. 

[00:11:44] Alan: True. In the old days, I think that was more important. In this day and age, I couldn't tell you who has tenure, who doesn't have tenure. I couldn't...I don't even remember. All I remember is who successfully got promoted. And I do think Dr. Rosner would say the same that we're looking for people who are excellent in what they're hired to do here. 

[00:12:03] And if you're hired as a provider, and you're excellent as a clinician that is a victory for everybody. And I don't think that that extra step makes any difference in terms of how the world views you or how you should view yourself. I think the point is to find the track that best fits what you're here to do and move forward and, and really to be honest, answer your question. I'm not sure what tenure gets you this day and age. 

[00:12:27] Taison: So not even a salary difference? 

[00:12:29] Well there's one. So historically it's a good question. Historically, promotional steps were linked to changes in compensation between five and 10% raised. So theoretically having the tenure track gave you one extra salary bump. But I think as we progress to a more reasonable compensation model where people are properly compensated for the work that they do in whatever area that is. I think that's going to become less and less of an issue. I think people's salary and benefits will be more appropriate for them as an individual, not for what rank they are. 

[00:13:05] Taison: I think that will be welcomed by a lot of our faculty.Second question: where do you see faculty get hung up the most when they're going through this process? 

[00:13:14] Alan: There's probably not a single answer to that. I think there's a number of different areas. If you pay attention as you go, they become less of an issue. I think the first one that comes up almost almost all the time is that of, "what is scholarship?" The definition of scholarship used to be how many articles you published as a first author or senior author, what the impact factor of that journal was, how many talks you gave at national meetings. That has really, I think, changed. I think that the issue is keeping track of all the little things that you do, because the little things nowadays count. I also think that the scholarship that is not classical scholarship. I would say, Taison, that your podcast here represents a scholarly piece of work that otherwise five, 10 years ago wouldn't have counted for anything really in the P and T world. So being able to keep track of this and being able to describe what you did, how you did it, the impact of what you did, and what the target audience was for that given product. Because I think all the scholarship is really asking for is proof that you're in a career that is academically successful and academics. Include scholarship, which separates you out from being in private practice. 

[00:14:22] The second area is probably reputation. And that is to say it's important to get out there. It's important to be involved in committees and organizations at the University, but it's also important to get involved in state medical societies in the parent organization for your specialty or for your practices. So in general medicine, there's a parent organization. Endocrinology, where I am, there's two main organizations the larger one being the Endocrine Society, but also the American Association of Clinical Endocrinologists. And getting on committees, getting out there where people in other parts of the world in other areas of your practice get to know you and can say, "Yes, I, recognize, Dr. Bell, I worked with Dr. Bell on this committee. We had a great impact and he was very helpful in doing X, Y or Z activity. 

[00:15:07] The other one, the other areas where I see people tend to fall down as is no good deed goes unpunished. Which is that when you do something right, somebody asks you to do something else because they know you're going to do a good job of that too. And people get overextended and they get out of their lane. You're hired as a primary care provider and you wind up on seven different committees that draw your time away from that. And it becomes hard to say, " Yes, I've established excellence in patient care when you're spending 50% of your time. Bouncing around between other meetings that don't necessarily directly impact patient care. So I think this is where the annual reviews with your division chief and having proper mentorship are important because I think that helps you. 

[00:15:49] It's hard to say no, Right? We're inherently good people who like to help other people-- it's like me doing your podcast-- and we want to do a good job when we want to make sure that the information is out there, but in your younger years, there's this tendency to just say yes to everything. And you gotta be... Saying no is hard, but you gotta be willing to do that at times. 

[00:16:07] The last area, I'd say where I see people need to pay attention is impact. Which is that, as you go through your careers, you do the parts that you're expected and that you're excited to do. Document what the impact was. If you give a talk it may be four or five years before that comes up on your promotion tenure thing. But try and write down what was the audience like? How many people were there. Get a letter from the person who asked you to give the talk, just to document that it was well received. It may not be a formal evaluation but I like in the portfolio process just scrap booking. And you need to pull together all those little pieces that tell the story properly and make it a the thread, something that's interesting and captures the importance of the moment. 

[00:16:50] Taison: I remember one, I forgot who told me this one. When I came on faculty, someone said to create an email inbox where I just put good things that people said about me. And they said it for two reasons. One, you can go back to it on a bad day and just look at what people are saying about you just bring your spirits up, but also it's helpful for the P and T process. So I think that's really good advice.

[00:17:10] Alan: It's an excellent idea. 

[00:17:10] Taison: Yeah, you always forget, and we end up doing a lot and it's hard to document sometimes and recall: when did I get that talk and what was that about? And... 

[00:17:18] Alan: And keep your CV updated. It is so hard to go back two years and look through your calendar and say, "Oh yeah, that's right. I forgot about the talk I gave to the family nurse practitioners." Just put it in the CV. It's easier to take something out. If it turns out it doesn't really look like it should be there than it is to go back and try to remember what you need to add. And CVs are a living and breathing document. They change monthly. Updated frequently. There's no harm. in adding something and then dropping it later. 

[00:17:45] Taison: Great advice. As we close, I just want to ask you looking forward. What would you say are the victories and some of the future directions that you'd like to see to P and T process move towards? 

[00:17:56] Well, there's actually a committee. Sue Pollard in the School of Medicine has pulled together a group of individuals, mostly department chairs, but I'm lucky enough to be on that too. Looking at what are the things that could be done? To make the process better. What are the things that could be done to enhance P and T so that it fits naturally with faculty growth rather than being this gargantuan hurdle that you have to do every six years or three years, whatever. So, the things that are included in that, that we're working on is trying to figure out a way to make the preparation and maintenance and updating of one's CV more automatic. In other words, there's got to be a way to pull a lot of this information together so you don't have to do it manually. 

[00:18:38] Alan: The ability to get annual evaluations so that they are automated and fit into a form that's allowable for the P and T process to document the words to support the notion of something being sustained. That every year you've done what you've been asked to do, then you've done it well. 

[00:18:54] I think we also want to look at how we can document the impact of roles that are not classically associated with promotable activities. One of the really important is the Designated Institutional Officer role, which historically wasn't part of anything. It didn't count for education, it didn't count for patient care obviously, and it isn't part of research. So it didn't help you in terms of excellence. It certainly is a great service. But I think we have to come up with ways to recognize jobs like that that are just so important for all of us, for learners, and for teachers, and for practitioners alike. To be able to do what we do here at the University and to be good at it. So there's that. And I also think the last thing is we have to be better at making P and T feel like the diversity and the breadth of medicine that we represent here as faculty. 

[00:19:46] That there's gotta be a bunch of ways in, and there may be common hurdles and common bars that we hold people to, but a bunch of ways into the process of P and T. And multiple ways to achieve excellence and multiple ways to sustain that excellence. We've gotta be flexible. It's not there's tenure and then there's everything else. Modern day academic medicine is not the same thing as it was 30 or 40 years ago and we have to recognize that. 

[00:20:10] Taison: That's a really good point. I appreciate you for coming on. And as I go through, the process, I've appreciate your guidance but I hope once everything's submitted, don't hear from you that much.

[00:20:20] Alan: It will be a victory. No news is good news. That does apply to P and T. But thank you, Taison, for having me. I, greatly appreciate the opportunity. 

[00:20:26] Thank you. 

Post Guest Segment

[00:20:28] Taison: This episode was really interesting to record while going through the P and T process for the first time. I ended up having to speak with Alan after our conversation. It turns out I was hired on one track- clinical faculty- but my job never really looked like someone who was hired to that track. So I had to make a switch. 

[00:20:49] And I hope one thing to take away from this is to make sure you pay attention to your annual reviews, because I could have benefited by paying more attention to that. But the broader point is that academic medicine has changed and P and T needs to continue evolving to match it. And the zoom out further. We need to create an academic environment where we all can thrive. 

[00:21:09] So there are specific things we should look at, like promotion and tenure for women in medicine or underrepresented faculty. And really produce metrics to know exactly how we're doing and where we can improve. 

[00:21:21] And there are probably many other things that we could be doing, especially if you look at how other institutions have solved these issues. But what's clear is that in order to represent the full faculty we're going to need lots of input and lots of ideas. So I hope this is just the beginning of the conversation.

Outro

[00:21:40] Taison Bell: And that's our show! Thank you for listening to This Medicine Life. If you enjoyed the show, please subscribe, write a review, and tell a friend. We are available wherever you get your podcasts. This show was created, recorded, and edited by - me. Music is by Dr. Malcolm Lex. 

[00:21:59] Views and opinions expressed to not necessarily reflect the view of the University of Virginia or any other entity. Please send me your ideas for topics you want to hear about or guests you want to have on the show. My Twitter handle is my first and last name, Taison Bell. Please stay tuned for the next episode. Until then, I'll see you around.