Every institution sets its own bylaws, that specify what is required for obtaining promotion and tenure and how long you may take to apply for these.
There are different positions in academic medicine, again depending on the institution. You may be on a tenure-track, which then will specify guidelines for achieving promotion and tenure. However, you may choose to be on a non-tenure track, and will then have guidelines for achieving promotion. In some settings, you can switch from a tenure track to a non-tenure track if it looks like you are not going to meet tenure criteria.
Either way, you would be part of the clinical and teaching faculty. The amount of clinical time versus teaching and research time will depend on the track, the position that is needed, and negotiations in your contract.
The latter is important if you want to actually have time to do research. Also, some institutions will "count" clinical trials toward research, some won't.
JRB
