If you are a medical school professor then what was your path to professorship? Are there a lot of politics involved with academia? Do you have to do basic science research to teach basic sciences in medical schools?
Short answers-
See below.
Absolutely lots of politics.
How lecturers are chosen probably is very institution specific. Most of mine were PhDs, certainly most of the course directors. Pathology was one exception, and our clinical medicine courses. I don't think any of them were very junior.
Here's something I wrote about clinical medicine tracks that may be of interest as it relates to your first question.
Most medical schools, including all that I looked at for a job, and the two where I have been on the faculty, offered three distinct academic pathways. They are separate and have different promotion requirements. What they are called may differ from university to university.
1. Tenure- Essentially a serious researcher who does limited clinical work as well. Usually 75% or more protected non clinical time. These guys earn their clinical time off by paying their salaries with grants, etc. Grant support and significant academic productivity is required for retention and promotion. An MD PhD would be useful for this track. Research has shown that academic career success in this track is significantly higher at >80% protected time, which makes sense.
2. The academic-clinicians, primarily clinical people who have 20-50% protected nonclinical time to engage in research. ~50% of our faculty are on this path. The department/hospital supports their time off, some have small grants, a couple are significant, and some are quite successful convincing manufacturers to donate their equipment, etc. for their projects. Some get money (time) from the university or hospital to devote significant time to important committees or projects, patient safety, quality improvement, etc. Research is required for promotion and Up or Out applies, though much less than for the tenure track.
3. The clinical-educator path. This represents a growing percentage of the appointments at the medical school. They teach residents and fellows and others rotating through the department, not usually lecturing to the medical students though. Promotion requires zero research commitment/productivity. Though many, myself included, have lectured at meetings, written chapters in textbooks, participated in clinical research, mentored fellows chart reviews, case reports, etc. The purpose of this track is to generate outstanding clinicians and superior educators for the residents and fellows. The other benefit is to have more people on the ground every day getting the clinical work done in the trenches. It also unloads some administrative burden off the research faculty. By report the university is very happy with it's success and the number of appointments into this track is increasing. The medical school has 3 goals. Excellence in research, education, and clinical work. The non research path recognizes that one can excel in the area of resident education and be clinically outstanding, without being a research leader. Clearly an asset to a demanding academic department. I do know that some other departments at the university do not have many/any non research track faculty. The individual department chairs have to decide what they want from their faculty, and mine places a very high value on trainee education and the reputation of it's graduates as well as clinical excellence and hires a significant amount of non research faculty. Promotion requires evidence of clinical excellence as well as higher teaching scores than the other tracks. Up or out does not apply. (here)
The reason I am in academic medicine is that I have a desire to participate in resident and fellow education, and I'm good at it. Also, I thrive on the constant supply of interesting and challenging cases available at a world class academic referral center. As an anesthesiologist, it's also fascinating to participate in cutting edge techniques that few facilities/surgeons in the world offer.
Anesthesia is a bit unique as it requires a lot of boots on the ground every day. You don't just have one call and back up person covering an entire service for a week at a time while all the other faculty have 1-2 clinic days and 3-4 research days, you need >20 faculty every day, working the whole time. If everyone had a tenure track or 50% protected non clinical time we would have a lot of problems with the clinical load and we would make a lot less money because we would have to hire so many more faculty.
There are also adjunct faculty that are affiliated with the university, but not really part of the university faculty. They may be guest lecturers, host clinical rotations at their hospitals or offices, etc. I'm not sure if they get any money for that service, I'd guess not. They don't vote in the faculty senate, can't hold university admin positions, etc.
As to income, many (most?) academic programs will pay less than similar private practice jobs where you own the group and contracts, but it's very variable. Some actually pay quite well, particularly comparing income to hours/days worked, offering incentive compensation, productivity based bonuses, etc. There are also groups that are really structured like a private practice model, but at major academic centers with real faculty appointments. That's a good gig if you can get it. Obviously that's a harder job to get as you have the benefits of higher income from a PP model as well as the benefits of being a member of the faculty at an academic program.
