IIDestriero: I don't know what medical school you are in. Educator track is exceedingly rare because it requires you being the course master of the curriculum. Each department may have one or two on such track. Most clinicians are on clinical track as they don't get serious funding. The tenure track is reserved for physician scientists with significant extramural funding and some basic scientists. We hire young attendings for several years. The contract is renewed annually. If we find a lack of academic progress, contract may not be renewed. We have quite a bit of turn-over in personnel in bad years. Unless you have the desire to contribute to the literature of medicine, there is no point to stay in academic medicine: It is underpaid and stressful (if you don't like research). Job security is nowhere as good as partnership. You have to get RO1 and to demonstrate the ability to renew it to obtain tenure position in medical schools. Unfortunately, most clinicians never even come close to that.
Many 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. It's a shame that your university doesn't offer them. You're probably losing faculty with outstanding clinical potential. It's worth noting that I'm not talking about random Podunk medical schools here, but top 20 schools with long track records of serious research.
1. Tenure- as you describe. Essentially a serious researcher who does clinical work as well. Usually 50% or more protected non clinical time. We have not had a new tenure track person in years. They are the senior faculty around before the development of the other tracks. These guys earn their time off by paying their salaries with grants, etc. We have a few 100% researchers as well.
2. The academic clinicians, primarily clinical people who have 20-50% protected nonclinical time to engage in research. ~40% of the staff are on this path. The department supports their time off, some have small grants, a couple are significant, and some are quite successful convincing manufacturers to donate their equipment for their projects.
3. The clinical-educator path. This represents a growing percentage of the appointments in my department and is about 50% of the faculty. They teach residents and fellows and others rotating through the department, not lecturing the medical students. 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. I think we've had the non research track for more than 10 years. 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 any non research track faculty. The chair has to decide what he wants from his faculty, and mine places a very high value on trainee education and the reputation of it's graduates as well as clinical excellence.
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. As for pay, many departments offer productivity based compensation, and I'm very fairly compensated for how hard I work. I have no reason to believe that I have any less job security than anyone else in anesthesia. Probably more than many small groups out there. My salary might be better protected as well because we could all work 10-20% more if we really wanted to, and we could focus on improving efficiency and throughput. Many of the PP jobs I looked at paid some more, but you worked much harder and many relied on significant, and easily cut, hospital subsidies. If they could, most hospitals/ASCs would love to employ anesthesiologists and CRNAs directly, making a nice profit off our backs. Those fat PP jobs are not as secure as you might think. There are many stories on the anesthesia board about decades old groups being outbid by management companies and leaner young guns willing to adopt more efficient staffing models. Some quite large. My own family had a physician let go when the hospital dumped them after leading them on for a year. They worked hard, were well liked, no lawsuits, just too expensive. The administration put a target on their backs and didn't lose a minute of sleep letting them all go to save some money.
