Regular Articles The Organization and Regulation ofVoluntary Faculty Landy F. Sparr, M.D. Joseph D. Bloom, M.D. Leonard j, Marcel, M.D. james H. Shore, M.D.

A large number of psychiatrists haoe been, or are currently, unpaid, voluntary, or "clinicaI" faculty. In 1987-1988, in 127 medical schools, there were approximately 122,000 c1inical faculty members, outnumbering regular faculty by approximately two to one. Yet, in contrast to primary facu1ty, administrative policies (e.g., appointmeni, reappointment, promotion) regarding c1inical faculty are often iII-defined or absent entirely. We discovered in a survey of 8 departments ofpsychiatry that most departments do nothaue separate administrative guide1ines or policies Jor these faculty. This artic1e addresses specific mechanisms Jor determining c1inical faculty membership andduties andsuggests po1icies Jor appoiniment, reappointmeni, and promotion. The authors focus onadministrative managemeni strategies, such as thecreation ofa departmental Clinical Faculty Committee andtheconsideration ofqua1ity assurance issues. n traditional medical education there has always been a major role for unpaid, volIuntary, or "clinical" faculty. In in

1987-1988, 127 medical schools, there were approximately 122,000 clinical facu1ty members,

outnumbering regular facu1ty by approximately two to one (1). Most departments of psychiatry have a large voluntary faculty that is primarily involved in resident teaching and supervision. Clinical faculty are usually private practice psychiatrists (or other mental health professionals) who are able to provide academic departments with a broader range of experience, interests, and expertise than would otherwisebe possible. Yet,unlike the administrative policies for regular faculty, the administrative policies (e.g., appointment, reappointment, promotion) regarding clinical faculty are often ill-defined or entirely absent.

In different institutions, unpaid faculty have a variety of titles, including clinical, voluntary, volunteer, adjunct, clinical preceptor, and clinical associate (2). Some medDr. Sparr is an Associate Professor, Deparbnent of Psychiatry, School of Medicine, Oregon Health Sciences University. Dr. Bloom is Professor and Chairman, Oeparbnent of Psychiatry, School of Medicine, Oregon Health Sciences University. Dr. Marcel is Clinical Assodate Professor, Deparbnent of Psychiatry, School of Medicine, Oregon HealthSciences University, Portland, Oregon. Dr. Shore is Professor and Chairman, Department of Psychiatry, School of Medicine, University of Colorado Health Sciences Center. From the Psychiatry Service, Department of Veterans Affairs Medical Center, Portland, Oregon; the Department of Psychiatry, School ofMedicine, Oregon Health Sciences University; and the Department of Psychiatry, School of Medicine, University of Colorado Health Sciences Center, Denver, Colorado. Address reprint requests to Landy F. Sparr, M.D., Deparbnent of Veterans Affairs Medical Center (l16A-oPC), P.O. Box 1036, Portland.OR 972r:Jl. Copyright CO 1991 AcademicPsychiatry.

\ ( )I I "\. I \ In I \ ( l I I)

ical schools have paid clinical educator tracks ("clinieal" faculty) that run parallel with academic tracks and confer primary faculty status (3). In this article we will use the terms clinical faculty, voluntary, and volunteer faculty interchangeably to refer to nonprimary faculty who provide service to a medical school without direct monetary compensation. Voluntary faculty can teach practical applications of patient management by providing role models in a variety of settings. Most academic programs rely heavily on voluntary faculty for clinical supervision of residents. Voluntary faculty are often highly valued by residents because of their enthusiasm for teaching-they generally teach for altruistic reasons-and because of their clinical expertise and experience in providing psychotherapy (4). Simon and Zippin (5) found that two-thirds of the Vniversity of Callfornia at Los Angeles (VCLA) Department of Psychiatry voluntary faculty said that their assignments usually included supervision of residents or students in the outpatient clinic. Only 2.4% said their duties included supervision of residents or students on an inpatient unit or in a team setting. In some academic programs, voluntary faculty members have been successfully integrated into academic research projects (6,7). Barondess (8)sees voluntary faculty as the ''hope of the future," as the importance of protecting full-time facu1ty from excessive clinieal demands at the expense of their academic responsibilities heightens. Over 80% of the volunteer faculty at VCLA were happy with their teaching assignments and a large minority were even willing to extend their teaching activities if given the opportunity (5).Their satisfaction remained high despite a feeling that fulltime faculty members were somewhat parochial in their adherence to academic psychiatry and that academicians often lacked an understanding of private practice. The voluntary faculty surveyed believed that they taught residents practieal patient ,

management and a real-world approach to medicine that contrasts with academic medicine. When they were asked to rate items from an extensive list of reasons for volunteering time, obtaining "stimulation through teaching" received the highest ranking. This paper discusses the organization and regulation of voluntary faculty within an academic psychiatry department. To gather some preliminary information, we conducted a survey of 12 departments of psychiatry. The departments, both publicly and privately funded, represent a geographical cross-section of the country. We asked department chairmen for either copies of their written voluntary faculty guidelines or, if not available, their thoughts and comments about managing voluntary faculty. Dur objective was to solicit information that would help us revise our own voluntary faculty policies. Of eight respondents, three had formal guidelines. We recognize the considerable scientificlimitations of this survey. Because the data are only suggestive, the results of the survey will be presented throughout the body of this article rather than in a formal Results section. CLINICAL FACULTY COMMITTEE A recent survey (9) of the clinical faculty appointment process in 79 aeademic obstetric/gynecology programs demonstrated that only 4 departments used a clinical faculty committee; 6 departments made appointments based on recommendation by the regular faculty promotion and tenure committee; and in the majority (36 departments) appointments were made by the department chairman. Thirty departments provided no information about the appointment process. We have found in our department at Oregon Health Sciences Vniversity that the most effieacious means of regulating the activities ofvoluntary faculty is through development of a standing committee, the Clinical Faculty Committee, which annually reviews \ ( 'I

1\1 1

' ·"\.I \lj,ll, ' . ',I \:\11 1; : '''1

the activities and performances of all voluntary faculty. The committee has the basic task of making recommendations to the department chairman regarding initial appointment, reappointment, and/or promotion of voluntary faculty. The committee may also assist the chairman in planning and coordinating educational activities that have special appeal to voluntary faculty. In our department, committee membership ineludes primary and voluntary faculty and resident representatives. In our view, a standing committee has the advantage of exclusively addressing the clinical faculty' s unique role. A regular faculty promotion and tenure committee, overloaded with primary faculty concerns, may not give adequate time to the concerns of the clinicalfaculty. The same can besaid ofhaving elinical faculty appointments entirely controlled by the department chairman. ADMINISTRATIVE PROCEDURES

Appointment In HaIe and Krieger's study (9)of ob-gyn clinical faculty, the usual appointment criteria included board eligibility or certification, interest in teaching, and/or demonstrated excellence as a teacher or clinician. Other criteria included being a former resident or faculty member, being a "senior person" in the community, having unique service or special skills, having an academic background, being an "exceptional" individual, having regional or national recognition, and, last but not least, having "political utility." Most departments require a certain minimum number of hours of service per year that must be performed in order to maintain clinical faculty status. In our survey of 8 psychiatry departments, we found that service expectations ranged from 26 to 208 hr/year, Many departments, however, do not specify time commitments. Finally, most psychiatry departments also allow for ap\ ( \ I )1 \ 11 ~ I' ,", II I 11 \ I In

pointment of mental health professionals other than psychiatrists. In the Oregon system, we have decided not to make appointments based only on seniority or political purposes.To make sure that newly appointed clinical faculty have a departmental service role and an opportunity to fulfill the hours required, the prospective clinical faculty member must have a defined function negotiated with the department prior to submitting an application. The potential clinical faculty member must be nomina ted by at least one primary faculty member who must explicitly define the applicant's clinical role in writing. After nomination, the applicant must complete a university faculty application form, provide a curriculum vitae and a copy of a current license to practice medicine, and two references. The candidate's credentials are then reviewed by the Clinical Faculty Committee. Recommendations regarding appointment and appropriate rank are forwarded to the department chairman who, if he concurs, forwards the recommendations to the Dean of the School of Medicine, who then officially makes the appointment. . From a medicolegal perspective, it is necessary for each applicant to demonstrate that he or she is a competent, licensed physician. When a voluntary faculty member accepts supervisory and potential legal responsibility for a trainee, he or she also accepts responsibility for the quality of care delivered by the trainee (0). The courts indicated in Tarasoffv. theRegentsofthe University of California (1) that supervisors are potentially legally liable for the actions of persons under their supervision. Voluntary faculty are expected to have a reasonable grasp of the abilities of specific trainees, to provide supervision accordingly 02,13), and to report deficiencies to the department. Promotion Criteria Because clinical or voluntary faculty are nonacademic appointments, they should "

~

\ ( )I l \. I \ I, 'l 1 \ ( 1 I I 'l

have appointment or promotion criteria separate from their academic counterparts. In practice, it is not unusual for clinical faculty guidelines to be unofficial and unwritten. Because most clinical faculty are appointed and reappointed by department chairmen, both the appointment criteria and the promotion process may be idiosyncratic and inconsistent. As a result, clinical faculty designation may become an appendage of the "buddy" system. On the other hand, the alternative development of objective clinical faculty appointment and promotion criteria can prove to be daunting. Traditional academic dependence on such factors as number and quality of publications is clearly not applicable. In an effort to recognize and validate clinical faculty contributions, we have developed the appointment criteria shown in Table 1. Reappointment and Promotion In our survey, the most rigorous departmental clinical faculty reappointment process required annual documentation by the department chairman that each clinical faculty member had contributed service by active and direct participation in teaching or supervision, patient care, and/or research. In addition, the clinical faculty member was required to have satisfactory evaluations from peers and/or trainees. Information was gathered together in a reappointment dossier containing the following documents:

1. The department chairman's letter of recommendation, including a narrative description of the clinical faculty member's participation during the review period, number of hours contributed, and type and amount of planned ongoing participation. 2. A clinical faculty worksheet completed by the clinical faculty member. 3. Peer evaluations. 4. An updated curriculum vitae. 5. Trainee evaluations. /· 1

6. A promotion summary prepared by the department chairman (if applicable), Most departments we surveyed had no written requirements (62%). One vice chairman described attending a meeting in which the issue of clinical faculty reappointment and promotion was discussed and the consensus seemed to be that informal reappointment and/or promotion criteria could include "a number of parameters," such as teaching, extra service to a department in the form of administrative support, scholarship, or service to the psychiatric profession such as American Psychiatrie Association activity. Some suggested allowing activities such as "treating a medical student or resident at reduced or no fee" to fulfill the requirements necessary for clinical faculty to obtain and maintain clinical faculty status. Simon and Zippin (5),who surveyed 221 voluntary faculty in the Department of Psychiatry at VClA, reported that 64% did not know how they were being evaluated or if they were being evaluated at all; 57% said that promotion was relatively unimportant, and 39%indicated that they were indifferent when asked about satisfaction with the promotion process. In contrast, 34% said they were dissatisfied with the promotion process. In our department, we have taken a systematic approach to voluntary faculty promotion and reappointment. Because of our large number of clinical faculty members, most activities are monitored by an annual activity form . The requested information is tabulated for yearly review by the Clinical Faculty Committee and forms the basis for consideration of promotion and/or reappointment. Failure to return this annual report is taken as an indication of disinterest in a clinical faculty role and may be a reason for noncontinuance. Reappointment is based on active participation in department activities. Promotion is accorded to those who meet the \ Cli L \11 1, · \.L\ I I\I 1\ 2 '

The organization and regulation of voluntary faculty.

A large number of psychiatrists have been, or are currently, unpaid, voluntary, or "clinical" faculty. In 1987-1988, in 127 medical schools, there wer...
5MB Sizes 2 Downloads 0 Views