Protecting Time to Foster Clinician Educators' Careers
By Seth Mark Berney, MD
John and Lillian Norfleet Professorship in Medicine
Professor of Medicine
Chief, Division of Rheumatology
Eastern Virginia Medical School
The Challenge
Several years ago, an American College of Rheumatology president remarked that "clinical research is facing an existential threat" because of declining research funding. While that concern remains valid, an equally significant—and perhaps greater—threat faces clinician educators.
Academic medicine has traditionally rested on three pillars: teaching, research, and patient care. Today, however, success is increasingly measured by teaching productivity, funded research productivity, and clinical productivity (RVU generation). As the business of medicine takes priority, non-reimbursable activities such as teaching are often devalued.
Many institutions expect faculty to teach simply because they hold academic appointments. Yet not all faculty contribute the same quantity or quality of education. Unlike research funding or clinical revenue, teaching is difficult to quantify, and many institutions lack meaningful ways to measure or reward it. As a result, educators who devote substantial time to teaching and mentoring often receive neither additional compensation nor protected time.
Teaching inevitably competes with patient care for faculty time—and too often, teaching loses.
Why Clinician Educators Matter
Clinical educators do far more than deliver lectures. They:
- Train medical students, residents, and fellows to become excellent clinicians.
- Mentor and advise trainees.
- Lead educational programs and curricula.
- Inspire enthusiasm for medicine and rheumatology.
- Shape career choices and future specialty selection.
- Serve as role models whose influence often lasts an entire career.
- Conduct educational scholarship and research.
Nearly every physician can identify a mentor who profoundly influenced their career. Without dedicated clinician educators, who will inspire the next generation of rheumatologists and future physician-scientists?
Valuing Academic Productivity
Academic productivity should extend beyond RVUs and grant dollars. Institutions should recognize contributions such as:
- Mentoring trainees
- Delivering lectures and small-group teaching
- Developing curricula
- Directing educational programs
- Supervising trainees in clinic and on hospital rounds
- Research funding and publications
- Local and national presentations
- Clinical productivity
These activities all create lasting value for institutions and for the future of patient care.
Who Should Pay for Teaching?
Medicare helps fund faculty who teach residents and fellows, yet medical student education often lacks dedicated financial support, despite frequently involving the same faculty. Medical school tuition should support undergraduate medical education, but those funds are not always distributed in ways that recognize teaching effort.
Meaningful teaching should be rewarded through either:
- Additional salary, or
- Protected non-clinical time.
Ultimately, department leaders determine how much value is placed on education.
Protecting Teaching Time
Protecting teaching time requires intentional leadership. As Hillel famously wrote, "If not you, then who? If not now, when?"
Division chiefs are often the strongest advocates for clinician educators. Strategies to support teaching careers include:
- Negotiating protected teaching time with department or health system leadership.
- Supporting faculty development through educator training programs.
- Pursuing educational grants.
- Using clinical trial revenue to offset teaching time.
- Developing specialty clinics that incorporate educational missions.
- Partnering with medical school leadership to secure educational support.
- Creating or leading new educational programs and courses.
Conclusion
As financial pressures on academic medicine continue to grow, protecting time for teaching becomes increasingly challenging—but also increasingly essential. Supporting clinician educators is an investment in our specialty, our trainees, and ultimately the future care of our patients.
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