Getting Promoted: Getting Promoted: It’s not an accidentIt’s not an accident

Louis J. Ling, MDLouis J. Ling, MD

Professor of Emergency MedicineProfessor of Emergency Medicine

Chair, Department P & T Committee Chair, Department P & T Committee

Associate Dean for Graduate Medical EducationAssociate Dean for Graduate Medical Education

University of Minnesota Medical SchoolUniversity of Minnesota Medical School

lingx002@umn.edulingx002@umn.edu

Is it important?Is it important?

• Tenure to keep your job?

• Teaching hospital: not necessary

• Pride

• Respect for the specialty in the school

• If it’s not important to you, go to the pool

For the academic residentFor the academic resident(Pick the right job)(Pick the right job)

• Where do you want to work?

• What type of academic life do you want?

• Do you mostly want to teach?

• Can you get promoted for teaching?

• Go where they value YOUR skills.

The academic residentThe academic resident(getting the right job)(getting the right job)

• Start looking in your 2nd year

• What do they want from you?

– Do you need a fellowship?

– What is their timing?

– Start your productivity

Keep in contact with the Chair

Visit, make friends, hang out at meetings

How to Play the GameHow to Play the Game

• Getting into your residency: an accident?

• Getting into med school: obsess about it

• Get a good advisor

• Volunteer

• Do research

• Perform (get good grades)

Your first appointmentYour first appointment

• Instructor– As resident or fellow– At Harvard– Time limit often 3 years

• Assistant Professor– Terminal degree– Board certified/board prepared

It’s not an accidentIt’s not an accident

• What do PD do ?

• PD usual work does not lead to promotion

• Recruitment, remediation, conferences, didactics, duty hour monitoring, etc

• For promotion, PD need to do more than the usual, something new

Long Term PlanLong Term Plan• Clinical Scholar vs Teaching vs Traditional

• Understand your school requirements

• Pick a mentor/advocate/advisor

• Talk to successful peers (other PDs)

• Get famous outside your school

• Focus your scholarly work

• Keep evaluations from everywhere

• Keep your CV up to date

Pick a track (with your boss)Pick a track (with your boss)

• Traditional– PDs have too much education, no research

• Clinical/Adjunct– For affiliated faculty

• Clinical Scholar and or Teaching – Rewards education– Research requirement varies among schools

Quality Improvement TrackQuality Improvement Track

• Shojania, Levinson. Clinicians in quality improvement, JAMA 301(7):766, Feb 2009

• Interest in QI, Errors, Safety, Teams, SBP

• Plan-do-study-act (publish)

• Measure changes in care/flow

• Attestations or consults from other institutions

Know promotion requirementsKnow promotion requirements• Every school has written criteria

• Set annual goals to reach the criteria

• Review your goals every year with chair

• Meet chair’s schedule

• How many years? More for part-time?

• What is the process in your school?

• What is the process in your department?

Typical Promotion ProcessTypical Promotion Process

• Chair or department talks to you

• Department P and T reviews CV

• Collect your dossier

• School P and T recommends

• Dean recommends

• AHC recommends

• Board of Regents approves

Tenure requirements Tenure requirements (it’s about the money)(it’s about the money)

• Tougher than just promotion

• Long-term money commitment

• May need grant history

• More than industry or state or EMF

• Federal grants NIH RO-1, AHRQ

• Peer reviewed grants RWJF

Tenure less than everTenure less than ever

• 6 yr up or out for research track

• 9 yr up or out for CS

• Less important than ever

Pick a mentorPick a mentor

• Do this anyways

• Inside department

• Outside department

• Someone successful you want to be

• Knows what it takes to be promoted

• Can be more than one mentor

Talk to successful peersTalk to successful peers

• Find peers doing the same thing as you

• Peers in your department

• Other program directors

• Around the country

• Find out what they did/are doing

Get FamousGet Famous

• List six (eight at MN) names

• At level of promotion:

• Associate Professor or Professor

Get FamousGet Famous

• Need letters• Join Committees, Editorial Boards• Write chapters• Become an expert in something• Develop a national peer network• Lecture out of town• Lecture for ACEP, AAEM, SAEM, CORD,

etc

Major CriteriaMajor Criteria

• Independent Area of Expertise

• Separate from your mentors

• First or last author publications

• Principal investigator on grants

Research Focus and ExpertiseResearch Focus and Expertise

• Study Section

• Editorial Board

• Journal Reviewer

• Program Committee

• Session Moderator

• Keynote Speaker, Visiting Professor

• Grand Rounds

Focus, Focus, FocusFocus, Focus, Focus

• Develop and demonstrate expertise• Pick an area• Write chapters on one or two topics• Limit outside distractions and maintenance• Stay away from admissions, P and T, And other time sucking commitments• Volunteer for innovative institution projects

and publish the results

Focus scholarly workFocus scholarly work

• Measure everything you do– Resident satisfaction, quality, duty hours– Outcomes project– Residents as guinea pigs

• Present at SAEM, AAMC, RIME, GRA, GEA, ACGME, Regional meetings

• Submit to Academic Medicine, AEM, Medical Education, new Journal of GME

Keep everythingKeep everything

• Education Portfolio or file folder

• Evaluations from everyone

• Annual review from chair

• Reprints of articles

• Education products, CDs, screen shots

• Invitations to speak if you decline

• Keep CV up to date

Keep More Than EverythingKeep More Than Everything

• RRC, LCME Consultation Site Visits

• Best Doctor Awards

• Clinical Expertise or Consults– Keep dictations, letters or reports

• Invitation to speak that you turn down– Keep correspondence

Getting by with less than everythingGetting by with less than everything

• Talk to YOUR Faculty Dean

• Examine other successful dossiers

• Pick similar track/situations

• Promotion criteria can change

• Interpretation of criteria can change

Keep CV Up to DateKeep CV Up to Date

• Use your med school format

• Have a complete CV that has everything– Include local and department talks– Include mentees and advisees– Include public speaking, media events– Include best doctor type recognition

• Have a concise CV that has the highlights– For public

CV BibliographyCV Bibliography

• Use standard citation format• Separate peer reviewed from others• Impact factor

• Explain your role

• 1st and last and corresponding author– Don’t give it up too soon

The Final PushThe Final Push

• Application Timeline

• Dossier

• Letters

• Lots of copies

• How many up this year?

• Start now

TimelineTimeline

• Final Submission date backwards

• Who does what– Individual: dossier, names, reprints– Department: votes, chair’s letter

• Find a support person to help– Chair can assign someone– Not your residency coordinator– Ten Copies, collate and staple

Reverse TimelineReverse Timeline

• November 1 submit to Dean

• September 1 submit letter names

• August 1 submit to department

• July 1 start your dossier

• June 2 start to collect your stuff

• June 1 or earlier annual review with chair

• March 9 check with your chair

Dossiers/PortfolioDossiers/Portfolio

• More than just a CV

• Specific format for dossier

• Has to tell your story well

• Specific CV format

• Keep it up to date

• Look at someone’s (successful peer) example

DossiersDossiers

• Essay summaries of research, teaching, service– Describe what you are focused on

– Be specific and give concrete examples

– Give time percentage or hours per week

– Proofread the grammar

DossiersDossiers

• Three reprints of publications

– recent, since your last promotion

– first or second or last author

– important

– avoid case reports or observations or editorials

Outside LettersOutside Letters• Find out how many• Ask peers if its OK• Suggest unknown letter writers• Higher rank than you• Well-respected institutions

– Harvard, Stanford, UC, etc– Wide geographic area– They don’t know famous EPs, they do

know famous places, titles and rank

Potential Letter WritersPotential Letter Writers

• Similar interests• Prominent researchers in your field• Editors you have written for• Committee chairs• Department chairs• Full professors• Do not pick Assistant Professors, Instructors,

former residents, former mentors, best friends

Inside institution lettersInside institution letters

• Chair letter is automatic– Offer to ghost write

• A few from within your department

• Some from outside your department

– Use your mentor to connect

– Do not piss everyone off

– Committee work pay off

Break into Small GroupsBreak into Small Groups• What 2 things you are going to do?• What 2 things are you going to drop?

• What 2 scholarly papers can you do?• Who can work with you on your project?

• Who do you want to get to know?• What 2 things are you going to do to

network at this meeting?

PromotionPromotion

• Don’t be an Assistant Professor for life

• Decide if you want to do this

• Plan for it, Count on it

• Slow and steady long term plan

• Don’t wait until the end to do it

• Keep the mad rush at the end organized

WorkshopWorkshop

• Bring your CV

• Bring your questions

• Sample summaries of research, teaching and service

• Questions