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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 53-58

Part-time faculty in academic surgical specialties: The view of Canadian chairs


1 Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
2 Center for Medical Education, McGill University, Montreal, Quebec, Canada
3 Department of Otolaryngology Head and Neck Surgery, McGill University; Center for Medical Education, McGill University, Montreal, Quebec, Canada

Date of Web Publication7-Jul-2017

Correspondence Address:
Nathalie Gabra
Department of Otolaryngology Head and Neck Surgery, Montreal Children's Hospital, McGill University, 1001 Boul Decarie, Montreal, QC H4A 3J1
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-5568.209852

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  Abstract 


Background: The rising rate of physician burnout and decreased interest in pursuing careers in academic medicine has popularized the option of part-time faculty (PTF). However, the current status and role of PTF in academic surgical departments are not well-defined.
Methodology: A survey was conducted to gather the perspectives of Canadian Surgical Department chairs in academic centers on the current status and role of PTF. Particularly, chairmen were asked to rate the advantages and disadvantages, perceived challenges, contributions, and overall satisfaction of PTF (on a 5-point Likert scale).
Results: Forty-eight percent (40/83) of surveys were completed by surgical department chairmen. There was a large variety of responses for the advantages and disadvantages and challenges of PTF. Full-time faculty (FTF) was reported to contribute significantly more to research and teaching than PTF (85% and 12% for research, respectively, P < 0.01; 90% and 53% for teaching, respectively, P < 0.01). Despite a decreased contribution to research and teaching as compared to FTF, PTF was reported to enhance the quality and diversity of the faculty. Overall, satisfaction varied largely, with chairmen reporting greater satisfaction for FTF over PTF (P < 0.01).
Discussion: The definition of PTF varied among chairmen, most being categorized into themes of time commitment, practice location, and salary. As a result, the variance in the precise role of what constitutes a PTF appears to contribute to the diverse perceptions of chairmen. The differences in contributions to the department among FTF and PTF appear nuanced. For instance, PTF was found to provide quality teaching; however, to a lesser extent than FTF.
Conclusion: The perceived status of PTF within Canadian academic Surgical Departments is highly variable among chairmen.
The following core competencies are addressed in this article: System-based practice, Professionalism, and Patient care.

Keywords: Academic medicine, part-time faculty, surgical specialties


How to cite this article:
Gabra N, Mascarella MA, Young M, Frenkiel S, Nguyen LH. Part-time faculty in academic surgical specialties: The view of Canadian chairs. Int J Acad Med 2017;3:53-8

How to cite this URL:
Gabra N, Mascarella MA, Young M, Frenkiel S, Nguyen LH. Part-time faculty in academic surgical specialties: The view of Canadian chairs. Int J Acad Med [serial online] 2017 [cited 2021 Jan 16];3:53-8. Available from: https://www.ijam-web.org/text.asp?2017/3/1/53/209852


  Introduction Top


The traditional sense of academic medicine as inflexible and structured has been shifting into a role with increasingly attention to work–life balance.[1],[2] In particular, the number of hours worked by attending physicians has been found to be directly and positively related to the rates of burnout and depression.[3],[4] Surgical specialties appear more affected, likely due to the relatively poorer work–life balance as compared to nonsurgical disciplines.[5],[6] It is the combination of poor work–life balance coupled with a decreased resident interest in pursuing academic careers that have prompted changes in faculty policy predicted to result in a shortage of academic physicians.[4],[6],[7],[8] The request for new recruitment and retention strategies, namely, alternative hiring pathways and lengthening of the probationary period in tenure tracks, has already taken place in many academic institutions.[9],[10],[11]

Although its definition varies across institution, part-time faculty (PTF) generally refer to members within the faculty having commitments outside of academic practice, such as time commitments in nonacademic institutions.[11] American-based studies showed that PTF had a similar involvement in teaching and clinical activities compared to full-time faculty (FTF). The authors also noted a lower proportion of PTF involved in research.[12],[13] Whereas the literature on PTF is well described in the United States, the Canadian counterpart is lacking.[14],[15] Given that the impact of PTF has not been well investigated in surgical specialties across Canada, our goal is to examine the perceptions of Canadian faculty chairmen regarding both PTF and FTF in surgical departments. Our hypothesis is that chairman would perceive a difference in contribution and productivity between PTF and FTF.


  Methodology Top


Survey development

A survey targeted to surgical department chairmen was developed to explore their opinions on the impact on, role of, and future challenges of PTF. The content of the survey was initially derived from the literature on the previous surveys of department chairs.[11],[12],[13] The initial survey draft was reviewed and adapted by a panel consisting of an otolaryngologist and specialist in medical education, the current Otolaryngology-Head and Neck Surgery (OTL-HNS) chairman at our institution and an expert in medical education research. A pilot study, where several Canadian departments of OTL-HNS chairs completed the survey, was conducted before final distribution. Feedback from the results of the pilot phase as well as from the panel was incorporated into the final version of the survey. As a result, the final survey consisted of five components: definition, general information, advantages and disadvantages, challenges and perceptions, and contribution to department duties. For the majority of components, chairmen were asked to rate statements using a 5-point Likert scale, where responses ranged from strongly disagree to strongly agree. The general information and definition sections of the survey contained open-response items. This study received Ethical Approval from the universities institutional review board.

Survey distribution

The survey was distributed first by E-mail in February 2014, consisting of a cover letter and link to the survey displayed on LimeSurvey. Reminder messages were sent 1 month later by E-mail and then in hardcopy by mail in May 2014. The mailed survey had a prepaid stamp included in the study. A total of 114 Canadian Surgical Departments were identified through the Royal College of Surgeons and Physicians website. Using this list, the name and contact information of Surgery Department/Division chairmen were searched on their respective university websites to obtain E-mail and mailing addresses. Eight-three chairmen with functional E-mail and mail addresses were found on university websites and subsequently included in the study. This sample size was in line with the previous surveys performed in the US.[11],[12] The surgical specialties included in this study were cardiac, general, neurological, orthopedic, otolaryngologic, plastic, thoracic, urological, and vascular surgery.

Data analysis

Responses were grouped into “generally agree” if chairmen indicated “agree” or “substantially agree.” Likewise, the term “generally disagree” was used to combine responses of “disagree” or “substantially disagree.” In addition, the items listed in the advantages and disadvantages [included items can be seen in [Figure 1] as well as the perceptions of PTF [included items can be seen in [Figure 2] were reorganized to facilitate data presentation. Content analysis was used to analyze qualitative data drawn from open-response items included in the survey. Chi-square testing was used to compare qualitative variables. P < 0.05 was used to indicate a statistical difference. In addition, Pearson's R was used to assess for linear associations.
Figure 1: Advantages and disadvantages of part-time faculty as rated by participating department chairmen. Presented as percentage of participants choosing each response option

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Figure 2: Challenges and perceptions of part-time faculty as rated by participating department chairmen. Presented as percentage of participants choosing each response option

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  Results Top


A total of 83 surveys were sent to academic surgical chairmen with functional E-mail and mailing addresses across Canada. Forty of the 83 surveys (48%) were completed with reasonable representation from all surgical disciplines [Figure 3] and [Table 1].
Figure 3: Steps of survey implementation

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Table 1: Surgical specialties participating in the survey and associated proportional responses

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Definition of part-time faculty status

Participants were asked to provide a definition for PTF at their institution and several descriptive characteristics of PTF. Twenty-one chairmen provided responses; these were categorized under three themes: Time commitment, salary, and practice location [Table 2].
Table 2: Definition of part-time faculty given by the participating chairmen, classified by theme

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Characteristics of faculty

Looking across all completed surveys, 534 faculty members were categorized as FTF and 598 as PTF, with a 4:1 male-to-female ratio within both groups. The most common age group for PTF was between 45 and 60-year-old (51%) and <45-year-old (46%) for FTF (P = 0.13). When asked about the evolution of PTF recruitment over the next 10 years, 78% (65/83) of chairmen noted a desire for the same number or more PTF in the future.

Perceived advantages and disadvantages of part-time faculty

Chairmen rated statements of perceived advantages and disadvantages of PTF using a 5-point Likert scale ranging from strongly disagree to strongly agree. Fifty-eight percent (18/40) of chairmen generally disagreed that PTF do not share the goals of the department and 60% (24/40) of them generally disagreed that PTF provide poorer quality in teaching. They generally agreed that PTF appeared less committed to the department (55%, 22/40) but that PTF enhance the quality and diversity of the faculty (63%, 25/40). The opinions for the other items within this section were wide-ranging, particularly with regard to scheduling and work–life balance. See [Figure 1] for a complete list of survey items addressing the advantages and disadvantages of PTF and associated ratings by participants.

Perceived challenges and perceptions of part-time faculty

A 5-point Likert scale was used to rate statements related to perceived challenges and perceptions of PTF. Chairmen generally disagreed that PTF is not fully integrated into the department (53%, 21/40) or are perceived negatively by other members of faculty (55%, 22/40). However, chairmen responses noted general agreement with having difficulty to ensure the participation of PTF in academic activities (70%, 28/40), of PTF having and equal representation in departmental decision-making (65%, 26/40) and in the difficulty of defining PTF (63%, 25/40). Regarding the statement on “difficulty to ensure that PTF have access to department resources” (38% [15/40] disagreed and 30% [12/40] agreed). [Figure 2] for a complete list of survey items addressing the perceived challenges and perceptions of PTF and associated ratings by participating chairmen.

Perceived contributions of part-time faculty

Chairmen reported that PTF and FTF contributed similarly to clinical duties (70% [28/40] and 88% [35/40] contributed significantly or very significantly, respectively). Research and teaching responsibilities were rated as higher for FTF as compared to PTF. In particular, when comparing the contribution to research among PTF and FTF, 13% (5/40) of chairmen felt that PTF contributed a significant or very significant contribution compared to 85% (34/40) for FTF (P < 0.01). Likewise, 53% (21/40) of chairmen indicated that PTF offer a significant or very significant contribution to teaching compared to 90% (36/40) for FTF (P < 0.01). [Table 3] shows a breakdown of responses to survey items addressing PTF and FTF contributions to clinical, teaching, and research responsibilities.
Table 3: Contribution to research, clinical, and teaching duties as rated by participating department chairmen

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Overall opinion of part-time faculty and full-time faculty

With regard to overall satisfaction, 48% (19/40) of the chairmen felt satisfied or very satisfied with PTF and 88% (35/40) for FTF (P < 0.01). This contrasts to 28% (11/40) of chairmen feeling unsatisfied or very unsatisfied with PTF in comparison to only 5% (2/40) for FTF (P = 0.02). Chairmen holding office for <3 years as head of the department felt overall satisfied (16/40) with PTF compared to chairmen working >3 years who indicated being overall unsatisfied (24/40) (P = 0.05). Furthermore, there was no statistical difference in overall satisfaction with PTF across gender or individual surgical specialties. An association between chairmen who rated PTF as having a significant or very significant contribution to clinical or teaching duties and higher overall satisfaction was noted (R2 = 0.4. P =0.05).


  Discussion Top


Over the last decades, a shift in the role of PTF within academia has occurred.[9],[10],[11] The reconceptualization of the academic workplace, driven by fiscal constraints and physician preferences, has brought about the popularization of PTF.[12],[13] Our study showed that Canadian surgical chairs felt PTF contribute community experience and diversify the workforce while seeming to be more challenging to integrate within the department, consistent with previous work.[12],[13] In contrast to prior studies, the chairmen who participated in this study felt that PTF offers little contribution to research and teaching duties. According to chairmen, PTF provide quality teaching, just to lesser quantity on average than FTF, as would be expected. As for research contributions, the chairmen's findings may reflect a low contribution of PTF research but this may not be an absolute decrease. In essence, the reasons behind the discrepancy between research and teaching contributions for PTF and FTF appear to differ. The varying perception from chairmen represents a nuanced view of PTF from the generally positive opinions portrayed in the current literature.[11],[12],[13],[14],[15]

The lack in precision of what constitutes a PTF likely contributes to the large variability across chairmen responses. Using qualitative analysis, chairmen responses to what constitutes a PTF could be categorized into 1 of 3 themes: time commitment, salary, or practice location. Accordingly, the role of PTF within each department appears individualized, varying in time contribution, pay, and location. However, the common thread across reported definitions of PTF is that these faculty members have formalized commitments outside of academia. Certain challenges continue to face PTF, and through this work, we have identified areas of potential dialogue in regard to PTF participation, involvement and integration within academic faculty. In a similar manner, Block et al. discuss the need to open a dialogue on what defines “faculty” within academic medicine to be aligned with the expectations of a changing environment.[16]

The reduced contribution to research for PTF has been described in the literature.[11],[12] In fact, responses from our survey indicate that PTF contributed less to teaching responsibilities as well. It remains unclear the extent and facets of teaching that the PTF engage in as the survey did not specifically evaluate the type of teaching. In addition, there did not appear to be a difference among PTF contributions as based on gender. Interestingly, chairmen holding office for <3 years appeared more likely to be overall satisfied with PTF as compared to those working longer. Despite this, chairmen who rated PTF as having a significant or very significant contribution to teaching or clinical duties were inclined to rate them with a higher overall satisfaction. In addition, chairmen saw no significant difference among contributions to clinical duties between PTF and FTF.

A recent study by Nguyen and Mofatt-Bruce reviewed the concept of relative value unit (RVU), the traditional measurement of clinical productivity used to determine compensation, reimbursement, and resources allocation. They suggested the need to implement a new system that would include not only clinical productivity but also clinical quality RVU and academic productivity RVU (aRVU). The proposed aRVU system would include publication, administrative work, teaching, and research. The use of aRVU could potentially help determining more objective and measurable definitions for PTF and FTF as well as defining expectations and appropriate resources allocation.[17] This system would also help facilitating the hiring choices based on the lacking components within an academic department and therefore improve the workforce diversity and overall productivity of the department.

Limitations to our study include a relatively low response rate and purposive sampling from a preselected group of respondents; however, we feel that our study population shows good representation across surgical subspecialty programs in Canada. Moreover, we were unable to contact all academic Surgical Department chairs in Canada as 31 did not possess a functional E-mail or mailing address. Accordingly, the results of this survey do not reflect the opinions of other stakeholders such as other members of faculty (whether FTF or PTF) or allied health professionals. In addition, socially acceptable responses from chairmen may have biased responses despite assurances of confidentiality.[11] However, some participants did respond to statements with a negative response (e.g., some reported being unsatisfied with PTF) suggesting that social response bias may not have played a major role in our findings. Finally, this study is focused on the perceptions of chairmen of PFT, and with little direct observation, it is difficult to quantify the amount of teaching, clinical duties, and research activities that PTF and FTF engage in. However, the goal of this study was to explore chairman perceptions, rather than explore the accuracy of those perceptions.

The increased demand for teaching, clinical and research duties of academic departments coupled with a limited funding has been incompletely addressed by FTF.[14],[15],[16] With the predicted growth in PTF employment paralleling the demand for increased teaching and clinical responsibilities, a clarification in the role of PTF is needed to ensure faculty integration.[11],[14] Moreover, the need for well-developed recruitment and retention strategies becomes essential to promote the growth of faculties.[10],[16] By diversifying the academic workforce, PTF can engage in and enhance clinical and teaching duties as a means to achieve departmental objectives.


  Conclusion Top


The perceived status of PTF by Canadian surgical chairs is highly variable and nuanced. It is likely that the wide-ranging definition for PTF contributes to this variability. Nonetheless, chairmen believe that PTF enhances the quality and diversity of academic surgical departments.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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