The Process Of Promotion in Academic Medicine

With the assistance of my department, I recently submitted my application for promotion to the rank of Associate Professor. I wanted to outline some of the considerations for promotion in academic medicine including the benefits and process.

First, one of the single worst mistakes I made was starting in October (instead of September). Traditional promotion from Assistant Professor (my current rank) to Associate Professor requires being with the institution for five years at the start of the academic year. This means I’m off cycle by literally one month. My department approved me for an accelerated promotion last year, but I was given one piece of advice from my mentor of over a decade: if the entire promotions committee consisted of faculty who were 10-15 years into their careers, then they would likely understand the impact of many of my activities on the Internet.

I was left with a choice: take a chance and not get promoted (and likely wait an additional year to reapply), or apply once I’m actually in the appropriate window and have a much better chance. I opted for the latter. 😃

So what’s the big deal about getting promoted? Here are a few benefits:

• Compensation and resources: Promotion is one of the few meaningful bumps in an academician’s base pay and often allows for more protected time
• Recognition of expertise: Promotion formally acknowledges growing reputation, scholarly contributions, clinical excellence, and educational leadership, strengthening academic credibility within and beyond my institution
• Career advancement: Promotion to Associate opens up additional opportunities to serve on committees, take on society leadership positions, and participate in grant review panels, as well as be considered for invited lectures, among others.

So, how does the process begin? First, each department has an internal review committee that essentially gives faculty members seeking promotion the “green light” to proceed after reviewing their CVs. After receiving this approval, the next step (in April) was to get three internal recommendation letters from non-anesthesiologists (I asked three surgeons I work closely with) and six external recommendations from other institutions.

Furthermore, I needed to help reconstruct a Chair’s letter summarizing my major contributions and the significance of my accomplishments for the department and medical school.

Additionally, I needed to write a personal narrative (no more than six pages… mine was precisely at the cutoff 😂), scoring myself 0 (meets basic employment expectations), 1 (above and beyond expected), or 2 (extraordinarily high performance) points in each of the following domains:

• Clinical Activities
  • Clinical service is highly valued  for its role in education and discovery
  • Volume, quality, and impact
  • Quality improvement projects – improving patient outcomes
  • Developing or expanding clinical programs
  • Innovation in techniques, instrumentation, procedures
  • Leadership in the clinical setting, e.g., medical director
• Scholarly Activities
  • Peer-reviewed publications, invited articles, awards and honors, participation on grants (PI, co-PI, consultants), patents issued/licensed
  • Grand rounds, podium presentation on scholarly products, e.g., abstracts/preliminary data, poster presentation
  • Where your expertise is needed: media, community education, etc.
  • Disseminated/adopted QI programs (change in policy or process)
• Teaching Activities
  • Didactic/classroom teaching
  • PBL/TBL
  • One-on-one mentoring/training
    • Undergraduates, graduate students (MS/PhD), medical students, postdocs, residents, fellows
  • Workshops, M&M discussions
  • Bedside teaching – both out-patient clinic and in-patient rounds 
  • Leadership in educational activities 
    • PD, APD, divisional lead, site director, elective director
    • Developing workshop or procedure skill clinic
    • Developing curriculum
  • Document awards, honors, recognition
    • Teaching effectiveness, evaluation and assessment – anything exceptional
• Service/Administrative Activities
  • Administrative activity is important to the institution, but it is rarely by itself the basis for promotion. 
  • Expected of all faculty at some level.
  • Committee work: division, department, school, university, hospital, society.
  • Grant/guideline/paper reviewing.
  • Leadership/admin examples: division director, vice chair, etc.
  • Leadership roles in professional societies: local/national/international

For promotion to Associate Professor, one needs to be exceptional (2 points) in at least one domain, at least 1 point in Clinical Activities, and a total of 4 points. For promotion to Professor, one must be exceptional in at least two domains, achieve at least 1 point in Clinical Activities, and total 5 points.

So in summary, my promotion package consists of:

• Updated CV
• My Chairman’s letter of nomination
• A promotion narrative
• Three internal letters of support outside of my department
• Six external references

I submitted everything in June 2025, but won’t find out about the promotion till next year. Regardless of the outcome, I’m grateful and humbled by the support of my peers through this process. Here’s hoping for the best! 🤞