title: Lower Rates of Promotion of Generalists in Academic Medicine: A Follow-up to the National Faculty Survey.
abstract: BACKGROUND
  Prior cross-sectional research has found that generalists have lower rates of academic advancement than specialists and basic science faculty.
  
  
  OBJECTIVE
  Our objective was to examine generalists relative to other medical faculty in advancement and academic productivity.
  
  
  METHODS
  In 2012, we conducted a follow-up survey (n = 607) of 1214 participants in the 1995 National Faculty Survey cohort and supplemented survey responses with publicly available data.
  
  
  METHODS
  Participants were randomly selected faculty from 24 US medical schools, oversampling for generalists, underrepresented minorities, and senior women.
  
  
  METHODS
  The primary outcomes were (1) promotion to full professor and (2) productivity, as indicated by mean number of peer-reviewed publications, and federal grant support in the prior 2 years. When comparing generalists with medical specialists, surgical specialists, and basic scientists on these outcomes, we adjusted for gender, race/ethnicity, effort distribution, parental and marital status, retention in academic career, and years in academia. When modeling promotion to full professor, we also adjusted for publications.
  
  
  RESULTS
  In the intervening 17 years, generalists were least likely to have become full professors (53%) compared with medical specialists (67%), surgeons (66%), and basic scientists (78%, p < 0.0001). Generalists had a lower number of publications (mean = 44) than other faculty [medical specialists (56), surgeons (57), and basic scientists (83), p < 0.0001]. In the prior 2 years, generalists were as likely to receive federal grant funding (26%) as medical (21%) and surgical specialists (21%), but less likely than basic scientists (51%, p < 0.0001). In multivariable analyses, generalists were less likely to be promoted to full professor; however, there were no differences in promotion between groups when including publications as a covariate.
  
  
  CONCLUSIONS
  Between 1995 and 2012, generalists were less likely to be promoted than other academic faculty; this difference in advancement appears to be related to their lower rate of publication.
authors.affiliation: Internal Medicine and Adult Primary Care, Tufts Medical Center, 800 Washington St., Box 212, Boston, MA, 02111, USA. dblazey-martin@tuftsmedicalcenter.org.
authors.forename: Deborah
authors.initials: D
authors.lastname: Blazey-Martin
authors.affiliation: Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
authors.forename: Phyllis L
authors.initials: PL
authors.lastname: Carr
authors.affiliation: Internal Medicine and Adult Primary Care, Tufts Medical Center, 800 Washington St., Box 212, Boston, MA, 02111, USA.
authors.forename: Norma
authors.initials: N
authors.lastname: Terrin
authors.affiliation: Internal Medicine and Adult Primary Care, Tufts Medical Center, 800 Washington St., Box 212, Boston, MA, 02111, USA.
authors.forename: Janis L
authors.initials: JL
authors.lastname: Breeze
authors.affiliation: Internal Medicine and Adult Primary Care, Tufts Medical Center, 800 Washington St., Box 212, Boston, MA, 02111, USA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Luk
authors.affiliation: University of California, San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.affiliation: Internal Medicine and Adult Primary Care, Tufts Medical Center, 800 Washington St., Box 212, Boston, MA, 02111, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Freund
mesh_terms: D002322:Career Mobility; D005180:Faculty, Medical / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners / Q000639:trends*; D006801:Humans; D008297:Male; D011897:Random Allocation; D012577:Schools, Medical / Q000639:trends*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: academic medicine; academic promotion; faculty advancement; faculty development; general internal medicine; medical education-faculty development; primary care