The Medical School Clinical Faculty

Abstract

Large-scale federal funding of research in the 1950s and 1960s enabled medical schools to hire many full-time clinical faculty members who differed from their part-time colleagues in their orientation toward research and patient care. When research funding leveled off in the late 1960s, medical schools turned to patient-care revenues from Medicare and Medicaid to pay faculty salaries. Faculty earnings from research and clinical activities have led to inbalances in the attention given to patient care, teaching, and research. Until well past mid-century, most clinical faculty members were part-time teachers with extensive private practices. In 1951, part-time faculty members comprised 32 percent of the non-M.D. faculty and 80 percent of the M.D. faculty, and they provided 40 percent of the total faculty time spent on all activities. The use of part-time faculty members in the clinical fields was considered advantageous because they retained their clinical skills and were paid lower salaries. When the federal government began large-scale funding of research in medical schools, full-time clinical faculty positions became more feasible because the government compensated faculty members for their research time. Some faculty members carried out federally funded research during the summer months to supplement their academic-year salaries. Many others carried out funded research during the academic year, with the medical schools receiving compensation on a prorated basis for the time lost from teaching and other academic obligations. Medical schools were also reimbursed by all grants for research overhead expenses. By 1970, 49 percent of all medical school faculty members received partial or full support for their research activities. Because research detracted from the private practices of clinical faculty members, few of them would have made the necessary financial sacrifices to undertake research and live on normal academic salaries. Medical schools and the NIH therefore used several devices to create nominal faculty salaries for purposes of grant funding that were much higher than the actual faculty salaries paid by medical schools. One method was for the medical school to pay only a part, such as one-third, of a faculty member’s salary, while the total salary was used in grant applications.