The effects of tenure and promotion on surgeon productivity

Background: Studies investigating the impact of promotion and tenure on surgeon productivity are lacking. The aim of this study is to elucidate the relationship of promotion and tenure to surgeon productivity. Methods: We reviewed data for the Department of Surgery at our institution. Relative value units (RVUs) billed per year, publications per year, and grant funding per year were used to assess productivity from 2010 to 2016. We analyzed tenure-track (TT) and non–tenure-track (NT) surgeons and compared the productivity within these groups by rank: assistant professor (ASST), associate professor (ASSOC), and full professor (FULL). Kruskal–Wallis and Mann–Whitney U tests were used to assess significance and relationships between the groups. Results: A TT faculty was promoted if they produced more research, with the highest publication rates in TT FULL. TT faculty publishing rates increased from ASST to ASSOC (1 versus 2, P = 0.006) and from ASSOC to FULL (2 versus 4, P < 0.001). There were no differences in the low publication rates among NT ranks. Grant funding was also highest at the TT FULL level. The clinical production (RVUs) was highest between TT ASSOC and NT FULL. TT faculty increased productivity between ASST and ASSOC (7023 versus 8384, P = 0.001) and decreased between ASSOC and FULL (8384 versus 6877, P < 0.001). Among NT faculty, RVUs were stagnant between ASST and ASSOC levels (4877 versus 6313, P = 0.312) and increased between ASSOC and FULL levels (6313 versus 8975, P < 0.001). Conclusions: Tenure and nontenure pathways appear to appropriately incentivize surgical faculty over the course of their advancement. TT FULL has the highest research production and grant funding, whereas NT FULL has the highest clinical production.