At a time when Stanford University is investing some $4 billion in expanding its adult and pediatric medical centers, it requires clinical care that is scaled to match this major expansion. Smaller in faculty size compared with its peer institutions, Stanford will be expanding from the current 900 faculty billets to as many as 1,200 over the coming five years. The School of Medicine is also is extending principal investigator (PI) privileges to its clinician educators to encompass all forms of clinical research, allowing them to expand their role in scholarship and to help bring the fruits of Stanford's leading basic science research to the benefit of our patients.
A taskforce, comprised of university tenure line, medical center line and clinician educators, together with department chairs and senior associate deans, evaluated the challenges ahead. To arrive at estimates of the faculty growth needed to support our clinical, educational and research programs, the group spent three months evaluating factors that influence school of medicine faculty size and composition, as well as the evolving roles of our various faculty types.
"Faculty growth is essential for the ambitious medical center expansion that's currently underway to succeed," says Robert Jackler, MD, chair of the task force charged with studying and making recommendations on faculty growth at the school. "Expansion of the clinically active faculty will also help us fulfill the health care needs of the community we serve and meet the challenges presented by a changing health care economy. Recruiting and retaining the 'best and brightest' faculty remains Stanford's highest priority."
Today, the school is facing an imminent faculty shortfall as a result of growing patient care operations, most notably the expansion of Lucile Packard Children's Hospital, which will add 104 inpatient beds, and the construction of the new Stanford Hospital, which will add 144 beds. Additional faculty is also needed to staff the growing number of community-based primary care clinics.
Compared with peer institutions such as UCSF Medical Center, Harvard and Hopkins, Stanford has a significantly smaller faculty. Most equally sized medical schools have 1,500 to 2,500 faculty members on average. Even when Stanford adds its clinician educators to the faculty count, the University is still somewhat smaller than UCSF, UCLA and Hopkins.
The task force recognized the importance of clinician-educators to the growth in clinical programs and their capacity to make important contributions to translational research programs. The group also determined that existing limitations on principal investigator eligibility for clinician educators at Stanford has been a factor in impeding growth in clinical and translational research.
Expanded research opportunities
As part of the school's push to promote clinical research, clinician-educators can now request principal-investigator (PI) status on a range of clinical studies. Previously, clinician educators could only request PI status on multicenter, industry-sponsored clinical trials for which they served as site director. Now, those at the rank of clinical assistant professor and above may request waivers so they can lead trials that include participants at Stanford Hospital & Clinics, Packard Children’s Hospital, as well as the Veterans Affairs Palo Alto Health Care System, Santa Clara Valley Medical Center and Stanford affiliated clinics.
Although clinician educators will continue to focus primarily on providing clinical care and teaching, says Jackler, they will now have an expanded role on a broad spectrum of clinical research, which may involve diagnosis, treatment or rehabilitation of human disease, and can lead studies in population science, innovative systems of care, optimization of health-care delivery models, novel methods of clinical teaching and other forms of clinical research.
"Stanford needs to build a cadre of clinician-investigators to foster coupling of our preeminent basic science community with our faculty practitioners," says Jackler. "We are superb in basic science, engineering and collaborating across the university. But the amount of clinical trials that exist at Stanford, especially in critical areas such as cancer, is smaller than at other universities of equal greatness. Bringing on more clinically active faculty will enable us to more readily translate discoveries coming out of our basic science and engineering labs into patient care."
Another result of Stanford's smaller faculty size is that many medical specialties have just one or two faculty members. "It is very difficult to develop cutting edge clinical programs without a critical mass of faculty who share a clinical interest because of the need for these specialists to participate in research and education programs in addition to their clinical practice," says Robert A. Harrington, MD, Arthur L. Bloomfield Professor and Chairman, Department of Medicine. "Expanding the role of the clinician educator to allow an expanded role as an investigator is a critical piece of building such programs.”
In particular, Stanford has recently recruited new division chiefs in oncology and rheumatology, and both have determined the need for more clinically active physicians in their specialty areas. Following the recruitment of a new GI/liver chief, there will be added faculty in those specialties as well. Growing subspecialty clinical practices also requires a robust primary care program as an important base, explains Harrington. As such, the Department of Medicine will continue to recruit and add several dozen primary care physicians over the next few years.
By Grace Hammerstrom