Novel work models needed for faculty members trying to balance clinical practice with scholarly responsibilities.

To the Editor. Many academic clinical pharmacists in the United States are challenged by figurative and literal separations from patient care. The literal difficulty is one of distance, where many colleges of pharmacy are not structurally proximal to the clinical sites with which they are affiliated. Thus, physical challenges of separation can cause divided attention within the workday. Travel to disparate sites can result in a significant proportion of unproductive time. Clinical faculty members are also challenged with separate reporting structures and management hierarchy in non-unified health systems. Thus, separate and often competing goals may exist. Certainly, many faculty members specifically have sought out the foci of clinical care, teaching, and scholarly activity. These areas, often specifically named in promotion and tenure guidelines for many colleges of pharmacy, are frequently distinct entities requiring undivided attention. In traditional models, a faculty member’s time at a clinical site is largely consumed by patient care activities, experiential students and residents, and site administrative duties. Often these duties comprise 50%-60% of time in the traditional tenure-track clinical position. In the 40%-50% of remaining time, college responsibilities such as teaching, workshops, committee obligations, and student needs usually predominate. Vacillating between campus and clinical site during the week poses concerns of achieving consistency, continuity, and accountability. This is not just from the perspective of the faculty member concerning college responsibilities and collegiality, but also from the clinical sites with regards to patient care. The faculty member’s personal goals for scholarly activities and research may depreciate, as protected time to achieve these goals is often improbable. Clinical faculty members recognize the importance of scholarship and research; however, over 50% of pharmacy faculty members surveyed from a Web-based study indicated insufficient time was the most common barrier to producing scholarship.1 In order to protect time for nonclinical activities and meet goals for patient care activities, our university developed a novel “block schedule” model. Faculty members who practice this model generally spend an average of 6 to 10 weeks on campus or at their clinical site. In these cases, commitment has been obtained from the college and the clinical site; such joint agreements are a cornerstone of the model. Both sites have an understanding that the “blocked time” allows concentrated focus to either the college or clinical site. From the college’s perspective, this model allows for protected academic time. Such academic time affords faculty-improved access to research-support personnel, like the university’s institutional review board, statisticians, and office of research personnel. In an effort to also cultivate a research environment, this sort of model affords faculty members the opportunity to collaborate academically with students and basic science and administrative science faculty members who are campus based. This “blocked time” also allows the faculty member to work on writing research manuscripts or creating time-consuming grant proposals for submission. Teaching quality can also be improved with dedicated blocks of time, both at the college and at the clinical site. In both settings, faculty members are more accessible for student interaction. At the clinical site, faculty members can provide more consistent preceptorship and foster student growth in clinical knowledge as they observe day-to-day changes in patient care. At the university, similar faculty-student relationships may be developed through course direction, faculty advising, and scholarly mentorship. The presence of the faculty member on campus allows for better visibility and perceived accessibility for students. Creating and sustaining a culture of scholarship using novel scheduling models requires active administrative support and a willingness for a dynamic infrastructure.2 Not all faculty members require the same quantity of blocked time for scholarship based on their clinical service, promotion and tenure track, and teaching goals and responsibilities. This type of model may impact the sense of community on campus. Most ideas of community require locality or physical proximity. The faculty member should consider that times blocked away for clinical service at the sites can weaken the relationship with colleagues on university committees and advisee/students, therefore the faculty member must work diligently to create a sense of presence and communication with members of the campus community. From an administrative perspective, the “block” model works best when the clinical site and the college of pharmacy maintain modes of communication that are continual, open, and transparent. This will help to prevent the faculty member from feeling caught in the middle or pressure to choose between clinical and academic responsibilities. An option that has worked well is to develop a team-based approach, preferably with a tenure-track faculty member paired with a nontenure-track faculty member or faculty member who works in concert with a full-time pharmacist from the clinical site. This relationship allows shared responsibilities for clinical practice and a schedule that provides continuous coverage. When “blocked time” is dedicated to the clinical sites, clinical faculty members can provide improved continuity of care for their patients and foster stronger, more reliable relationships with their healthcare colleagues as they are viewed more consistently as a reliable resource. “Blocked time” at the clinical site has also improved relationships with the clinical pharmacists at the site because they also experience a more consistent presence and involvement from clinical faculty members. Job satisfaction is key to faculty retention in an academic setting. One recommendation is to provide institutional support for scholarship and faculty development opportunities. Another is to create an environment that allows a faculty member to achieve work and life balance.3 This “block schedule” model is one step that our college has implemented to help faculty members achieve job satisfaction and work and life balance, and will hopefully result in long-term faculty retention.