When the academic physician develops a substantial body of work that results in recognition or has evident impact, then the person is working toward becoming an associate professor. The associate professor probably has eight to 15 publications, in addition to much evidence of involvement and impact. The associate professor must be working on the national stage, producing publications, doing committee work, or giving lectures in the field that are well-received by other thought leaders. There needs to be some evidence that the work is making a difference and influencing others, perhaps because others are referencing the work, others have chosen the associate professor for leadership roles, or subsequent external grant funding has been achieved.

My advice is to choose the career that makes you happy. Be excited to wake up every day. Know you are influential, even powerful, in the lives of those you come in contact with. I wish you peace, happiness, and fulfillment. You deserve it.

As the career progresses and the body of work expands, professorship will be considered. The professor is a widely recognized authority. At least 20 publications, perhaps dozens more, are required to be considered in this category. National or international work will be sustained over time, a continuous record of productivity will be maintained, and other top leaders in the field will validate that the person is among the best thinkers in the field. This is a high bar, as it should be. Different universities have different standards, with top-tier places clearly stating that they will name a professor only when they find clear evidence that the person is one of the leading authorities in the field.

It gets confusing, however, because some universities will call a valued doctor “clinical professor.” This carries a different meaning. In some cases, this specifies a clinical doctor who does not do academic work. In other cases, there is expectation of academic work, but the many clinical hours of work, administrative leadership, and university committees are taken into account. Universities recognize that this work contributes greatly to the culture and environment of a scholarly institution, as well as recognize that this work allows less time for research and publications. Promotion can be successful as the full range of contributions is taken into account, not just publications and academic work. The “clinical” modifier is one way to note the difference.

For those who work full time on research, it is expected that external grants will be consistently obtained. This is a tough task and takes deliberate additional preparation through research fellowships and mentored projects. When a faculty member takes this route and is willing to be judged based on the quality of research and grant funding, then tenure is possible. Most tenure tracks have a strict up-or-out policy. By a defined time—six to nine years is typical, depending on the institution—the promotions committee will judge whether tenure should be granted. If it is not granted, the person has to leave the faculty. This is tough and has changed the trajectory of many academicians’ lives, sometimes for the better and sometimes for the worse. Tenure is a rare and honorable recognition in the field of emergency medicine.