The hospital system you are working with will be affiliated with a university. Traditionally, the hospital name included the university name; however, more recently, many business relationships have changed so that academic practice plans have given way to hospital employee business arrangements with academic affiliations. Sometimes, a hybrid of the two exists. For more information, see Chapter 6. With an academic affiliation, your department will be accountable to the dean of the medical school and/or the university. Obtaining some history of this relationship,

which may vary widely from toxic to functional and mutually beneficial, is crucial to understanding the department culture and to your academic prosperity. Maintenance of academic affiliation is supported by a dean’s tax or stipend of financial support to the academic system. This may entail direct support of administrative personnel, such as medical student and resident education coordinators or credentialing specialists.

Surgeons working within an academic system will have an academic rank. Usually when starting in practice the rank must be applied for, and your hiring department will manage it. Clarity around the process and your responsibilities are essential to ensure that it happens in a timely fashion. Most surgeons start as a clinical instructor or at the rank of assistant professor. The requirements to achieve a given rank (even an initial appointment as above) will be stipulated by the university and are not subject to negotiation, unless a surgeon already has an academic rank at another institution and is transferring practices. A timeline for anticipated promotion and the process and procedures for promotion should be discussed with your chairperson initially, and at annual intervals thereafter.