Our Neurological Institute’s early experience with a notable four-track framework
Cleveland Clinic’s Neurological Institute last year established a distinctive framework of career tracks for its professional staff. By the end of June 2020, all the institute’s physicians, scientists and other professional staff clinicians in Northeast Ohio were asked to self-identify into one of the following four career tracks:
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While having a career track framework is not unprecedented, neither is it widespread, particularly not with the granularity of four tracks. “Few academic medical centers put as much emphasis on care delivery as Cleveland Clinic does, and nonacademic centers don’t have as much opportunity for research and educational activity,” notes Robert Fox, MD, the Neurological Institute’s Vice Chair for Research and one of the staff who helped develop the career tracks initiative.
The idea of career tracks arose a little more than a year ago when Neurological Institute leaders were discussing how to cultivate more researchers among the institute’s professional staff while also supporting the staff’s clinical care and educational roles. The conversation soon led to a realization that there were few ways in which researchers — or, for that matter, those who served in other distinct roles — were differentiated from the rest of the institute’s staff.
“We quickly recognized that although we have staff who serve in various roles critical to the institute’s mission — whether by devoting significant time to research or education, or by exclusively caring for patients — we weren’t adequately capturing and supporting the different ways they were directing their professional time,” explains Dr. Fox.
The discussion revealed opportunities to refine how professional roles are defined and evaluated at an academic center with a mission as multidimensional as Cleveland Clinic’s. “This was clearest in terms of our annual performance review (APR) process,” Dr. Fox says. “There were measures for clinical productivity and clinical expertise. There were measures for educational activity. There were measures for research. But having a single APR for all professional staff ended up serving everyone in a suboptimal way. Too many staff felt the APR process was better oriented to those who devoted their professional time differently than they did.”
“We saw this as a chance to further support our staff and accelerate their professional development,” says Neurological Institute Chair Andre Machado, MD, PhD. “Our goal is to recognize the many types of contributions our staff make to the Neurological Institute and Cleveland Clinic as a whole, and to promote effective and innovative approaches to patient care, biomedical research and medical education. For 100 years Cleveland Clinic has had a three-part mission focused on care, research and education, and we want to continuously invest talent toward fulfilling that mission. All of the career tracks are equally important in enabling us to simultaneously care for the patients of today and develop the neurological care of tomorrow.”
Four working groups of professional staff from across the institute were formed and charged with defining each career track, the resources available to ensure success in each track, and the evaluation metrics for assessment of performance and accountability for resources used.
Master Clinician. Staff on the Master Clinician track devote most or all of their time to the clinical care of patients. They demonstrate outstanding clinical expertise in their field of practice and aim to inspire the rest of the healthcare team in patient management.
“Master Clinicians need opportunities and resources to maintain up-to-date skills and knowledge,” says Andrey Stojic, MD, PhD, chair of the working group for this track. “Their performance should be modeled on best practices in patient care and continuous improvement in safety, patient experience and disease-based outcomes. This track is meant to support professional development to meet those goals.”
Clinician Educator. Staff on this track make important contributions to the Neurological Institute’s educational mission through significant activities in one or more of the following: Cleveland Clinic Lerner College of Medicine or other medical schools; residency and fellowship training programs; development of curriculum and learning assessment tools; and leadership of CME programs. They typically have specified time devoted to education efforts in addition to clinical care.
“This track provides a path for early-career staff with an interest in education to understand what being a Clinician Educator entails,” says Karen Jacobs, DO, chair of the Clinician Educator working group. “Along the path they have opportunities to pursue responsibilities in teaching, developing curriculum, scholarly activities and administrative roles, among others. They may be active in medical schools and residency or fellowship education, including service as a program or clerkship director.”
Academic Clinician (also referred to as “Clinician Scholar”). Those on the Academic Clinician track pursue activities that have clinical care and clinical expertise at their core but are supplemented by academic pursuits such as research, teaching and high-impact publishing. This track encompasses a variety of staff with diverse interests who share a goal of shaping care through investigation and communication.
“Cleveland Clinic has long offered intangibles that allow staff to participate in complex patient care while making scholarly contributions and developing leadership in their fields,” says Robert Bermel, MD, chair of the Academic Clinician working group. “This career track formalizes and energizes what has long been intangible, to help staff with an academic mission achieve their career goals more easily and successfully.”
Clinician Scientist. This track is for staff who devote substantial time and effort to clinical, translational or laboratory research, typically supported by external funding. Clinician Scientists demonstrate standout expertise in their field via publications, professional presentations and training of future researchers. Their work is expected to help transform neurological and behavioral care.
“Success as a Clinician Scientist requires specialized training, mentoring, resources, a record of research productivity and a demonstration of scientific leadership,” says Jeffrey Cohen, MD, chair of the Clinician Scientist working group. “This track was developed to address those needs for individual staff and across the institute as a whole.”
Within each track, early-career staff work primarily to advance their own professional goals and fulfill their professional duties, while senior staff are also charged with supporting and mentoring more junior staff and overseeing program development.
All tracks offer opportunities for staff who seek leadership roles and administrative responsibilities, both within and beyond Cleveland Clinic.
The designers of the framework emphasize that staff are free to change tracks over time. “This is not meant to be a permanent pigeonhole,” says Dr. Fox. “We expect some people will seek to change tracks as their professional interests and goals shift over time.”
Likewise, the initiative is not meant to discourage activity not explicitly included in a given track’s description. For instance, engagement in education and scholarship is anticipated across all career tracks, although to different degrees in different tracks.
“Additionally, we recognize that no one track is perfect for every individual,” observes Dr. Fox. “It’s a matter of identifying which track aligns best with one’s goals and career trajectory. From the Neurological Institute’s perspective, it’s a matter of better clarifying where everyone’s professional effort is devoted.”
The initiative is translating to changes in the APR process, which will be more customized to each individual’s career track. “There are now better-tailored metrics for each track,” Dr. Fox explains. “And metrics are connected to the resources provided for each track, because the types of resources can differ considerably between, say, a Master Clinician and a Clinician Scientist. But for all tracks, tailored resources are linked with expected deliverables specific to each track. The result is more meaningful support as well as more meaningful accountability through more customized empowerment.”
After rollout of the career tracks last spring, Neurological Institute staff self-identified into tracks with the approval of their center director. The breakdown by tracks was roughly as follows:
According to Dr. Fox, response following the rollout has been quite positive. “The most common feedback,” he says, “was from staff saying, ‘I really thought my particular career area wasn’t as valued as this shows it to be.’ We heard this from staff across all four tracks, people saying things like, ‘Now I feel like I have a home.’ So it’s been helpful in terms of showing staff that their particular work is truly valued by the institute.”
Indeed, increased professional fulfillment and staff retention are hoped-for effects of the initiative, which is being considered for expansion to professional staff across the broader Cleveland Clinic enterprise.
Career tracks also help inform staffing decisions and may prove to be a recruitment draw. “Physicians join an institution like Cleveland Clinic because being here helps them become the best version of their professional selves, better than they could be elsewhere,” says Dr. Bermel, who also serves as Director of Cleveland Clinic’s Mellen Center for Multiple Sclerosis. “We believe career tracks will further enhance that distinction by enabling us to support our staff’s growth in their professional aspirations better than ever before.”
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