Chapter 3.1 Definitions, Resources, Titles and Ranks, Duration of Appointments

A. Clinician Educator Role

The Clinician Educator role is defined by engagement in clinical care and teaching that advances clinical medicine.  While not required, Clinician Educators may also engage in scholarly activities and/or perform in an administrative role.

With four ranks and opportunities for reappointment and promotion, the Clinician Educator line is structured as a career path for both junior and more senior clinicians who add value to the School by providing essential care in an active practice setting; teaching that advances the missions of the School of Medicine and the Stanford Hospital and Clinics and/or Lucile Packard Children’s Hospital; and through service as specialists in fields that are not covered by members of the Professoriate.  The Clinician Educator is normally a highly qualified, licensed M.D. (or equivalent medical degree) or Ph.D.

B. Definition of Clinician Educator

Clinician Educators are salaried employees of Stanford University, classified as exempt staff and are, in general, subject to and expected to comply with the University’s applicable policies and procedures, including (in general) the employment policies and procedures in Chapter 2 of Stanford University’s Administrative Guide.

While Clinician Educators are classified as staff, many of their responsibilities, which focus on clinical care and clinical teaching (and may involve an administrative role or scholarly activities), are similar to those held by members of the Professoriate.  Therefore, as a result of their academic credentials and multifaceted contributions to the School’s educational mission, Clinician Educators are regarded colloquially as faculty and are referred to as such in everyday usage.

C. Definition of Clinician Educator (Affiliated)

A Clinician Educator (Affiliated) is employed by another institution with whom the School of Medicine, Stanford Hospitals and Clinics, and/or Lucile Packard Children’s Hospital has an affiliation agreement and provides patient care, clinical teaching or other duties that advance the missions of the Stanford University Medical Center.  Individuals in private practice or employed by institutions having no affiliation agreement are appointed as Adjunct Clinical Faculty (see Chapter 5 of this Handbook).

A Stanford academic appointment as a Clinician Educator (Affiliated) is expected for persons holding leadership positions at the affiliated institution, e.g. department chair, chief of service.  Stanford School of Medicine department chairs and division chiefs, in consultation with their counterparts at affiliated institutions, determine the appropriateness of an academic appointment as Clinician Educator (Affiliated) for attending physicians or other medical providers who have frequent and sustained interaction with Stanford students and trainees.  An academic appointment may not be deemed necessary for individuals with casual or infrequent student/trainee interaction.

The appointment, reappointment and promotion criteria, duration, evidentiary requirements and review processes are generally the same for these individuals as for Clinician Educators who are paid by Stanford.

Clinician Educator (Affiliated) is an academic title only, rather than an employment category; a Clinician Educator (Affiliated) does not receive compensation by or thruogh Stanford University.  Thus, the sections below that relate to Stanford employees (for example, 3.1.E-F; 3.1.K; 3.4.A-D; 3.5) are not applicable.

When using their Clinician Educator (Affiliated) titles, appointees must include the word “(Affiliated)”, for example “Clinical Assistant Professor (Affiliated)”.

Membership in the Clinician Educator line entitles a Clinician Educator (Affiliated) to identify himself or herself as such and to include his or her Clinician Educator (Affiliated) title on stationary, business cards, and (with advance approval and in limited circumstances, such as those rare occasions when the research relates specifically to the Clinician Educator (Affiliated) member’s Stanford-related duties, activities and responsibilities) in certain publications.  Because the production of written scholarship is not, in general, a component of a Clinician Educator (Affiliated) appointment, the use of the title on publications may only be included when the use has advance, written approval from the department chair.  A record of the department chair’s approval for the use of the Clinician Educator (Affiliated) title in a publication must be submitted to the Office of Academic Affairs prior to the submission of the publication.

D. Programmatic Need, Position and Resource Allocation

Programmatic need, including financial viability, must be evaluated and established for each Clinician Educator appointment, reappointment and promotion.

Unlike the Professoriate, which is subject to a billet cap, there is no limit on the number of Clinician Educator positions in the School; rather, the number of positions is governed strictly by a department’s programmatic need and funding capacity.  Each regular (benefits-eligible) Clinician Educator position is assigned a unique position number for purposes of recordkeeping and reporting.  Clinician Educators employed in contingent or casual capacity are assigned to shared position numbers.

In addition to salaries, other resources provided to Clinician Educators may include some of the following:  administrative supplement, participation in departmental incentive plans, and moving expenses.  Benefits available to Clinician Educators are described in Section 3.3 (Other Policies).

E. Business Plan

As a first step in initiating a Clinician Educator position, a department, in consultation with the Office of Faculty Compensation, should develop a detailed financial feasibility plan and compensation program to cover the initial term of appointment for the Clinician Educator.  The level of detailed financial analysis required will be determined by whether the appointment represents a new line of practice, an urgent clinical need, a replacement or planned program growth.

F. Identification of Candidates, Diversity Considerations

Clinician Educator positions are not normally subject to the posting and search procedures required for other exempt appointments to the University staff.  Candidates currently affiliated with Stanford in some other capacity (e.g., Resident, Postdoctoral Fellow, Instructor) are often identified as potential Clinician Educators; other candidates may emerge as a result of networking conducted at peer institutions.

Occasionally, it may be appropriate for a department to conduct a national search for a Clinician Educator position.  Under such circumstances, the search process should follow the guidelines in the School of Medicine’s Guide to Faculty Searches to the extent possible.  It is recognized that the process may be somewhat different than that required for a new member of the Professoriate; for example, approval from the Office of Academic Affairs to initiate or conclude the search is not required.

In their identification of candidates, departments are expected to keep in mind Stanford’s commitment to diversity and to the recruitment of women and members of minority groups, as well as others who would bring additional dimensions to the University’s research, teaching and clinical missions.

G. Licensure, Medical Staff Membership and Privileges, Malpractice Insurance, and Authorization to Work

1. Licensure

Before a member of the Clinician Educator Line is permitted to assume responsibilities for the care of patients at Stanford Hospital and Clinics and/or Lucile Packard Children’s Hospital or at an outreach site of Stanford Hospitals and Clinics, he or she must have or obtain a professional license from the State of California and apply for Medical Staff membership and be approved through a formal credentialing process that results in clinic privileges.  Similarly, a Clinician Educator who serves in a non-Stanford facility must obtain and maintain in good standing the privileges at that facility applicable to his or her duties.  Information about obtaining a professional license from the State of California may be obtained from the Medical Board of California, and from Graduate Medical Education.

California Business and Professions Code Sections 2100 et seq. apply to the applications of graduates of medical schools located outside the United States or Canada.  In particular, Section 2113 applies to a person who does not immediately qualify for a physician and surgeon’s certificate and who is offered by the dean of an approved medical school in the State of California a full time faculty position.

Section 2113 describes the requirements for applying for a certificate of registration to engage in the practice of medicine only to the extent that the practice is incident to and a necessary part of the person’s duties as approved by the Medical Board of California in connection with the faculty position.  Section 2113 registration is for full time faculty positions only.  A clinical fellowship shall not be submitted as a faculty service appointment.

Additional information regarding this legislation is available from the Division of Consumer Affairs, Medical Board of California and from Graduate Medical Education (GME).

The “Notice of Separation Under Business and Professions Code Sections 2111 and 2113”, used to notify the Medical Board of California that the faculty appointment of a 2113 registration holder has ended, is available on the GME’s web site.

2. Medical Staff Membership and Privileges

Clinician Educator appointments are contingent upon and coterminous with the candidate obtaining and maintaining in good standing the privileges necessary for the performance of his or her intended clinical role.  Failure to obtain and maintain in good standing such privileges will generally result in the immediate termination of the Clinician Educator’s appointment.  Medical Staff membership and privileges apply only to clinical practice as a Clinician Educator and are coterminous with that appointment.  Information about medical staff membership and privileges at the Stanford University Medical Center may be obtained from the Medical Staff Office.

The Stanford University Medical Center Medical Staff Office will conduct a credentialing process for a Clinician Educator (Affiliated). This process includes a full background check requiring "primary source" verification of all information provided in the application. Additionally, a Clinician Educator (Affiliated) who supervises students and trainees at an affiliated institution where medical staff privileges are required must obtain and maintain medical staff privileges at the affiliated institution. Failure to obtain and maintain in good standing such privileges will generally result in the immediate termination of the Stanford appointment.

3. Malpractice Insurance

Information regarding malpractice coverage for providing services at the Stanford University Medical Center is available from Risk Consulting.

4. Authorization to Work, Visas for and Employment of Foreign Nationals

The Clinician Educator must be authorized to work as required by the Immigration Reform and Control Act, as explained on this page about the I-9 form. 

If the candidate for a Clinician Educator position is a foreign national, the candidate and the department must comply with the applicable policies and procedures appearing in Administrative Guide Memo 23.1, http://adminguide.stanford.edu/ch2contents.html, and on the Bechtel International Center website, http://icenter.stanford.edu/scholars/atstanford/classification.html - faculty.

H. Titles and Ranks

The Clinician Educator ranks are:

• Clinical Instructor
• Clinical Assistant Professor
• Clinical Associate Professor
• Clinical Professor

The word “Clinical” must be included as part of the title for those holding a Clinician Educator appointment.

• The Clinician Educator (Affiliated) ranks are:
• Clinical Instructor (Affiliated)
• Clinical Assistant Professor (Affiliated)
• Clinical Associate Professor (Affiliated)
• Clinical Professor (Affiliated)

The word “Affiliated” must be included as part of the title for those holding a Clinician Educator (Affiliated) appointment.

I. Concurrent Appointments

1. Joint Appointments

a. Definition

Two departments may recognize the interdisciplinary nature of a Clinician Educator’s role and responsibilities with joint appointments.  Under this arrangement, one department is designated as “primary” and the other as “joint.”  Normally, both departments split the salary.  The Clinician Educator is assigned two position numbers, one in each unit.

b. Titles

Titles reflect both of the Clinician Educator’s primary and joint departmental roles by using, for example, the following format:  Clinical Professor of (subject affiliated with primary department) and of (subject affiliated with secondary department).

c. Terms

Joint appointments are normally effective and coterminous with the primary appointment.  If the joint appointment is added, the start date may postdate the start date of the primary appointment but under no circumstances may the joint appointment extend beyond the end date of the primary appointment.

d. Responsibilities

Clinician Educators holding joint appointments are expected to carry a normal load of clinical care, clinical teaching, administrative, and/or scholarly activity as applicable to the percent time of appointment and to the roles is expected by the departments to which they are appointed.

2. Secondary Appointments

a. Definition

A secondary appointment is defined as an arrangement whereby the Clinician Educator holds a primary appointment, as well as a secondary appointment, in departments within the School of Medicine.  It is permissible for a Clinician Educator to hold more than one secondary appointment.  A secondary appointment acknowledges the Clinician Educator’s active participation in a department’s educational, clinical, and scholarly activities, recognized by the secondary department with the allocation of resources (e.g., position number, salary) commensurate with the percent time of appointment.

b. Titles

Titles reflect the faculty member’s primary and secondary departmental roles by using, for example, the following format:  Clinical Professor of (subject of primary affiliation) and of (subject of secondary affiliation).  Multiple secondary appointments should be listed in descending order of involvement or in alphabetical order.

c. Terms

Secondary appointments are normally effective and coterminous with the primary appointment.  If the secondary appointment is added, the start date may postdate the start date of the primary appointment but under no circumstances may the secondary appointment extend beyond the end date of the primary appointment.

d. Responsibilities

Departments have discretion in determining the set of responsibilities that are associated with secondary appointments, although it is expected that a minimum threshold will be established for conferral of the title and will be applied equitably and will reflect the department’s specific programmatic need.

3. Courtesy Appointments

a. Definition

A courtesy appointment is defined as one in which the Clinician Educator often makes a substantial contribution to departments or divisions other than their own, but in ways less formal than would justify a joint or secondary appointment.  It is permissible for a Clinician Educator to hold more than one courtesy appointment.  There is usually no commitment of salary, space, research or other support involved in a courtesy appointment.

b. Titles

Formally (that is, in all appointment documents), the title should read, for example, Clinical Professor of (subject of primary affiliation) and, by courtesy, of (subject).

c. Terms

The duration of a courtesy appointment may be less than or coterminous with the primary appointment.

d. Responsibilities

Departments have discretion in determining the set of responsibilities that are associated with courtesy appointments, although it is expected that a minimum threshold will be established for conferral of the title and will be applied equitably and will reflect the department’s specific programmatic need.

J. Duration of Appointments

The duration of appointment is generally the same for Clinician Educators paid by Stanford and for Clinician Educators (Affiliated).

All Clinician Educator appointments are for a term of years.  In accordance with Administrative Guide Memo 2.1.9.5, candidates are notified in writing of the planned fixed term end date in a letter from the Vice Dean of the School of Medicine..

The usual duration of an appointment (subject to relatively rare exceptions granted by the Vice Dean for a good cause and on a case-by-case basis) for each rank is

1. Term Appointments

Although term appointments are frequently made with the clear possibility of reappointment or promotion, there is no entitlement to such action at the end of the term, and it is not automatic.  Instead, decisions on reappointment and promotion, like decisions on initial appointment, are subject to programmatic need and budgetary considerations, as well as the exercise of professional and scholarly judgment and discretion by the School’s departmental faculty and the School’s academic leadership.

Promotion is not a requirement for continued affiliation; qualified candidates may be renewed at the same rank for an unlimited number of terms.  However, Clinician Educators are encouraged to take advantage of career development opportunities to meet the criteria for advancement.

Reappointment and promotion reviews are generally (but not always) initiated approximately six months in advance of the appointment end date so that a decision is reached before the candidate’s current appointment ends.  Extension of term appointments is discouraged.  In the event that an extension is necessary, it is expected to be of short duration and supported by a reasonable explanation.

2. Coterminous Appointments

If a Clinician Educator is assigned to an outreach site of Stanford Hospitals and Clinics, his or her appointment as a Clinician Educator will be coterminous with the continued existence of the contract between the outreach site hospital and the Stanford Hospital and Clinics (SHC) or Lucile Packard Children’s Hospital (LPCH), as applicable.  In the event that the contract with the outreach site hospital and SHC or LPCH, as applicable, terminates, the Clinician Educator’s employment with Stanford will likewise terminate, unless Stanford at its sole discretion determines that an alternative position is available.

K. Offer Letters

It is the responsibility of the department chair to see that a candidate for appointment as a Clinician Educator is informed in writing of, and agrees to, the terms and conditions of his or her proposed appointment before hire.  The approved offer letter template is available on the Office of Academic Affairs’ website, http://med.stanford.edu/academicaffairs/CEs/.

An offer letter addendum is required if there are changes to a Clinician Educator’s percent time of appointment, assigned role and responsibilities, and/or compensation other than an increase occurring as a midyear salary adjustment or as part of the annual salary setting process.  The approved addendum template is also available on the Office of Academic Affairs website.

All offers are contingent upon final review and approval by the School of Medicine.

L. Notifying Clinician Educator Candidates of Appointment Terms

Administrative Guide Memo 2.1.9.5(1) requires that at the time of appointment, the department notify a fixed-term employee in writing of the planned termination date.  This requirement is met with the issuance of an offer letter or addendum.  It is the responsibility of departments to inform Clinician Educators of any changes in their term of appointment resulting from reappointments or promotions.  

Departments may provide a formal letter to the candidate with the following statement, as an example, “This will confirm your «Action Type» as «Rank» in the Department of «Department Name» at «Percent» FTE for the period «Appt Start Date» to «Appt End Date».”  Alternatively, departments may notify the candidate of the dates of the fixed-term appointment by forwarding OAA’s approval notification email.

M. Resignations

For planning purposes, the University requests that employees notify their supervisors as soon as possible of any intention to resign.  At least four weeks’ prior notice is expected.  Therefore, if a Clinician Educator resigns before his or her appointment ends, a written statement of resignation should be submitted that includes the date of and reasons for the resignation.

N. Terminations and Nonrenewal

A Clinician Educator may be separated from employment prior to the planned termination date of his or her appointment as set forth in Administrative Guide Memo 2.1.9.6 and 2.1.17.  Generally, such termination may be based on a change in programmatic need (including budgetary considerations) or for just cause, when satisfactory performance ceases.  Proper notice should be given in all circumstances, normally 90 days for programmatic reasons and 30 days for non-programmatic reasons.

As noted above, although continued affiliation in the form of a reappointment or promotion may occur, there is no entitlement to such action at the end of a term, and it is not automatic.  It is expected that discussions between a Clinician Educator and his or her supervisor will be held well in advance of the appointment end date regarding the possibility, if any, of renewal.

O. Personnel Files

The Personnel Files and Data policy found in Administrative Guide Memo 2.1.3, https://adminguide.stanford.edu/chapter-2/subchapter-1/policy-2-1-3 applies to the personnel files of Clinician Educators.  Section 2.1.3.4, Access & Use, reflects Stanford’s policy of many years that an individual should be able to learn the general substance of the information contained in his or her personnel file. 

However, material supplied to the University by a third party (whether inside or outside the University), or supplied by a member of the University to a third party, is presumed to be confidential unless otherwise stated and should not be shown to the individual.  Because the quality of the University’s appointment, reappointment and promotion process depends on the candor of the participants of the process, Stanford’s policy is to protect vigorously the sources of information.  Accordingly, materials in a Clinician Educator's appointment file such as peer evaluations from outside and inside sources, letters from students, departmental or higher-level documents regarding the review process, and documents containing statements based on personal knowledge, judgments or opinions are regarded as confidential.  Such material should, therefore, upon request, be summarized by a responsible School officer in a manner that preserves the confidentiality of the source of the information.

P. Records Retention

Records of former Stanford employees should be retained until the later of eight years following the date of termination or, if a claim is brought (e.g. grievance, lawsuit, or charge with state or federal agency), until the disposition of the claim is final.  See Administrative Guide Memo 2.1.3.5.b.  The records of non-employee affiliates who formerly held an academic appointment as Clinician Educators (Affiliated) should be retained in a similar manner.