Physician faculty are critical to medical student learning.  From classroom education, which may include didactics or facilitating small group discussions, to clinical experiences in hospitals or outpatient clinics, to mentorship and administrative roles, physician educators are at the pulse of the student experience.  

Though quality medical education is critical for training the future physician workforce, academic faculty must balance a myriad of competing demands. Physician salaries are typically driven by clinical productivity, whereas teaching and other efforts to support academic missions may be unfunded.  Additional barriers to teaching include time constraints, limited space in the clinic, a lack of confidence or experience on the part of the clinical teacher, bureaucratic rigmarole surrounding student onboarding, volunteer faculty paperwork, , meeting dynamic Liaison Committee for Medical Education Requirements, and completing cumbersome grading forms, just to name a few.  

As medical student enrollment continues to increase, from 85,122 in 2014-2015 to 99,562 in 2024-2025 [1], additional faculty and clinical training sites are needed to accommodate these learners.  An all hands on deck approach is necessary to ensure continued medical education quality.  This includes optimization of academic faculty teaching, recruitment of additional faculty, and expansion of training sites outside of the home institution.  Already- stretched academic faculty may feel pressure to take on additional students without additional incentive and risk site overcrowding.  Expansion of training sites often means reliance on volunteer, non-salaried faculty in the community.  As such, strategies to motivate and incentivize faculty to undertake medical student education activities become increasingly important. [2, 3]

While increased student numbers may have exacerbated the need for volunteer faculty, the need for volunteer clinical educators is hardly new.  The Alliance for Clinical Education (ACE) published guidelines on recruiting and retaining community-based faculty to teach medical students nearly 10 years ago [4].  ACE highlights practical teaching strategies that can be leveraged in the community setting, including increasing student involvement and value to the care team by identifying tasks for which the student is responsible; this could include patient check-in, medication reconciliation, updating the patient history, or helping with post visit follow-up [4]. ACE also highlights potential benefits to preceptors including prestige or resources through medical school affiliation, and marketing benefits [4]. 

Institutions also have a role in developing a culture of educational commitment.  Some schools have adopted Educational Value Units (EVUs) to help capture educational efforts.  A review from Husain, Chen and Lelli (2023) suggests that EVU implementation can have a wide impact.  Institutions noted a wide range of impact types when EVUs were introduced, including redistributed teaching responsibility, increased conference attendance, increased evaluation completion, increased teaching productivity, increased mentorship, increased peer-reviewed publications, increased leadership in academic organization, increased external funding and redistribution of funds within and between departments [5].  While paying physicians to teach has been shown to improve educational experiences for learners [6], funding availability and allocation can be fraught.  If faculty time cannot be reimbursed, bonus structures that financially incentivize teaching may be helpful, as demonstrated at the University of Nebraska Medical Center. 

Institutions can foster faculty confidence and teaching skills.  This may be through supporting travel or CME funding for education-focused conferences, through institutional faculty development presentations on educational pearls and best practices, and through valuing teaching efforts in promotion and tenure processes [2-4].  

Additionally, medical colleges can be mindful to streamline paperwork requirements, removing redundant or ambiguous grading questions, and simplify the student evaluation process [2]. Faculty should be provided with clear objectives for students and given autonomy to meet these expectations through methods that are most appropriate to their care setting.  Simulation activities can be employed to ensure that key elements are covered and alleviate pressure from faculty and training sites, which often emphasize different skills or serve specific patient populations.   Examples of simulation activities include standardized patients, manikins, or virtual modules.

Furthermore, institutions should ensure faculty understand the breadth of clinician educator opportunities available.  Although most physicians equate medical education with direct teaching, there are many other roles in education including mentoring and administrative roles such as clerkship directors or pre-clinical course directors that may be of interest to faculty and play to different faculty strengths. 

Nationally, specialty boards certifications should also support CME and Maintenance of Certification opportunities to reflect educational quality improvement work undertaken as educators, akin to clinical performance improvement activities.  Additionally, several states now offer tax incentives for clinical precepting [7], or enhanced Medicaid payments which may help offset perceived financial impact without directly impacting medical school budgets. 

In summary, the need for physician educators is chronic and growing.  Despite barriers, opportunities exist at the departmental, institutional, and national levels that can be employed to help mitigate these barriers.  With increasing demands on physicians and rising numbers of medical students, ongoing attention must be paid to ensure physician faculty are motivated and empowered to train the next generation. 

What do you think?  Here are some questions to consider:

• How can institutions balance clinical and educational needs? What strategies could align both? 
• What do you think is most likely to motivate physicians to engage in teaching?
• What bureaucratic barriers do you think have the biggest impact on physicians’ willingness to teach and how could these be streamlined?
• How can institutions ensure that expanding training sites to community settings with volunteer faculty have high educational quality and satisfaction from both the physician educator and the student?

References:

1. Boyle P. Medical school enrollment reaches a new high [Internet]. Washington (DC): Association of American Medical Colleges; 2025 Jan 9 [cited 2025 Oct 1]. Available from: https://www.aamc.org/news/medical-school-enrollment-reaches-new-high
2. Theobald M. STFM tackles preceptor shortage. Ann Fam Med. 2016 Mar;14(2):183-4. doi:10.1370/afm.1917.
3. Hobson WL, Olson LM, Hopf HW, Winter LC, Byington CL. “The adjunct faculty are our lifeblood”: an institution’s response to deliver value to volunteer community faculty. Fam Med. 2021;53(2):133-8. doi:10.22454/FamMed.2021.565994.
4. Christner JG, Dallaghan GB, Briscoe G, Casey P, Fincher RM, Manfred LM, Margo KI, Muscarella P, Richardson JE, Safdieh J, Steiner BD. The community preceptor crisis: recruiting and retaining community-based faculty to teach medical students—a shared perspective from the Alliance for Clinical Education. Teach Learn Med. 2016 Jul-Sep;28(3):329-36. doi:10.1080/10401334.2016.1152899. Epub 2016 Apr 19. PMID:27092852.
5. Husain A, Chen DA, Lelli GJ. A review on the use of the Educational Value Unit (EVU) among teaching hospitals. Healthcare (Basel). 2023;11(1):136. doi:10.3390/healthcare11010136
6. Ashar B, Levine R, Magaziner J, Shochet R, Wright S. An association between paying physician-teachers for their teaching efforts and an improved educational experience for learners. J Gen Intern Med. 2007 Oct;22(10):1393-7. doi:10.1007/s11606-007-0285-2. Epub 2007 Jul 26. PMID: 17653809; PMCID: PMC2305849.
7. Smith T. An update on state preceptor tax incentives: Where do we stand? [Internet]. Washington (DC): Physician Assistant Education Association; 2023 Oct 28 [cited 2025 Oct 1]. Available from: https://paeaonline.org/resources/public-resources/paea-news/an-update-on-state-preceptor-tax-incentives-where-do-we-stand

Authors: Dana Raml, M.D.; Mary Steinman, M.D.; & Linda Love, Ed.D.; Association of Directors of Medical Student Education in Psychiatry