Faculty Tenure in US Academic Medical Institutions: A Critical Review of Controversy and Debate

For over a century, tenure has been a foundational tenet in American academic institutions, being synonymous with the concept of academic freedom. This concept has been extrapolated to US Academic Medical Institutions (AMIs) in multiple domains including teaching and research, sharing opinions as private citizens and on matters of institutional governance as well as providing clinicians, educators, scientists, and scholars opportunities for secure employment. In recent decades, however, there has been a steady erosion of the tenure system in US AMIs, and constituents suggest that this archaic construct would benefit from reform or even its complete abolition. The present treatise offers a historical perspective on the tenure system in AMIs, reviews the enthusiastic debate and controversies including the concomitant advantages, disadvantages, challenges, and the underlying reasons for its decline over the last few decades, and expounds on the ramifications of such trends. This exposition also discusses alternatives and reform to the tenure system which, if implemented, would still guarantee freedom in academic medicine.