Changing role of tenure in academic medicine: a national survey of faculty affairs deans

Background Tenure has traditionally signified academic freedom, job security and scholarly independence at US medical schools, yet the proportion of faculty in tenure-track positions has declined markedly in recent decades.Methods To assess tenure's contemporary relevance, particularly for academic medical leaders, we conducted a national survey of senior faculty affairs deans at US medical schools from September to November 2025.Results Of 139 faculty affairs deans contacted, 78 (56%) responded. Most respondents were physicians in clinical departments (n=44, 56.4%) and over half were not tenured or worked at institutions without tenure systems (n=43, 55.1%). Faculty affairs leaders viewed that tenure was slightly or not at all important for deans (n=42, 54%), clinical department chairs (n=57,73%) and themselves (n=45, 58%), but remained very important for basic science department chairs (n=56, 72%). Two-thirds believed it is important for medical schools to offer tenure, citing academic freedom, recruitment and retention value and its importance for basic scientists. Qualitative themes highlighted that tenure may confer leadership credibility, though leadership experience itself was viewed as more important.Conclusions While tenure is still perceived as valuable in specific contexts, particularly for basic science department chairs, modern academic medicine may consider evolving tenure systems and requirements for tenure in leadership roles so that the pathways to leadership better reflect the diverse missions, expertise and contributions required to advance academic health centres.