Innov Surg Sci 2019; 4(3): 108–115 Original Article Seyed Arash Alawi*, Rosalia Luketina, Nicco Krezdorn, Lukas Fabian Busch, Anne Limbourg, Ludwik Branski, Peter M. Vogt and Andreas Jokuszies How to become a medical professor – a comparative analysis of academic requirements in Germany and the United States https://doi.org/10.1515/iss-2019-0011 Due to different scientific cooperation and exchange pro- Received June 11, 2019; accepted August 6, 2019; previously grams, research and academic activities have reached an published online August 22, 2019 intense international exchange level. Yet there is no inter- Abstract national or even national standardization, quality assur- ance, and comparability to gain a medical professorship. Background: The acquisition of a medical professorship Keywords: academic career; academic system; professor- represents a significant step in a physician’s academic ship; research and teaching. career. The responsibility as well as the honor and the asso- ciated obligations are significant; however, the require- ments to become a medical professor vary in Germany. Objective: We analyzed the variable requirements for Introduction prospective medical professors in Germany, with special focus on the tenure track concept and the U.S. system. German academic system Methods: Based on an online research, we queried German medical faculty regulations to obtain a medical If you aspire to become a medical professor in Germany, professorship within Germany. the stairway is steep; however, there are different ways of Results: We analyzed 35 German universities. On average, climbing up the academic career ladder. As soon as you 11 publications are required after “venia legendi” to meet reach “venia legendi”, specific faculty requirements are set professorship (apl) prerequisites (median x̅ = 10, max = 24, to obtain professorship. For example, among all members min = 6, n = 16), whereas 6 publications with first or last of German plastic surgery departments, about 14% of the authorship are required on average (x̅ = 6, max = 16, members of the German Society of Plastic, Reconstructive min = 4, n = 26). In most German universities, it takes an and Aesthetic Surgeons ( DGPRÄC, Deutsche Gesellschaft average of 4 years after gaining habilitation to apply for der Plastischen, Rekonstruktiven und Ästhetischen a professorship (x̅ = 5 years, max = 6 years, min = 2 years). Chirurgen) complete their habilitation, and about 7% reach Candidates for university chair positions, however, can an associate professorship/full professorship [1]. Candi- shorten this period by an average of 38%. dates who are willing to obtain a professorship show special Discussion: In the German academic system, the prereq- research enthusiasm, persistence, creativity, ambition, and uisites to gain a professorship differ among universities. resilience for extended periods. The possible reasons to go the extra mile of an academic career might be curiosity and interest in optimizing treatment modalities. Salary increase *Corresponding author: Seyed Arash Alawi, Department of Plastic, as a further motivation has to be considered as second rate, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany, but working in an academic environment with scientific net- Phone: +49 511 532-8864, works may count as an incentive. Fact is that research takes E-mail: [email protected] a central role in clinical routine, especially for those who Rosalia Luketina, Nicco Krezdorn, Lukas Fabian Busch, have the ambition to be a senior academic. Further factors Anne Limbourg, Peter M. Vogt and Andreas Jokuszies: Department of motivation can be the prestige and influence that impact of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany on one’s decision making at the university level. Especially, Ludwik Branski: Department of Plastic Surgery, University of Texas in university departments, potential political influence and Medical Branch, Galveston, TX, USA committee membership is limited to esteemed professors. Open Access. © 2019 Alawi S.A., et al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 Public License. S.A. Alawi et al.: Academic requirements for earning a medical professorship 109 The thrill and burden of high responsibility accompanied the research field varies and may range from losing inter- usually by massive workload and limited private life are est in research to “burn out” considered as not being able two sides of the same medal. to exhibit the expected results. In addition, reorientation The management of universities has not only changed and the desire to work in a private practice count as further drastically in recent years. University and faculty leaders reasons [11, 12]. At the same time, the absence of financial carry an ascending influence as experts in health politics and structural incentives leads to a lack of willingness to and economics. For example, ministries negotiate target choose the stony path of obtaining a professorship. Analy- agreements with universities to allocate their funds accord- ses of German plastic surgery departments show that the ing to key performance indicators [2–4]. Fifteen federal intention to proceed with academic career stagnates after states have introduced university councils called “Hochs- the accomplishment of habilitation [4]. chulräte” as the new governing body [3]. The university’s Regarding the comparable academic positions, senate nominates these members. The state ministries of a so-called “Privatdozent” in Germany is not com- education decide on the recruitment of professors and can pletely comparable to an “assistant professor” in the reject the submitted candidates. Although the state laws United States, as an assistant professor might not have differ considerably, the university council executes three completed as much research as a German “Privatdoz- basic functions in varying degrees. It is intended to address ent”. Comparatively, a senior physician in the United the concerns of society, to take over the supervisory func- States can be termed as an assistant professor (Table 1). tions formerly assigned from the state to the presidium/ rectorate, and to advise the university in its strategic devel- Table 1: Overview of the German and U.S. academic systems. opment based on the expertise and experience. With this functional spectrum, the university council receives one (1) German system (2) U.S. system central role for the development and sustainable manage- Professor emeritus (Prof. em.) ment of the respective university [2, 3]. Professor ordinarius (ordentlicher Full professor In comparison to the German university system, indi- Professor, o. Prof., Univ. Prof.) vidual universities in the U.S. higher education system Professor extraordinarius Associate professor have maximum autonomy in an output-oriented and (“extraordinary professor”, competitive environment [5, 6]. This reflects the ongoing außerordentlicher Professor, ao. political discourse of the Federal Republic of Germany Prof., apl Professor) regarding the future strategic orientation of universities Privatdozent (Priv.-Doz. or PD) Assistant professor (not being forced by the American model, which appears to entirely comparable) “strengthen university autonomy” and “introduce a board Dr. med. Research associate, as a steering committee” [2, 5]. lecturer, and instructor For example, from the perspective of the field of (1) German system. Professor emeritus is used both for the university plastic surgery worldwide, we have gone through excit- ordinarius and for the extraordinarius. Nevertheless, strictly ing and innovative developments, especially in the last speaking, only the professor ordinarius can be described as such. decades. Plastic surgery departments of high output in In spite of retirement, there is the possibility to proceed working in Germany have developed a high level of specialization private practice. Extending his or her former ordinariate beyond the regular time frame is a matter of negotiation. Professor ordinarius: If with an academic background that is defined in an inde- one person holds a university chair, he is called University Professor. pendent academic environment within the university Professor extraordinarius: An extraordinary professor is comparable [7–9]. This independence is the base for academic careers. to an associate professor and does not hold a university chair. The Additionally, funding and financial resources seem to be title is given to a former Privatdozent who did excellent research more available at university hospitals. Current develop- before and after habilitation but has not attained a regular chair. The nomination “außerplanmäßig” means extraordinary. Nonetheless, ments include the establishment of a registry of research his obligations are mainly teaching and conducting research besides funding at the DGPRÄC [10]. Currently, significant discrep- clinical care according to her or his status being a member of the ancies exist between dependent and independent plastic faculty. Privatdozent: The Privatdozent is also member of the faculty surgery university hospitals regarding material and human and is not completely comparable to an “assistant professor” in the resources. Investigations showed that the scientific perfor- United States, as an assistant professor might not have completed as mances of university hospitals are significantly