Recruitment of faculty into academic medicine is an ongoing concern (1). Interest in an academic career has been shown to decline during residency (2), and the percentage of graduates entering academic careers has been declining, as well (3). One study in dermatology found that few residents (8%) choose academic medicine as a career (4); no similar studies exist for psychiatry. The AAMC Workforce Report found that, compared with other specialties, psychiatry has the greatest frequency of physicians practicing in the state where they were trained; however, the report makes no mention of whether they remain at the same institution (5).

Although little has been published characterizing the population of physicians who enter academic medicine (6), presumably, many begin their academic careers immediately upon completing residency or fellowship training. This is a critical time-period for the resident, as there is a limited window for academic programs to recruit them before they decide rather to pursue a career in private practice or elsewhere. Recruitment of faculty is an ongoing labor for department administrators. Lowenstein et al. (7) report that up to 42% of current faculty members are seriously considering leaving academic medicine. In locations with shortages in physician supply, recruitment strategies designed to attract residents into private practice may become very competitive (8).

In many general higher-education universities, explicit policies discourage departments from recruiting their own doctoral graduates (9). In medical schools, however, there is little evidence to suggest that such policies exist or that they would be valued by institutional stakeholders. When a critical need for competent clinicians exists, a resident from one’s own institution may be viewed as a “known quantity” that has been trained to perform in that specific medical and cultural environment. Such individuals may even be considered superior faculty candidates over those who have been externally trained (10–12).

To-date, there is little published literature at either the institutional or national level regarding the prevalence of internal hiring of a department's own graduates as faculty members, and none in the field of psychiatry. Our motivation for this study arose from a desire to know more about patterns of departmental employment of physicians who trained at that institution. Specifically, the purpose of this study was to examine national data to determine an estimate of the frequency of faculty psychiatrists being employed in the same department in which they completed their residency training.

Information about where departmental faculty received their training is often publically available on university websites. To obtain a sample of psychiatry department websites for review, we randomized an alphabetical listing of all 130 AAMC-affiliated medical schools listed on the AAMC website (in December 2008), using the randomize function in Microsoft Excel. We then sequentially reviewed the faculty listings on each psychiatry department website to determine the location where each physician (M.D., D.O.) faculty member completed their residency training. If the faculty website had information on less than 80% of the faculty members’ training location, we excluded it from the study. As programs were excluded, we continued down the list, collecting the training location data until a 20% sample of the medical schools was obtained. We selected the 20% random sample as a target that has been used in previous studies (13, 14). Of the 86 school websites reviewed in this process, 60 were excluded because of incomplete information. The review occurred between January and August of 2009.

Physicians completing primary residency at the institution where they were currently employed were considered to be “internally trained” faculty. The percentage of internally-trained faculty for each department was computed as a ratio of physicians completing residency at their current department of employment as compared with the total number of physician faculty members in the department. Non-physician faculty were excluded from the total counts.

Table 1 lists results for the 26 psychiatry departments reviewed for this study. The medical schools are displayed in ascending order according to the percentage of internally-trained physician faculty members in the psychiatry department. As shown, 0%–71% of the physician faculty members were currently employed by the university where they completed residency training. Approximately 10% of the schools had less than 25% of faculty who were internally trained; about half had between 25%–50% who were internally trained; 40% had between 50% and 75% who were internally trained, and none had more than 71% of their faculty who were internally trained.

This study presents the first examination of internal hiring patterns in psychiatry departments in the United States. Results suggest that recruiting one’s own graduates is common in academic psychiatry, and there is wide variation in this practice across institutions. These results are similar to the only other identified study of internal hiring, which was completed in dermatology by Wu et al. (4). That study (4) found a broader distribution of internally-trained faculty than we did (0%–100%), but they also found a similarly high prevalence of internally-trained faculty, with 50% of the programs reporting between 26% and 75% of their faculty who were internally trained.

This study was a review of publically available information from websites to obtain a general estimate of internal hiring in academic psychiatry, and it may be limited in terms of the frequency with which the website was updated, the complete listings of faculty, and the possibility of interim employment between graduation and appointment within the department. In the future, a more thorough approach might include direct surveys of departmental faculty and stratification of the sample frame by relevant characteristics. Such data could be used to examine whether these differences are correlated with other factors, such as geographical area, size, financial status, prestige and reputation, departmental standing and strength, medical student recruitment, recruitment ethics, salary, job opportunities, facilities associated with training site, mentoring quality, and so on. It would be useful to determine whether this pattern of internal faculty recruitment is generalizable to other medical specialties, as well. Further work on this topic could be beneficial for residents, faculty, and administrators involved in the hiring process, as we believe that internally-trained residents represent a special, and perhaps vulnerable, population that may need consideration for individualized hiring practices.