A high level of skill in teaching, advising, or mentoring, and as a practitioner, and who has contributed actively to clinical or research programs. The individual must have a regional reputation in his or her area of expertise. Scholarly activity will be given positive consideration. Service to the university, its affiliates, or to the profession will be given positive consideration where a substantial role can be documented. Criteria for promotion to clinical professor Excellence in teaching, advising, or mentoring, and as a practitioner, and who has contributed actively to clinical or research programs. The individual must have a national reputation in his or her area of expertise. Evidence of scholarly activity is required. Service to the university, its affiliates, or to the profession will be given positive consideration where a substantial role can be documented. Neurology.org/N Neurology | Volume 94, Number 2 | January 14, 2020 79 Copyright © 2019 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. structure, as well as the actual job description of the physician who will be delivering that care. Job descriptions based on human resource offices should be reviewed and updated to reflect the actual work and duties of each physician. 2. The consultant’s statistical methods for determining average wRVU production should be disclosed. The current data appear to reflect a blend of private practice and academic practice, even in communities without private practice child neurology services, without any consideration of the difference between a neurologist who performs clinical neurophysiology vs a non-procedure-based, general neurologist. 3. wRVUs should not be used as the sole basis of compensation for child neurologists. There are other tangible and essential requirements that require time during the work day, and these should be accounted for in detail before coming to any firm decision regarding annual wRVU requirements. wRVUs can be used as part of the calculations, but other contributions should be included. Downstream revenue should be a part of the evaluation for compensation, using the mission statement and job descriptions. We were able to obtain downstream revenue data from 4 academic institutions. The collective downstream revenue per child neurologist (procedure-based combined with non-procedurebased) was estimated to be between $1.2 and $2.0 million dollars per child neurologist per year. These 4 institutions declined to be identified. In many institutions, these data are carefully guarded and difficult to obtain. Child neurology services that are essential to the maintenance of a functioning medical center do not generate wRVUs. Although many of these duties are not unique to this specialty, some of the duties are overrepresented in this specialty. This includes, but is not limited to, the volume of phone calls at night from the emergency department requesting phone consultation, phone calls at night from various intensive care units, and phone calls from colleagues during the day for curbside consultations, none of which generate wRVUs. Much of this work is performed at night, during normal sleep time, which is essential, but most programs have no method of tracking or reacting to sleep deprivation. Although there are health concerns and patient safety concerns that should be addressed separately, extra consideration should be given for reducing the wRVU requirement for those practices that require nighttime work more frequently. In addition, children entering our care will also ultimately be generating revenue for radiology, orthopedics, and other specialties within the organization. The downstream revenue argument works both ways but neurology, specifically, is the nidus of activity for entry into the medical system rather than a competitor’s medical system. There needs to be recognition of the value of the input into the system that general child neurologists (nonproceduralists) bring. These general child neurologists feed the neuroscience enterprise. They are not a loss-leader scenario. Rather, these general child neurologists are an essential part of the corpus of child neurology. We also need to explain clearly to our respective institutions why the providers who serve and bring patients into the health care system cannot possibly meet the productivity measures set by ECG and Sullivan Cotter, given that they do not have procedures to increase their wRVUs. Furthermore, the productivity measures for general child neurologists do not consider the current deficiencies in scheduling, no-show rates, and same-day cancellations. None of these factors is under the control of the providers. Call responsibilities are also not accounted for adequately using the wRVU system, specifically, the need to be available 24/7 and the many interruptions during the day and night while on call. Expectations for our general neurology providers must be realistic and achievable and recognize the deficiencies in our systems. If the mission of the employer/institution includes education or research, the clinical faculty without extramural research support should have reduced clinical time and wRVU requirements to enable them to achieve the criteria for promotion (table). Specifically, those full-time clinical faculty in an academic center, pursuing promotion without extramural research support, should be expected to do no more than 5 or 6 half-day clinical sessions per week (20–24 hours of face to face clinical time. The decision for clinical time should be determined by the child neurology division, not administration. Clinic schedules should allot 60 minutes for a new patient and 30 minutes for established patients. Clinic time should be reduced when the individual has inpatient care responsibilities.