How can universities grant you tenure if they don't pay you?

Medical schools need full-time doctors to work in their hospitals and clinics; they also employ physicians who, because they carry out clinic-based research, can earn their salary by treating patients. You can recognize these docs by the word "clinical" in their titles, as in "clinical professor" or "professor of clinical (pick a medical specialty)."  For whatever reason,  these professors are subject to a system of evaluation and promotion that awkwardly overlaps that of a professor of, say, art history, but that's a topic for a later time.
This post is not about these clinically-oriented physicians, but rather about "tenure-track" physician faculty members who spend most of their time doing non-clinical/basic research.

"Tenure-track" physician-scientists are evaluated and promoted in exactly the same way as any other aspiring professor, for example the professor of art history I mentioned above. This means a period of time at the assistant professor level and then, after six or seven years max, it's either up or out. "Up" means tenure. Universities have basically handed over decision-making regarding tenure to their faculties. Which is to say, faculty committees set up to play an advisory role have become the de facto arbiters of tenure decisions, only rarely (at the universities I am most familiar with, in any case) being overruled by university chancellors or vice-chancellors. The fun part is that the final faculty committee to weigh-in is often a university-wide committee, comprised of professors of you-name-it (history, sculpture, engineering, music, physics and so on).  If you think that it may not always be optimal to have, say, a professor of political science weighing in on the scientific output of a molecular biologist or, say, a Ph.D. molecular biologist commenting on the clinical service and teaching of an MD of MD-PhD, I would have to agree.

Though faculty members are subject to this promotion system throughout their career, the biggest step is the tenure decision. This is also a big step for the university, since, by giving someone tenure, they are committing to career-long employment of that individual. So, the assistant professor has to run this gauntlet, but, if successful, will thereafter have career-long economic security.  Unless he or she is on a medical school faculty, in which case she will get all of the same stress and little or none of the resulting security (see my earlier post on soft money). I found this galling before I received tenure and, now that I have tenure, still think it is highly unfair.  I was interested to learn that the major trade organization for professors, the American Association of University Professors (AAUP), has been clued in to this problem and is most displeased. They are insistent that "economic security" is an essential component of tenure. Here is some of what the AAUP has had to say on the matter (from the AAUP report "Tenure in the Medical School"):

•  . . . . The 1940 Statement of Principles stipulates that tenure is a means not only to academic freedom, but also to “a sufficient degree of economic security to make the profession attractive to men and women of ability.” Except, as is sometimes the case, where the reward of rank and tenure is purely honorific, all tenured and tenure-track faculty should be guaranteed an assured minimum salary adequate to the maintenance of support at a level appropriate to faculty members in the basic sciences, and not merely a token stipend,  . . .
  (emphasis added)

and

• We question whether any institution of higher education or one of its components, whether the purpose be undergraduate, graduate, or professional education, can provide such educational quality without that reasonable assurance of stability that helps ensure the commitment of its faculty members to freedom of inquiry in teaching and research and to the preparation of its students.
  (emphasis added)

"Assurance of stability" eh?  Oh well.

(P.S. see also this)