Sunday, July 31, 2005

College (Governance) Follies

One issue that at least some of us here on Health Care Renewal think may be important in the revitalization of academic medicine (see post below) is the revitalization of the governance of academic medical organizations.
In the US, at least, medical schools own or operate most academic medical centers and teaching hospitals. Medical schools, in turn, are usually part of larger universities.
Heather MacDonald, writing in the latest City Journal, has quite a bit to say about the governance of American universities, which should be relevant to the governance of academic medicine.
In particular, she indicts the trustees, who ought to have ultimate authority over how the universities are run, and ought to be insuring that they are run in accord with their missions:
College trustees seem even more determined than alumni to see and hear no evil. Nothing produces more discomfort and denial in your average trustee than being told about the excesses at his college. Federal appellate judge Jose Cabranes has served as a trustee at Yale and Colgate, and is currently on the Columbia board. Have you ever heard your fellow trustees express an interest in the curriculum? I asked him. “Not only never, but such questions make them anxiety-ridden. If the question comes up, most trustees stare vacantly into space.”
A Brown trustee explains: “The culture wars are vicious; most trustees don’t want to be involved. They don’t care about the curriculum. All they want to know is if SATs are up.”
To test this claim, I asked a New York University trustee what she thought about Andrew Ross, a royally paid American studies professor. [Ross is the editor of Social Text, the journal that published Alan Sokal's hoax article about post-modern science.] But though Sokal’s hoax won wide press coverage, including a front-page New York Times story, the NYU trustee had never heard of Andrew Ross. She quickly changed the subject to NYU’s rising place in U.S. News and World Report’s annual college rankings.
[MacDonald inteviewed John Moores, Sr., a "renegade regent" at the University of California, San Diego.] “The regents are furniture,” he says. “They do absolutely nothing. If they were a board of directors of a corporation, they would fire people on the spot for not revealing material information. But the regents don’t want to know about admissions standards. They accept [them] with a sort of biblical inerrancy [as] the revealed truth....
A trustee at one of the most notoriously liberal private universities in the country sounds anguished discussing his service. “Being a trustee is hard to do if you want to live an examined life,” he says. “It’s a very problematic equation. Maybe I should just walk away. It would be completely rational, because so much is so bad.”
Such unruffled acquiescence in whatever folly one’s university has cooked up is not surprising. A board is a creature of the college president, nominated by people close to him or by alumni associations whose members are also chosen for their loyalty. Trustees are usually so grateful for the honor and prestige of the position that they shy away from rigorous oversight. As one big donor observed, the “anxiety for status among what should be self-confident businessmen is remarkable. Once on college boards, they grovel.”
This is all anecdotal, to be sure. But if it is at all representative of how universities are run, the implications for how academic medicine is run are dire. If university trustees are cronies of the administration, and/or unwilling to exercise any oversight over central academic matters such as curriculum and admissions, what sort of oversight should we expect over issues peculiar to academic medicine. And is it then any surprise that American medical schools offer so little instruction on evidence-based medicine, on one hand, and on the business ethics of medicine (for want of a better term), on the other?

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