"Academic Doctors Increasingly Despair at Push for Revenue Over Research"

An important article on the state of academic medical faculty appeared in Academic Medicine [Schindler BA et al. The impact of changing health care environment on the health and well-being of faculty at four medical schools. Acad Med 2006; 81: 27-34.] The article was summarized in the Chronicle of Higher Education with the provocative title, "Academic Doctors Increasingly Despair at Push for Revenue Over Research, Study Shows."

The authors surveyed faculty at four medical schools in the east, southwest, and western US, three state supported, one private, in 2000 and 2001 up to September 11. Some of their most striking findings were:

• Academic physicians spent an average of 40.7% of their time in direct patient care (up from 23% in a 1984 survey).
• Academic physicians spent less time supervising residents and medical students (15.2%) than they did in 1984 (21%), and overall spent only a little over a quarter of their time overall in teaching and related activities.
• Academic physicians spent less time on research (14.7%) than they did in 1984 (29%).
• One fifth (20.5%) of faculty were clinically depressed as indicated by scores of 16 or greater on the CES-D scale.
• About 11% of faculty had moderate to severe anxiety.
• One quarter (25%) of faculty had salaries completely dependent on their "productivity." More than one-tenth (12.6%) of faculty were contemplating leaving their institution within the next few years. Only 18.5% of faculty thought their institutions were in good financial shape.

Some notable comments in the discussion section were:

The future of medicine resides in the medical students of today and tomorrow, who in turn depend on the quality of faculty and teaching in our nation's medical schools. This study raises the concern that current medical students are being taught by faculty who are increasingly stressed and dispirited.
For many faculty, the lure of academia seems to have been the relatively stable mix of patient care, research, and teaching. Yet our study supports LUdmer's assertions that in recent years patient care responsibilities have burgeoned, crowding out time for teaching and research.

The title of the Chronicle article seems a bit more to the point, though. Something is very wrong when one-fifth of academic physicians are working while clinically depressed.

The authors of the study did not talk much about the source of the stresses under which the faculty labored. Persual of Health Care Renewal would suggest that many of them realized they were working in a health care environment that had decreasing interest in training the doctors of the future, and increasingly threatened their core professional values. Some may have realized that the financial pressures to which they were exposed were partly a result of health care organizations that sent most of the money elsewhere, some of it wasted in foolish pursuits and cumbersome bureaucracy, some handed as lavish salary and perks to undeserving managers, perhaps a bit of it literally stolen. That truly could make honest academic physicians depressed.