Flash: Harvard Medical School to Start Paying Faculty to Teach Clinical Medicine

The Boston Globe just reported on an amazing new development. Harvard Medical School is going to try to pay its faculty something, even more than $30/hour to teach medical students.

Harvard Medical School will increase by millions of dollars a year its payments to doctors for teaching students, a recognition of how difficult it has become to persuade busy physicians to devote time to educating the next generation of care givers.

The medical school, Harvard University, and three major Harvard teaching hospitals -- Massachusetts General, Brigham and Women's, and Beth Israel Deaconess -- have agreed to double the funds for hospital-based instructors from $8 million to $16 million a year starting July 1.

There is wide variation in what the roughly 7,000 full-time instructors at Harvard Medical School are paid to teach the school's 771 students in classrooms, labs, and hospitals. Some are paid at well below going rates for doctors' services -- $30 an hour for some courses -- and many who provide on-the-job teaching at the hospitals are not paid at all. Under the new plan, the goal is to pay doctors $100 an hour to teach. The amount is comparable to the hourly rate that a typical primary care doctor earns, though far less than what some surgeons and other specialists make.

Medical school faculty are required to teach or volunteer on committees 50 hours a year, but Harvard does not track how many hours doctors teach and does not actively enforce the policy.

'The pressures of clinical practice make it harder for faculty to free up their time for teaching,' said Cynthia Walker, executive dean for administration at the medical school. 'Now it will be easier for them.'

'It's the single biggest problem facing virtually every course director,' said David Cardozo, a neurobiology professor who headed a medical school task force created to study the problem. Cardozo is course director for the study of the human nervous system that students take during their second year. As in most Harvard Medical School courses, the students are divided into small groups of six to 10, requiring about 50 teachers. The job pays $1,500 for 48 hours of work over eight weeks -- about $30 an hour. 'It's almost embarrassing for course directors to tell tutors and lab instructors what it pays,' Cardozo said.

Ha, and I bet that readers who are not in academic medicine actually thought that medical school faculty members were paid, probably quite well, to teach.

In fact, at many medical schools, hospital-based faculty are not paid much, if at all, specifically for teaching. At Harvard, as noted above, up to now medical school faculty who were paid at all to teach were paid at a rate lower than the hourly rate received by public school teachers. Many faculty are judged, instead, by how much "external" income they bring in, either by practicing medicine, for which the hospital, or medical school, or some other umbrella organization bills, or through grants and contracts, usually for research. Since there is often unrelenting pressure to see and bill more patients, or get more grants to "support one's salary," teaching, which is usually "required," but which the school often pays for little or not at all, gets short shrift.

We have posted before about the strange disparity between ever rising medical school tuition (at Harvard, currently $37,200/year) and how little medical schools actually spend on teaching clinical medicine.

What has been going on at most schools seems oddly in conflict with the fundamental mission of the institutions. One would think that the primary mission of a medical school is to teach. Therefore, a medical school ought to invest a reasonable amount in the people who do the teaching.

What is going on here? Where does the tuition money go? Why do the private schools have endowments, and the state supported schools get state support, if not to teach? (Yes, I know that academic medical centers have important patient care missions, and often important research missions, but they are called academic medical centers for a reason, aren't they?)

This has been going on for so long, at least for 20 years, that only a few people in academic medicine recognizes the absurdity of the current situation. We need to start thinking about where these emperors' clothes have gone.