Friday, March 09, 2007

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.


Anonymous said...

This from a university ranked number one in endowments with $25.9B, yes billion, in endowments and one of the most aggressively managed, and best performing, funds in the financial industry.

You should also get a look at some of the fee schedules. Harvard Law has to be making money on it's summer CLE courses given the price structure.

Steve Lucas

MsMelody said...

With the author's permission, I offer two paragraphs from the book entitled "Too Profitable to Cure" which further address current shortcomings of our medical schools:

The government allows the pharmaceutical corporations to put money into all facets of our educational institutions—teaching, research and outreach programs. Although these schools are tax-supported entities, their opinions and recommendations are no longer impartial. The reason and truth we once expected from these institutions have been corrupted by the influx of corporate dollars. The medical care that each of us receives is influenced by corporate dollars. Professors who teach future doctors, while at the same time doing applied and basic research, have been coerced into studying disease maintenance rather than searching for cures. The rarified air of academia has implanted in the psyche of some professors/doctors that they are infallibly unbiased; some of these poor souls even believe they have attained sainthood. In reality, no matter how great the contributions by academics, the pharmaceutical corporations interfere and compromise their good works. Cures do not improve the “bottom line” for the medical community or for the pharmaceuticals.

Pharmaceutical corporations work assiduously to entice prestigious schools and respected doctors/researchers to work cooperatively with them. These doctors/scientists are depended upon to provide credibility for sponsored research, to publish and/or peer-review findings that are providential for the corporation, and to provide support for medical recommendations that are beneficial for the corporations. At the same time, the greedy pharmaceutical elitists are filling young medical minds with corporate propaganda, and instilling in them attitudes of ego and entitlement.

Anonymous said...

From a layperson's perspective I have always wondered why Harvard's teaching faculty has not been paid more. I think they should further use some of their large endowment to help struggling physicians pay off large tuition debt. The winners in the end will always be the patients.

Anonymous said...

$30 an hour is $60,000 a year.

I am sure some schoolteachers make this much, but it's a pretty robust salary.

It's what an Assistant Professor of psychology would make at a research-1 university, for instance.

Sure they should increase these payments, but I also never fail to be impressed by the degree of greed displayed by those who enter the medical profession.

MsMelody said...

My niece recently accepted her first job as a "real" doctor, after additional training in a highly specialized area. I never understood her complaint when as a resident, she told me "at least I'll get paid a little bit this year."

Of course, when niece had finished this year's training with merely "pittance pay," ($40-50K)she told me her first real job came with a salary ten times that much, as well as a generous time-off package . . . for every two months she works, she "earns" a month of leisure.

One commenter above referenced "struggling physicians" with humongous loans to pay off. My niece has big loans, too, but with her now-generous salary, she isn't too worried about low-interest loans; those can be paid off over time. In the meantime, all the bells-and-whistles (new cars, new home, extended vacations) that she had to sacrifice during her medical school days are at the top of her to-do list.

Greed AND entitlement seem to be two of the lessons many doctors learn exceedingly well in their pre-practice education.

Roy M. Poses MD said...

Take a look at this post for more information on hourly pay of US primary care doctors and US public school teachers:

One issue is that there is quite a disparity in the remuneration of primary care physicians, and other "cognitive" physicians, on one hand, and physicians who perform procedures on the other. Some sub-specialized "proceduralists" do make amazing amounts of money.

In the US, this disparity has been driven by how Medicare reimburses physicians.

But, as noted in my post above, the typical primary care physician earns about $150 K/ year, for a typical work-week of 61 hours (for an academic physician) for about 46 weeks a year. In my town, the medican salary for public high-school teachers if $65 - 69 K/year, for a mandated work-week of less than 35 hours, and for about 36 weeks a year. In both cases, the hourly rate works about to $50 - 60. But that is still a lot more than Harvard (and many other medical schools) pay its faculty specifically to teach.

. said...

Thank you Dr. Poses for gathering so much relevant information about a topic that is SO relevant to my life.
As an associate professor in the psychiatry department in a large, research funded university, I can say that most of the MDs and PHDs LOVE to teach. BUT THERE IS ZERO, NO money towards your FTE if you teach. Only the residency directors.. get any money. EVEN the K and T training grants from NIH and NIMH and NIDDK, do not allow you pay for mentoring time. So we sign on to RO1s and K awards for FREE to mentor more SENIOR faculty members. How is this fair?

So on top of having a salary lower than in private practice, people who want to be of service in public "charity" type teaching hospitals get penalized for wanting to teach. Because if they DO teach, they lose valuable journal article AND grant writing time.

Taking the risk of being totally pedantic to this audience, these papers and grants ARE ALL THAT MATTER to climb the ladder to higher ranks and more $.

The powers that be have 2 answers for me: 1) COST SHARING.. we will see how it turns out when docs have to work 100 hr weeks to justify this concept; 2) Changing people who LIKE to teach to a new track - CLINICAL-TEACHING track , instead of the REGULAR RESEARCH professor track. Now you instantly create a class of "2nd class" MDs. The later seems to be working... It FORCES our teaching staff to publish peer reviewed articles AND curriculum. THIS IS INSANE. These folks have to see a full load of patients, train medical students, residents, attend tons of meaningless administrative meetings. ON TOP of this they are EXPECTED TO TEACH FOR FREE.

I was discourage from teaching high level statistics for psychiatric health service researchers, in favor of doing data analyses for grants and contracts.

On a very sad note, we have lost many important attendings to private practice, Canada, and other non-teaching hospitals because the pressure is just too great and the hours are just too long... and patients are so very sick.

Thanks again for the AWESOME blog and the great collection of people you have collected.

It is my sincere intention, that blogs like this uncover the true injustice of taking souls like myself who want to work with disadvantaged people (or in my case data) and do not pay them to teach, AND DISCOURAGE teaching in favor of getting pharma and government funding for meaningless, efficacy or effectiveness studies on more white middle class people.

Anonymous said...

good points by all. however i do agree that many mds seem to think they have a god-given right to 200,000 a year in salary. many phds work for 50-60-70k and carry six figures in student loan debt...and they wrote a dissertation so they actually KNOW research!

go to a psychology or counseling program in a university and try to find sympathy for the plight of these doctors- you may have to look pretty hard....