Wednesday, April 09, 2008

University of Arizona Medical College Faculty Reported on "the Verge of Desperation"

We have posted before (here and here) about how medical schools, despite their name, often fail to pay or otherwise reward faculty to actually teach.

We also noted that one US medical school dean was frank enough to admit that his institution most values faculty members who are "taxpayers," i.e., those who bring in large amounts of what is euphemistically called "external support." On the other hand, faculty who are "welfare recipients," that is, those whose work fails to bring in such support, have at best a "tenuous" position. Since teaching in medical schools almost never brings in substantial "external support," faculty who spend most of their time teaching may be in a "tenuous" position. Similarly, faculty who do research that may not be popular with current research sponsors (now mainly pharmaceutical, biotech, and device companies) may also be in a "tenous" position.

Just recently, the (Tucson) Arizona Daily Star reported on the current situation at the University of Arizona College of Medicine in terms that should be familiar.

Widespread turmoil causing extremely low morale within the University of Arizona College of Medicine 'could destroy the fabric of the college,' says a new report on the situation.

The problems plaguing the medical college have pushed many of the UA's top senior physicians and scientists to the verge of desperation,' said UA faculty Chair Wanda Howell.

The report, which cites 'considerable unrest, demoralization and loss of focus on mission' at the UA medical college, will be presented today at a meeting of the UA Faculty Senate.

What is so greatly demoralizing the faculty?

At the crux of the crisis, according to the report, is the amount of time UA doctors must give to their clinical practices, in order to generate profits, at the sacrifice of academic research and teaching, the report stated.

'As a university medical college, we are supposed to pay more than lip service to research,' Howell said. 'But the doctors are so burdened by their clinical duties, there is absolutely no time for research.'

'This has put many faculty members (teaching physicians) on the verge of desperation.'

In particular,

'After investing 10 hours a day in clinical duties (patient care), they did not understand how they could provide high-quality teaching and build a competitive research program.'

So here is another example of medical school faculty, whose titles imply that they are supposed to teach and conduct other academic pursuits as their main responsibility, instead are expected to "support" their work with "external funds," in this case, derived from their own clinical practice. This leaves them with no time to actually act like faculty.

What is the point of having medical school "faculty" who aren't paid and have no time to teach?

Faculty at no other professional schools would tolerate this. Has anyone ever heard of law, engineering, architecture, accounting, business school faculty who are supposed to "support" their entire salaries by working full-time in their field (or bringing in huge research grants)?

So why are medical faculty supposed to do so?

And what sort of medical education will be provided by faculty who spend 10 hours a day bringing in money for their institutions instead of teaching?

As I wrote before, the call to "show me the money" is mission-hostile management, writ large, of some of our most important, and heretofore revered academic medical institutions.The continuance of such mission-hostile management may yet doom these institutions.


Anonymous said...

Faculty at no other professional schools would tolerate this. Has anyone ever heard of law, engineering, architecture, accounting, business school faculty who are supposed to "support" their entire salaries by working full-time in their field (or bringing in huge research grants)?

Because other professions are not the "suckers for punishment" that doctors are.

I have 2 observations:

1. Doctors deserve what they get, for they do not stand up for their own profession. They have been emasculated.

2. Patients deserve what they will get (that is, substandard care delivered by the lowest-cost supplicants and mediocre "care extenders") because they are happy that "those high paid, easy-street doctors" are "gettin' what's comin' to them" and are having their noses ground into the dirt. (While the healthcare "suits" who sit at a desk all day are raking in millions, no less.)

Sorry to be so candid, but this is the ugly truth.

Anonymous said...


You are so correct. I would suspect that Hippocrates 101 has been supplanted with MedEcon 101. Frankly, there is never a black-or-white model. But the bad news gets the "press" which has resulted in tarnishing the reputation of the profession.

Personally, I would probably be among those who say "they are getting what they deserve." From a patient perspective--who has long yearned for these professionals to speak FOR their patients, not merely TO their patients--I have wondered how long it would take for them to wake up. In speaking up for themselves, they might also speak for voiceless, powerless patients. If they wait too long, however, they may lose their voice.


Anonymous said...

I recommend Buying in or Selling out? by Donald G. Stein.

This an excellent book regarding the issue of commercialization in academia. He and several authors (including Marcia Angell) from a variety of backgrounds review the purported benefits and risks of ever-increasing commercialization in academia.

Originating in college sports in the mid-19th century external for-profit entities have progressively infiltrated, and clashed with the ethos characteristic of, the academy.

The currency of conflict used to be personal and institutional reputation. It still is today but in addition that currency is now monetary. I think most would agree that when direct profit drives things it tends to do so with greater force.

It's one thing to have a colleague, who is arrogant, pedantic and has a large ego, with an over-sized influence on policy, research directions, etc. (where the latter characteristics are perceived to be unjustly driving things). It is quite another to substitute the dollar as the source for injustice. I guess for some there is no difference. I also suspect that such individuals also might completely accept the notion that "speech and money" are equivalent.