Clinical Pediatrics

2 downloads 12250 Views 239KB Size Report
Nov 28, 2014 - Email Alerts: ... Here is what one Ivy League division chief e-mailed me: My chair and ... Why does it take a business plan to show what you are ...
Clinical Pediatrics http://cpj.sagepub.com/

How Academia Is Failing Academic Faculty Victor C. Strasburger CLIN PEDIATR published online 27 November 2014 DOI: 10.1177/0009922814561355 The online version of this article can be found at: http://cpj.sagepub.com/content/early/2014/11/27/0009922814561355

Published by: http://www.sagepublications.com

Additional services and information for Clinical Pediatrics can be found at: Email Alerts: http://cpj.sagepub.com/cgi/alerts Subscriptions: http://cpj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav

>> OnlineFirst Version of Record - Nov 27, 2014 What is This?

Downloaded from cpj.sagepub.com by guest on November 28, 2014

561355

research-article2014

CPJXXX10.1177/0009922814561355Clinical PediatricsStrasburger

Commentary

How Academia Is Failing Academic Faculty

Clinical Pediatrics 1­–2 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0009922814561355 cpj.sagepub.com

Victor C. Strasburger, MD1 proposal for support of the teaching we are required to do for the (clerkship) did not qualify by their estimation!

Not everything that counts can be counted and not everything that can be counted counts. —Albert Einstein

Increasingly, academic medical centers are starting to look—and treat their faculty—like big businesses. Only the “bottom line” matters; in other words, “Show me the money.” The idea that perhaps originated at Harvard but has now spread to many other medical schools as well is that faculty need to buy out their free time if they want to do research, scholarly activities, or even teach. To me, that seems supremely un-academic and even hypocritical: Don’t medical schools exist to foster research, scholarship, and teaching? It is not really free time anyway, is it? Faculty need time to be productive. Old-time academics may claim that faculty can do that early in the morning, late at night, or on weekends; but with today’s high-stress, RVU-obsessed academic workplace, that seems highly unrealistic. Perhaps “free time” should be called “productive time.” But who should pay for it? My answer: medical schools themselves. Pediatricians in academic medical centers take a significant pay cut when they choose an academic career over a private practice career. They do that because they enjoy teaching or want to do research or want to stay in the kind of constant learning environment that they experienced as interns and residents. I am not saying that one job setting is superior to the other, but the financial realities are that private practitioners earn substantially more money than most academics (in Pediatrics, anyway). Two recent surveys show the discrepancy: The 2012 Medscape survey has academic faculty lagging $30 000 a year behind private practitioners1; a 2011 Careers in Medicine survey puts the media salary for an academic assistant professor at $140 000 and associate/full professors at $170 000 while private practitioners average $192 000.2 Here is what one Ivy League division chief e-mailed me:

Do departments and divisions need to be fiscally responsible? Absolutely, no one is suggesting otherwise. But academic faculty should not have to pay to teach— that is part of their job, and they should be paid appropriately to do it. I am not suggesting unlimited time to do uncompensated research or scholarly activity, but a certain amount would seem to be both necessary and reasonable—say 30%. It might vary depending on seniority and on productivity, but if faculty are going to be required to publish and acquire a national reputation, they obviously need time to do it. They also need resources. You want to run your medical school department like a business? Then provide faculty with the necessary support to succeed—secretarial support, grant-writing support, travel money to network and present abstracts and talks at national conferences. Most businesses are very clear about both their expectations of workers and exactly what support they will give their workers for them to succeed. Academic medical centers seem to want the entire final product from faculty without willing to give them any raw materials to work with. Academic medical centers could do far more than what they are currently doing to make academic faculty’s lives easier (and more productive): 1. RVUs should be a starting point, not a yardstick. The system is far from perfect, and over-rates for procedure-based specialties and under-rates for cognitive work. How else can you explain why a general pediatrician averages a much higher salary than a board-certified adolescent medicine specialist according to AAMC data?3

1

University of New Mexico, Albuquerque, NM, USA

My chair and his vice chair for finance have had a new plan of requiring us all to account for 100% of our time with either clinical revenue or grants. . . . It is all about RVUs . . . the department no longer supports educational/scholarly work, unless it is a highly specialized program, and my

Corresponding Author: Victor C. Strasburger, University of New Mexico School of Medicine, MSC 10 5590, 1 University of New Mexico, Albuquerque, NM 87131, USA. Email: [email protected]

Downloaded from cpj.sagepub.com by guest on November 28, 2014

2

Clinical Pediatrics 2. How many administrators does it take to run a department? The proliferation of administrators at many departments has gotten out of control. Worse yet, they are not held to the same strict scrutiny as faculty are. In our department, for example, faculty are reviewed annually by their division chief or the Chair; but administrators are not reviewed by the faculty whom they are supposedly serving. In addition, new administrators are hired easily, seemingly at the whim of the Chair; new faculty hires require many different hurdles to overcome. 3. Why does it take a business plan to show what you are worth? The new currency of academic departments seems to be the business plan. You cannot hire new faculty without one, and you cannot even demonstrate your own value to the department if you do not have one. But should not there be other criteria besides money? I recently interviewed at an Eastern medical school that desperately needs a director of adolescent medicine because of Residency Review Committee requirements but declined to offer me a job because I could not guarantee that I would bring in $250 000 annually in revenue.

What would it take to overhaul the way academic Pediatric departments currently operate?4,5 1. The business model should be modified. We do not pay public school teachers according to how many students they teach, why should we pay academic faculty according to how many patients they see or how much revenue they generate? You would think quality of care—and quality of teaching and of research/scholarship—would matter far more. If it were up to me, all Pediatric faculty would be paid the same at each professorial and experience level, with adjustments for on-call and similar factors. Does an intensivist really “deserve” to be paid more than a general pediatrician? (Similarly, does an internist really deserve to be paid more than a pediatrician?) 2. Hiring new administrators should require the same sort of documentation of need as hiring new faculty.

3. Academic faculty need new ways of being recognized and rewarded. Currently, there are really only 2 ways that faculty can be rewarded—salary and promotion. Academic salaries are lower than practice salaries, and those of us who work in state medical schools are subject to the slings and arrows of state legislatures. Promotion can only occur twice. Big business has a multitude of ways of recognizing its workers, from promotions and salaries to paid trips, additional office space and secretarial support, annual bonuses, and so on. If academia wants to function like big business, let it come up with the same positive reinforcement schemes. 4. Academic faculty need to speak up! All too often, faculty seem afraid to contradict their Chairman, or the Dean. “You have to go along to get along” seems to be the watchword in many institutions. But the very foundation of academia should be “question everything—nothing is sacred.” Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.

References 1.  WebMD. 2012 Physician compensation report. http://www. medscape.com/features/slideshow/compensation/2012/ pediatrics. Accessed October 15, 2014. 2.  ShortWhiteCoats.com. The ultimate guide to physician salaries. http://shortwhitecoats.com/2012/the-ultimate-guideto-physician-salaries. Accessed October 15, 2014. 3. Association of American Medical Colleges. Report on Medical School Faculty Salaries 2012-2013. Washington, DC: Association of American Medical Colleges; 2014. 4.  Strasburger VC. Momma, don’t let your babies grow up to be academics! Clin Pediatr (Phila). 2000;39: 167-168. 5. Strasburger VC. Momma, don’t let your babies grow up to be academics! The sequel. Clin Pediatr (Phila). 2013;52:387-388.

Downloaded from cpj.sagepub.com by guest on November 28, 2014