Last month, an abstract was presented at the Annual Conference on Research in Medical Education at the Annual Meeting of the Association of American Medical Colleges, in a session entitled "Your Career is More than Your Specialty." The citation would be: Pololi L, Ash A, Krupat E. Faculty Values in the Culture of Academic Medicine: Findings of a National Faculty Survey.
The authors described a large survey, of over 5000 faculty at 26 US nationally representative medical schools, done as part of the National Initiative on Gender, Culture, and Leadership in Medicine (known as C ‐ Change) project. The overall response rate was good (53%). Here are the striking results:
51% agreed that 'the administration is only interested in me for the revenue I generate'; 31%; that 'the culture of my institution discourages altruism'; 31%, that other people have taken credit for my work'; and 30% that 'I am reluctant to express my opinion for fear of negative consequences.' Half perceived that the institution does not value teaching and 27% that it does not reward clinical excellence; Over half disagreed with the statement that their own values are aligned with those of the institution. Also, 30% had seriously considered leaving academic medicine and 46% their own institution, both in the prior year.
These results show that US medical education is in moral crisis, and probably close to catastrophe. These results should provoke shame and outrage, and cause widespread discussion. On the other hand, it is remarkable that they were allowed to see the light of day at all, given the persistent strength of the anechoic effect. Pololi and colleagues obviously never got the message that one is never ever supposed to discuss such things in public.
Instead of being about discovery and dissemination of knowledge, the fundamental mission of education, a majority of large sample of faculty surveyed says American medical schools are about making money. Instead of putting teaching first, half of the faculty said their institutions explicitly do not value teaching. Instead of supporting free speech, free enquiry, and academic, a significant minority of faculty say that are afraid to speak out.
It is no wonder that nearly half of the faculty are considering leaving.
On Health Care Renewal, we have discussed evidence, mostly anecdotal, about the rot within the foundations of medicine and health care. (Note, posts on conflicts of interest, often affecting medical school faculty and leadership, are here; we have posted about how academic medicine has often allowed suppression and manipulation of research; posts on excessive compensation of health care executives, including those of academic institutions, not based on upholding the academic mission are here.) Now it appears that the rot is so severe that the whole edifice is about to fall down.
Our foolish transformation of the calling and profession of medicine into a business (see posts here and here) at a time when businesses were taken over by the arrogance, greed, unscrupulousness, and amorality that lead to the global financial collapse will surely also lead to a global health care collapse if something is not done very soon.
We need a new effort much bigger than but at least as influential as the Flexner Report to re-imagine academic medicine again as valuing teaching, learning, research and patient care, while regarding its financing only as the means to reach those ends.
The Carnegie Foundation sponsored the original Flexner Report, and the Rockefeller Foundation then hired Dr Flexner to reform medical education (see Mitka M. he Flexner Report at the century mark: a wake-up call for reforming medical education . JAMA 2010; 303(15):1465-1466. Link here.) Will anyone or any organization have the courage to sponsor a new, bigger, and likely much more contentious effort?
Meanwhile, the academic leaders who have personally profited from and colluded with the transformation of the system into one that is only in it for the money should resign. The few remaining leaders will need to draw upon all their honesty, integrity, knowledge, and determination to rebuild the system.
Finally, shame on all of us for letting us get to this place.
With apologies to the late Frank Zappa and the Mothers of Invention.
