EDITORIAL

Mickey M. Karram

Current and future challenges facing academic medicine

Published online: 17 February 2006� International Urogynecology Journal 2006

These are very anxious times for academic medicalcenters. They are confronted by the challenges of man-aged care, decreases in reimbursement, restrictions onhouse staff working hours, heightened scrutiny of clini-cal research, declining federal support for medical edu-cation, and the growth of formidable competitors, suchas non-academic hospital chains and large groups ofpractitioners who attempt to provide high-margin ser-vices. Academic centers can no longer be complacentabout their financial health or their reputation as thebest places to receive care. Many of these institutionshave political clout and access to considerable privatewealth, but none of them can count on a bail-out fromgovernment or donors if they flounder. If we put thiscurrent state in perspective for the medical student orresident who is interested in an academic career, one canstart to see how the future of academic medicine maynot be one that nurtures and nourishes our best poten-tial academicians. Most academic centers still have amindset that if someone is in an academic setting theyare expected to work and be financially productive but,at the same time, perform scholarly activities in the formof research and the publication of manuscripts. What,unfortunately, happens in many situations is that themost productive people are penalized because others inthe department are not as productive and a significantamount of the money they generate must be dispersed toother divisions or other individuals. This has resulted ina mass exodus of skilled productive clinicians andresearchers who are moving out into the private sector.

Historically, policies that emanate from ‘‘Ivory Towers’’often have an adverse impact on the people in the fieldwho are bringing in revenues.

If we look specifically at the subspecialty of obstetricsand gynecology in the United States, it is easy toappreciate the impact of these previously mentionedchallenges. Currently, approximately 30 university-based programs are searching for a chairman. Thechairman of a department must, on a daily basis, wearmany hats that involve a good business background, anda good understanding of managing and dealing withpeople, on top of the traditional aspects of recruitingtop-notch division heads and maintaining productivityin both a clinical and research setting. In reality, at theend of the day, the current system is all about the bot-tom line.

A better system is immediately needed or the scientificproductivity of many of our fields in medicine is going tosuffer drastically. The mindset of academic centers needsto change. One should be rewarded, not punished, forone’s clinical and research productivity. In the words ofColin Powell, ‘‘Don’t be buffaloed by experts and elites.Experts often possess more data than judgement. Theelite can become so inbred that they produce hemo-philiacs who bleed to death as soon as they are nicked bythe real world’’. Physicians and surgeons, in academicmedicine, should not be paid sub-optimal salaries if theyare clinically productive and continue to pursue aca-demic achievements mostly on their own time and ex-pense.

M. M. KarramSeton Ctr, Advanced Gynecology and Obstetrics,Good Samaritan Hospital, 375 Dixmyth Avenue,Cincinnati, OH 45220-2489, USAE-mail: Mickey_Karram@trihealth.com

Int Urogynecol J (2006) 17: 203DOI 10.1007/s00192-006-1378-x