Arguments presented by Dr. Loriaux (pro position)
Dr. Loriaux supports the implementation of a clinical professor track. The SoM P+T guidelines have not evolved in step with the evolution of the academic medical center over time. The guidelines were based on the premise that all faculty members were clinicians, taught, and were involved in research, and one's academic integrity was based on how well one did in those three areas. Three events changed this equation:
1) The National Institute of Health
The NIH budget in 1947 was $8 million, and it reached a $1 billion in 1966 and increased geometrically in the 1980s. This is money that built Seattle, UCSF, UCLA, and academic medical centers throughout the nation. The end result was that there were more scientists than teaching to do and little or no practice. Careers were built on the quantity and quality of their research. Many of these academic medical centers had a research track.
2) End of the draft
With the end of the draft, MDs moved into different areas and subspecialties.
3) Medicare Legislation of 1965
Between 1965 and 2002, Medicare has infused $257 billion directly into the medical equation. This was a windfall for academic medical centers because they were now paid for caring for elderly and poor patients. The more doctors you had, the more money you made. The end result was that were more doctors than teaching to do. Doctors were no longer interested in research and unfunded scholarships. Private academic centers strengthened their affiliated clinics. Examples of these are the Kelsey-Seybold Clinic, Duke Diagnostic, Lahey Clinic and the Mayo Clinic. These doctors admitted their patients to the academic medical centers. They were faculty members on the clinical track and promotion was based on the quality and quantity of their practice. These clinical professors were not second class citizens. Many were revered physicians in their community.
OHSU does not have an affiliated clinic, we have a closed faculty. We need to implement a clinical track to strengthen our ability to increase clinical revenue. We have to hire our faculty but we cannot attract people if we do not provide a career path that allows them to do research and write scholarly papers. We end up with young doctors who come here only to move on to better jobs in the community.
In today's academic medical center, the unit of academic integrity is in the division, department or the institution, not the individual. The department has to balance the need for clinicians, scientists and teachers so we need three tracks. We need a clinical, research and traditional track. Every track will have its own set of benchmarks so people know what they need to do to get promoted. If we diminish these tracks, we diminish our ability to compete and survive as an institution. It is imperative that we have a career track for clinicians that only do clinical work.
Arguments presented by Dr. Fields (con position)
Dr. Fields argued against the implementation of a clinical professor track. He emphasized the positive affect the single track system has had on our institution. He has been here for nineteen years and served on the P+T committee for six years and has watched us deal with the fact that all of us have different job descriptions. The P+T committee has demonstrated its ability to deal with different job descriptions and give people a career. As a professor of family medicine, one of the most clinically intense departments in the School, it is his job to help faculty members be successful in an academic institution. Dr. Fields outlined three reasons for a single track system:
1) Cultural
Culturally, we are a unified faculty with a single mission. When we implement a two track system, we will become a two class system. All we need to do is look to the north and south in Washington and California.
2) Financial
We are at the cutting edge of a translational research environment. In order to have true translational research, we have to go from the bench to the bedside. We need researchers at the bedside who are clinicians. If we do not have an incentive to participate in research, it is unlikely that clinicians will participate in the translational agenda as we would like to see. This will put our success at obtaining research grants at risk.
3) Legal
We are at a legal impasse. Stark III requires an academic exemption for there to be 8 hours per week of some sort of scholarly performance. It can be teaching or scholarship but it must be documented. If we remove that incentive from the P+T system, we will be putting ourselves at risk in regards to compliance.
If we continue with the single track system, we continue huge success we have seen over the past decade.
Rebuttals
Dr. Loriaux
Dr. Loriaux countered by stating that the P+T process can become arbitrary and that it would be better if we rigidified the promotional criteria. Teaching holds this institution together so everyone will have plenty opportunity to teach in both the clinical and research tracks.
Dr. Fields
In order to be successful in an academic institution, we are required to be successful and productive as clinicians, researchers, and educators. The issue of a two track system is a two class system issue. You just have to read the policy to see that there is a professorial track and then there is the clinical and research track. There is a research track but fortunately for the educational programs and services needs of the institution it is rarely used so it is not necessary to create a clinician track.
