Realigning the Values of Academic Health Centers

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Abstract
As a market economy continues to permeate U.S. health care, fiscal accountability imposed by purchasers of medical services will reduce funds for medical education and will heighten the scrutiny of that activity. The authors propose that U.S. academic health centers must respond to these changes in the health care environment by critically examining their culture and values. This process will call for a reorientation of their values to place clinical education at the center of the academic enterprise. The authors challenge the notion that research- and publications-oriented faculty are the best group to train optimally effective clinical practitioners. They argue that although faculty promotion and rank in American medical schools are highly correlated with publications and funded research, there is no body of evidence that shows that fecundity in research or publications is essential for faculty to be excellent medical educators. The authors maintain that the main tool for realigning the fundamental values of academic health centers will be a new form of faculty management by the medical leadership. After outlining the current approach to research, teaching, clinical service, and administration at academic health centers, the authors challenge the traditional view that a faculty member should master all of these four elements, and state that the era of the “quadruple-threat” faculty member is passing. What can emerge is an emphasis on departments' and institutions' becoming “quadruple threats,” which can occur only if institutions' leaders become better managers of their individual faculty members' priorities. Similarly, chairs should be selected, trained, and evaluated on the basis of not only their professional skills but also on their abilities to be effective administrators and managers. The ultimate goal is to better match the skills of individual faculty with the complex and evolving missions of academic health centers.

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