Abstract
The academic mission (education, research, publication, and patient care) in today’s era of corporate domination is in danger. The problems stem from several issues: (1) cost-effectiveness has become the prime goal for many institutions, reducing clinical spending; (2) hospitals, and especially university hospitals, are costly, mainly because they are high-technology and multidisciplinary enterprises, and reimbursement has declined.
With respect to their teaching mission, the financial constraints and obligations discourage hospitalists from traditional academic pursuits. Moreover, recent reductions in resident training hours and an increasing demand to provide safe and 24-h coverage have altered the traditional role of teachers. Last, working hour restrictions have widened the knowledge gap separating what should be known and what is known and so have intensified the teaching burden on academics.
Teaching and good teachers are costly, and without adequate funding and dedicated faculty time, in or outside the operating room, the quality of the formation of future academics is imperiled.
Lengthy operations and high-tech techniques not only cost more money but take time away from other academic activities. Teaching in the operating room takes more time and costs more. Most countries and faculties are poorly organized with regard to teaching, research, and publishing activities. Solutions have to be found but most likely require a new mind-set for both the academic physicians and the administration. We owe this to our profession and to our patients.
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Zelenock GB, Zambricki CS. The health care crisis. Impact on surgery in the community. Hospital Setting Arch Surg. 2001;136:585–91.
Zelenock GB, Stanley JC, More RA, et al. Differential clinical workloads among faculty at a major academic health center. Ann Surg. 1997;226:336–47.
Money J. Merger scuttled between OU Medical Center and St Anthony parent. Oklahoman. March 6, 2017. http://newsok.com/article/5540555. Accessed 11 June 2018.
Koperna T. How long do we need teaching in the operating room? The true costs of achieving surgical routine. Langenbeck’s Arch Surg. 2004;389:204–8.
Harington DT, Roy GD, Ryder BA, Miner TJ, Richardson P, Cioffi WG. A time-cost analysis of teaching a laparoscopic entero-enterostomy. J Surg Edu. 2007;64:342–5.
Babineau TJ, Becker J, Gibbons G, Sentovich S, Hess D, Robertson S, Stone M. The “cost” of operative training for surgical residents. Arch Surg. 2004;139:366–70.
Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, Jain A, Wexner S. Converted laparoscopic colorectal surgery a meta-analysis. Surg Endosc. 2001;15:827–32.
Balser J, Lee TH. The danger and opportunity of leading a hospital interview NEJM Catalyst. August 7, 2017. https://catalyst.nejm.org/leading-academic-medical-center/. Accessed 11 June 2018.
University of California San Francisco Mission statement. https://www.ucsf.edu/sites/default/files/legacy_files/LRDP-Appendices-C.pdf. Consulted online March 2018.
Keswani SG, Moles CM, Morowitz M, Zeh H, Kuo JS, Levine MH, Cheng LS, Hackam DJ, Ahuja N, Goldstein AM, Basic Science Committee of the Society of University Surgeons. The future of basic science in academic surgery: identifying barriers to success for surgeon-scientists. Ann Surg. 2017;265:1053–9.
Ko CY, Whang EE, Longmire WP Jr, McFadden DW. Improving the surgeon’s participation in research: is it a problem of training or priority? J Surg Res. 2000;91:5–8.
Narahari AK, Mehaffey JH, Hawkins RB, Charles EJ, Baderdinni PK, Chandrabhatla AS, Kocan JW, Jones RS, Upchurch GR, Kron IL, Kern JA, Ailawadi G. Surgeon scientists are disproportionately affected by declining NIH funding rates. J Am Coll Surg. 2018;226:474–81.
Campbell EG, Weissman JS, Moy E, Blumenthal D. Status of clinical research in Academic Health Centers views from the research leadership. JAMA. 2001;286:800–6.
Ioannidis JPA. Defending biomedical science in an era of threatened funding. JAMA. 2017;317(24):2483–4.
Katz IT, Wright AA. Scientific drought, golden eggs, and global leadership—why Trump’s NIH funding cuts would be a disaster. N Engl J Med. 2017;376:1701–4.
Laret MR. Academic medicine in the 21st century. JAMA Intern Med. 2013;173:1739–41. https://doi.org/10.1001/jamainternmed.2013.7763.
Medical services in Tokyo area in danger of collapsing. Japan Times, Sept 21, 2015.
Hauptman PJ, Bookman RJ, Heinig S. Advancing the research mission in a time of mergers and acquisitions. JAMA. 2017;318:1321–2.
Schein M, Farndon JR, Fingerhut A. Why should a surgeon publish? Br J Surg. 2000;87:3–5.
Kron IL. Getting promoted. J Thorac Cardiovasc Surg. 2001;121:S17–8.
Fingerhut A, Lacaine F. Critical appraisal: an essential skill for all surgeons. Surg Innov. 2017:1–2. https://doi.org/10.1177/1553350617690311.
Galea S, Saltz R. Funding, Institutional conflicts of interest, and schools of public health realities and solutions. JAMA. 2017;317:17 1735–6.
Moses H, Matheson DHM, Cairns-Smith S, George BP, Palisch C, Dorsey R. The anatomy of medical research US and international comparisons. JAMA. 2015;313(2):174–89. https://doi.org/10.1001/jama.2014.15939.
Stimpson JP, Li T, Shiyanbola OO, Jacobson JJ. Financial sustainability of academic health centers: identifying challenges and strategic responses. Acad Med. 2014;89:853–7.
Goldman L. The academic health care system: preserving the missions as the paradigm shifts. JAMA. 1995;273:1549–52.
Jones RS, Debas HT. Research: a vital component of optimal patient care in the United States. Ann Surg. 2004;240:573–7.
Murphy B. Meeting the challenge of the academic mission: 3 strategies to improve efficiency in academic hospitals’ ORs. Becker’s Hospital Review, February 21st, 2017. Retrieved from: https://www.beckershospitalreview.com/hospital-management-administration/meeting-the-challenge-of-the-academic-mission-3-strategies-to-improve-efficiency-in-academic-hospitals-ors.html.
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Fingerhut, A., Latifi, R. (2019). Academic Mission of the New Hospital: More Than Just the Bottom Line. In: Latifi, R. (eds) The Modern Hospital. Springer, Cham. https://doi.org/10.1007/978-3-030-01394-3_5
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DOI: https://doi.org/10.1007/978-3-030-01394-3_5
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