'Full-time' faculty: an evolving construct?
Institutions throughout the United States and elsewhere are struggling with the economic pressures of healthcare delivery and education. While there was a time when it was possible to provide substantial support to medical schools through excess income from physician faculty, such heady days are gone in most places. Recently, most academic institutions in the United States have responded to such pressures by trying to minimize or eliminate the role of volunteer faculty in order to maximize the practice plan's market share, influencing clinicians to either leave universities or become full-time, salaried employees. Although this strategy has worked at some institutions, it has resulted in "red ink" for more than a few practice plans, particularly in some of the nonsurgical disciplines. Moreover, it has forced many experienced clinicians and teachers to abandon institutions whose reputations they helped establish, often taking their patients and prestige with them. This situation naturally leads one to wonder whether there is a sensible alternative to the current trend toward "full-time or no-time" academic practice.
One solution may be a shift back toward the model that worked so well throughout the first three-quarters of the 20th century. Many of us over 50, and most otolaryngologists over 70, were trained by dedicated clinical teachers and scientists who were committed to resident and medical student education, who amassed an impressive record of advances in the field, and who did all their teaching on a volunteer or "geographic full-time" basis. Most paid no "dean's tax," but they also charged institutions little or nothing. They were responsible for their own economic success or failure and never generated any red ink for an institution. While changes in the economics of private practice have made this model a bit more challenging, the trend toward minimizing or abandoning its potential contribution to academic programs does not seem to be the most sensible solution. It is time for us to reassess the structure of our academic faculties (not just in otolaryngology, but in all fields) and to reconsider models that combine full-time, salaried clinical and research faculty (perhaps in somewhat smaller numbers) more effectively with volunteer faculty whose academic status and title are determined by their academic performance, not by the source of their income.
In these days of limited resources, it makes little sense to squander clinical and academic expertise that used to be incorporated into our educational programs at little or no cost to academic institutions. It was the model that got us where we are. While the pendulum may never swing back to a complete dependence on this model (and probably should not), it is time to consider whether the pendulum has swung too far toward the other extreme and to open our minds and our institutions to a structure that incorporates the best of both approaches to medical education.
(1.) Sataloff RT. The academic practice of otolaryngology: Philosophical and practical perspectives. Ann Otol Rhinol Laryngol, 2006;115:403-7.
ROBERT THAYER SATALOFF, MD, DMA
EAR, NOSE & THROAT JOURNAL
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|Author:||Sataloff, Robert Thayer|
|Publication:||Ear, Nose and Throat Journal|
|Date:||Sep 1, 2006|
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