In an article called “The precipitous decline of academic
medicine in the United States" from the American Academy of Clinical Psychiatrists by Richard
Balon, MD and Mary K. Morreale, MD, the authors describe how the profiteering currently
infecting medical treatment in this country is also in the process of
destroying medical education.
Some of what they wrote:
“Structural problems in academic medicine
exist within all parts of its tripartite mission: education, clinical care, and
research. With clinical care, there are tedious requirements for documentation
in difficult-to-navigate electronic medical record systems, demands on
productivity in the form of ever-increasing [office visits], and senseless
demands from managed-care organizations. All of these clinical demands reduce
the time for teaching, which, ironically, university deans expect us
instructors to increase. Similarly, education has been increasingly regulated
by what has been referred to as the ‘medical-education industrial complex.’
Regulatory agencies have introduced changes with possibly negative consequences
and no evident benefit.
“Academic research—at least in psychiatry—has
been experiencing an ‘intellectual crisis,’ leading to the conclusion that ‘evidence-based
medicine does not appear to provide an adequate scientific background for
challenges of clinical practice in psychiatry and needs to be integrated with
clinical judgment.’ And despite the glow that research funding brings to
investigators and administrators, the sad fact is that, for the institution,
research is a money loser.
“Due to the pandemic, in anticipation of a
loss of $350 million, Johns Hopkins ‘imposed a hiring freeze, canceled all
raises, and warned about impending furloughs and layoffs….’…[despite] Johns
Hopkins had $10 billion in assets and a $6 billion endowment …Leadership
compensation at Johns Hopkins is similar to the business world, with the
university’s president earning $1.6 million in salary and an additional $1.1 million
in deferred and other types of compensation.
“In Michigan... the CEO of the
William Beaumont Health system affiliated with Oakland University had a total
compensation of $5.9 million in 2018, with a base salary of $1.85 million, a
bonus of $1.6 million, deferred compensation of $1.66 million, and $810,000 in
other compensation.”
And here I thought that this had only happened at the medical
school I worked at, the University of Tennessee in Memphis. When I first
started there as psychiatry residency training director in 1992, the faculty
practice group called UTMG was a delight to work with. The administrators
worked for the doctors. We were told that we had to bring in 160% of the UTMG
portion of our annual salary in patient care activities. The department was
flush with cash, with a million dollar reserve for research and other
academic activities. Faculty could earn extra money by seeing extra patients,
keeping a percentage of every additional dollar they brought in.
The psychiatric emergency room at the public hospital, run by
our department, was a model. We also trained police to deal with mental illness
through the formation of what was called a Crisis Intervention Team, which was copied by
several police departments throughout the rest of the country. Police became experts at
de-escalating conflicts and apprehending the seriously mentally ill safely,
transporting them to the Psych ER for evaluation. (Does this sound like
something that might help the police regain public trust in today’s atmosphere?
I think so).
Meanwhile pressure was building to install managed care models,
especially after Medicaid in Tennessee
was changed into Tenncare, which called for the formation of several HMO’s to provide treatment.
UTMG decided that they wanted to form one, which they called TLC. Having experienced
managed care in California, I warned everybody what might happen, but no one
would listen. One child psychiatrist thought managed care was a good idea and
advocated for it.
Before long, the doctors were working for the administrators
instead of the other way around. Top administrators were paid over a million
dollars apiece. The department’s reserves suddenly disappeared. UTMG drained
the Psych ER of funds until it had to close. The child psychiatrist who
advocated for managed care had his own pet project, a day care center for
teens, destroyed. Faculty members were told they had to keep working any extra
hours that they had been working – but without any of the extra pay they had
been getting! Faculty members were also suddenly told they were “losing money” for
the organization, even though they were bringing in the same amounts they had
been, and even though the state - not UTMG - was paying for the faculty’s office rent and
the cost of their phone system!
