School of Medicine maneuvers shifting academic winds
As the “dean of the faculty” of the School of Medicine, advised and supported by the committees of the Faculty Senate, the dean’s staff, and the academic administrators including the chairs and center and institute directors, I get a lot of input, and a good deal of advice.
On an average day, I respond to about100 e-mails, take/make 10-15 phone calls, and attend five-plus meetings. And I have just acquired an i-phone so that I can stay “plugged in” to MCG 24/7/365.
I meet faculty during their recruitment into the departments of the school, and I do exit interviews when faculty leave us (14 in 2006-07). I am invited, and always accept, invitations to participate in faculty retreats in the departments (such as medicine, neurosurgery, anesthesiology, radiology, etc.). And I have held 38 regular meetings and two retreats for the chairs, center and institute directors.
Former faculty, alumnae and alumna of MCG School of Medicine, are an important constituency and sounding board, who bring their passion for MCG to the fore on a variety of issues and topics. The SOM Alumni Association has hosted me in cities all across this state, and their hospitality is as great as their love for their alma mater.
Membership is up to an all-time high, reflecting the efforts of our recruiters, our SOM Alumni Association President Alan Kaplan, and the growth of interest in MCG affairs among our 8,000 living alums.
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What do we talk about? There are plenty of “hot button” issues:
*Are we ready for LCME accreditation? *Is our Clinical and Translational Science Award proposal with our partners, Medical University of South Carolina and University of South Carolina, competitive? * What is happening to government and hospital funding of graduate medical education residencies? * Will the state fund Trauma Care at Level 1 centers? * Why are faculty leaving academic medicine in greater numbers these days? (68% of clinical departmentshave open junior faculty slots = 2,097; 52% of departments have positions they cannot fill). * Is student debt reaching $100K too high, and is student tuition of only $15K too low?
I don’t have all the answers.
The answers to many of these questions remain significant works-in-progress. They await their future-day solutions, solutions informed by faculty dialogue, consultative input and public discourse. Of note, the +/- very same “hot button” list exists at almost every medical school across the country. But Augusta and MCG bring their own history and flavor to the solutions.
MCG School of Medicine celebrates its 180th birthday in 2008. There will be some firsts, despite that long history and glorious legacy:
* New Chair Investiture Ceremony (Nov. 13, 2007) * New published bi-annual reports (Winter/Summer)
Big plans to ponder. And lots of strategies and ‘strategery’ to render into reality.
At the Association of American Medical Colleges (AAMC) meeting last week in Washington, D.C. (not Ga.), AAMC President Dr. Darryl Kirch, former dean of the school (1994-2000) made the following insightful pronouncement:
– “Culture eats strategy for lunch every day…”
I think he’s right. Because even the best conceived strategic plan can be trumped by entrenched cultural dissonance. Organizational gurus call this the prevailing “culture code”. The culture of an organization is often complex, as those of you who watch NBC’s “The Office” know.
Seriously speaking, culture is closely connected – hard wired – to organizational performance and group morale. |
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And culture-dominated organizations often find themselves in that state as a result of suboptimal organizational structures and related coping behaviors.
To boot, cultural norms in academic medicine are shifting like the Santa Ana winds – culture change – and changing the rules in mid-game, can be highly stressful, especially if you’re on the firing line.
Old academic medicine culture defined success as:
* THE RO1 principal investigator
* THE independent investigator
* THE clinical rainmaker
* A one-to-one physician-patient relationship
* THE first-authored paper for promotion
* THE expert in the field (expert-centered care)
* HAVING health-care insurance.
New academic medicine culture talks in different terms, such as:
* “Team” RO1’s
* Collaborative research
* Multidisciplinary clinics
* Physician extenders
* Mentoring others
* Patient-centeredness in continuity of care
* Closing ‘gaps’ in care, even for insured patients.
So, if these old and new cultures clash, resulting in general distress and individual dislocation, is anyone to blame?
It is a known fact, that when left alone, hamsters die. They thrive when two or more are left in a cage together. It is also a factthat when forced together on an island, wolves will kill each other.
Some faculty are like hamsters, while other are like wolves. How best can we coexist – we hamsters and we wolves – in our cages and on our islands? Are we better off together, or apart?
Moving from the island to the cage, and vice versa, is called “cultural emigration”. And it takes faith, and some courage. And when it occurs, it can be fulfilling, even fun! It is possible, I think, to stay focused on excellence while traveling a different pathway. And it can be healthy, even liberating, to visualize a different future without being wistful about the past.
The future, the next 10 years, heck the next 180 years, will test and temper the organizational values and culture at academic medical centers across this country, and in this state. One problem can be stated as follows: “When food is short, people lose their table manners”… it’s the money that is short, and belt-tightening is uncomfortable.
Financial paradoxes already confronting us include:
* Individual job security versus group success (one M.D. versus one department/practice): Revenue Distribution Plan and other incentive plans
* No trust without transparency (a shared obligation, but can you handle the truth?): Mission-Based Management Advisory Committee
* Efficiencies gained from work of teams, results not found in the direct academic chain of command: Dr. Scott Lind’s leadership of the adult operating room re-organization project.
I was interested to read a recent Boston Globe headline (June 2007) about the retirement of the Harvard SOM dean, Joe Martin, after 10 years of service to that school. Joe, a neurologist, is one of my former McGill Medical School professors. The article was titled “Big Challenges Abound for Next Harvard Medical School Dean”. Hummm… Harvard… big challenges… hmmmm. Dr.Martin mentioned the following thoughts in no particular order:
“… (W)hether research can be … a more collaborative endeavor….”
“…That would be a culture change in how we do things…”
“…We got a planning grant…will be sending our (Clinical and Translational Science Award) application in this October….”
“… (S)kepticism … over whether Harvard and its hospitals could work together….”
“ There’s a deep-seated sense we’re divided here….”
“… (G)etting our education reform accomplished … was very symbolic of the importance Harvard places on medical education.”
“… (W)e now will face level (NIH) funding in terms of real dollars. This is a powerful negative incentive for young people who are planning their own careers.”
“ The (second big challenge) is the development of the (new) campus…question of just who goes to it….”
In Quebec, we say, “Le plus ca change, le plus ca reste quand meme.” Some things never change, but change is a constant.
I believe that MCG School of Medicine can change… adapt… and in doing so, can succeed.
We can swim to the island of the wolves, and squeeze into the hamster cage. We owe it to our students to successfully make this “cultural emigration.”
In doing so, we strengthen this school, our faculty, and the state that we serve.
Thank you
