The Cri$i$ in academic medicine

Many believe that academic medicine is failing to meet all of its responsibilities and is in crisis. We interviewed a number of distinguished academicians and, while they held different views, found agreement that academic medical centers in the USA have gradually changed during the past half century from small, cloistered, scholarly institutions to large, complex, corporate-style organizations. These changes were fueled by large contributions of funds for research and great research accomplishments. However, these institutions seem to have insatiable needs for more money, which refocuses institutional culture, making them behave more like business corporations. The result is very high tuitions, enormous student debt burdens, and pressure on young academicians to become self-supporting more quickly. Almost all non-compensated activities, especially teaching, suffer. Since clinical care pays an increasing portion of school operating revenue, those who teach and do research are under increasing pressure to provide more clinical care, to see more patients per unit of time and do more procedures, resulting in fatigue, less time for teaching and research, and less gratification for doctors and patients. Attention to community needs and providing help to academic medicine in less developed nations are very low priorities. Academic medicine appears on the surface to be vigorous and healthy but is at risk of imploding. The heads of academic centers, working together, must be charged to create plans to restore a healthy culture.