Author + information
- Christopher M. O’Connor, MD, FACC, Editor-in-Chief, JACC: Heart Failure∗ ()
- ↵∗Address for correspondence:
Dr. Christopher M. O’Connor, Editor-in-Chief, JACC: Heart Failure, American College of Cardiology, Heart House, 2400 N Street NW, Washington, DC 20037.
In March, I attended the American College of Cardiology’s Annual Scientific Sessions in Chicago, Illinois. As usual, it was an excellent meeting; however, I was discouraged by the number of highly respected colleagues in cardiology who have become dismayed with the environment of academic cardiology. It is no surprise that the economic environment of health care has put enormous pressures on academic divisions, who try to pursue the trifold mission of outstanding clinical care, research, and education, while competing with other health systems whose only focus is on providing outstanding clinical care. It has become more and more difficult for academic medical centers to continue to take advantage (financially) of the clinical enterprise to support their research and education missions. The undergraduate institutions’ philanthropy cannot keep up with the complexities of medical centers in the ever changing competitive environment of value-based health care. A recent example includes the mandate to implement the electronic health record and a subsequent economic catastrophic event resulting in the near closing of a medical school hospital.
What are We Hearing Today in the Environment of Academic Medical Centers?
1. There are no longer discretionary dollars for protected research, education, and teaching. New faculty recruits are being asked to immediately commit to an 80% clinical load or arrive with significant funding at the time of hire or shortly thereafter; if unable to do so, they must revert to high-volume, high-intensity clinical activities.
2. The 50-50 model that we previously promoted, which resulted in significant advancements of clinical knowledge, is a nonviable model in most academic cardiology institutions. Leadership in academic medical centers continues to be challenged, fractured, and self-fulfilling. It is no longer the case that department heads are the primary leadership positions, similar to that of a state governor; consolidation of resources has put the power in the dean’s and chancellor's offices. Department chairs have become the new middle managers, and division chiefs have even less autonomy in the academic hierarchy.
3. The flexibility to change, innovate, and alter the course is much more difficult in the academic institutions.
4. The concept of tenure continues to reward individual behaviors and not team-oriented research.
What Observations Do We See?
There has been an efflux of highly talented individuals from academic medicine into independent academic organizations, industry, and government. The academic leader’s ability to retain highly talented and well-developed investigators appears to be diminishing as time passes. Only a few select centers are able to retain their most talented members and continue to get wealthier as they stockpile physician talent and promote innovation, research, and education. Those who have not adapted to the changing times continue to see an efflux of talent, resources, National Institutes of Health funding, industry dollars, and future trainees.
What Can We Do?
1. We need to be proactive in advocating toward new types of leaders. The traditional model of academic medicine has not changed in over 40 years! If we look at the business model for IBM today versus 40 years ago, we see a completely different model. If they had stayed on course with large frame computers and hardware they never would have survived.
2. Academic medical centers have dug in their heels to continue the traditional hierarchy: dean, chair, and division chief. Service lines that have tried to emerge have been attenuated or redirected. Yet, the top heart centers in the country have promoted the service line heart team approach, thereby reducing barriers, promoting innovation, fostering flexibility, enabling quick changes, and being nimble.
I am concerned about the future of academic cardiology divisions. We need to promote a new type of leadership at the level of the dean and chair within academic medicine. We need leadership that understands the changing environment, the changing requirements for medical students, trainees, post-graduate education, research funding, philanthropy, and team-based approaches. The old school of honor societies, individualism, and tenure no longer works. As a community of cardiologists, let us band together to promote and change academic cardiology divisions so that they can survive in the new health care era, and continue to train the next generation of heart failure investigators and clinicians.
- American College of Cardiology Foundation