Keepers of the Academic Mission: Calling All Faculty

Academic medical centers expand their patient care mission through mergers often with nonacademic health care organizations to create more clinical revenue and a larger financial margin with the intent of cross-subsidizing the academic mission. Ironically, an unintended consequence of governance changes implicit in such mergers is the marginalization of the academic mission. Historically, the education and research missions have been effectively cross-subsidized by the medical school dean from the margin derived from the faculty clinical practice plan. Yet, in many merged entities, the faculty practice is subsumed under the health system, where its margin no longer directly accrues to the school. Concurrent shifts in health system governance have removed clinical enterprise oversight from the dean and chairs, effectively assigning financial support of education and research to the health system where it competes with a strong appetite to grow the clinical enterprise. Likewise, faculty are conscripted to more clinical service rather than encouraged to engage in academic endeavors. Consequently, the vigor of the education and research missions has been compromised in academic health system mergers. This circumstance invites critical review of the fundamental concept of academic medical center mergers and their resulting unintended consequences for the academic mission and faculty well-being to inform the wisdom of continuing this trend. A unified cadre of university leaders, deans, and faculty are needed to advocate for greater reinvestment of the margin in teaching and research efforts. Concurrently, academic medicine must develop more academic physicians committed to the academic mission as leaders of health systems. Taken together, these actions can reinforce that funding the academic mission must be an obligation rather than an option for academic health systems. Nothing less than the future of academic medicine, the well-being of faculty and learners, and the health of the nation depends on it.