William T. Mallon

How Do Medical Schools Use Measurement Systems To Track Faculty Activity and Productivity in Teaching

The authors describe their findings from a study that (1) identified 41 medical schools or medical school departments that used metric systems to quantify faculty activity and productivity in teaching and (2) analyzed the purposes and progress of those systems. Among the reasons articulated for developing these systems, the most common was to identify a “rational” method for distributing funds to departments. More generally, institutions wanted to emphasize the importance of the school’s educational mission. The schools varied in the types of information they tracked, ranging from a selective focus on medical school education to a comprehensive assessment of teaching activity and educational administration, committee work, and advising. Schools were almost evenly split between those that used a relative-value-unit method of tracking activity and those that used a contact-hour method. This study also identified six challenges that the institutions encountered with these metric systems: (1) the lack of a culture of data in management; (2) skepticism of faculty and chairs; (3) the misguided search for one perfect metric; (4) the expectation that a metric system will erase ambiguity regarding faculty teaching contributions; (5) the lack of, and difficulty with developing, measures of quality; and (6) the tendency to become overly complex. Because of the concern about the teaching mission at medical schools, the number of institutions developing educational metric systems will likely increase in the coming years. By documenting and accounting financially for teaching, medical schools can ensure that the educational mission is valued and appropriately supported.

The benefits and challenges of research centers and institutes in academic medicine: findings from six universities and their medical schools.

Purpose To understand the benefits and challenges of using centers and institutes in the academic research enterprise, and to explore institutional strategies that capitalize on the strengths and ameliorate the weaknesses of the center/institute structure. Method Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six institutions, which can produce extrapolations to, but not necessarily findings that are generalizable to, other institutions and settings. Results Centers and institutes offer a number of benefits to academic institutions. Centers can aid in faculty recruitment and retention, facilitate collaboration in research, secure research resources, offer a sense of community and promote continued learning, afford organizational flexibility, and focus on societal problems and raise funds. Despite their many benefits, centers can also create tensions and present management challenges to institutional leaders. Centers can compete with departments over resources, complicate faculty recruitment, contribute to a fragmented mission, resist effective evaluation, pose governance problems, and impede junior faculty development. Conclusions Institutional leaders might capitalize on the strengths of centers through three strategies: (1) reward leaders who embrace a collaborative point of view and develop a culture that frowns upon empire building; (2) distinguish among the many entities that share the “center” or “institute” labels; and (3) acknowledge that departments must maintain their place in the organizational milieu.

Tenure in Transition: Trends in Basic Science Faculty Appointment Policies at U.s. Medical Schools

This article—based on a 2002 survey of 125 U.S. allopathic medical schools, reviews of institutional policy documents, and interviews with medical school leaders—explores and analyzes three trends in appointment and tenure policies for basic science faculty at U.S. medical schools. First, the percentage of full-time, nontenure track basic science faculty has increased, from 12% in 1980 to 20% in 2000. More dramatically, by the late 1990s, the percentage of new basic science faculty hired on a nontenure track surpassed the percentage hired on a traditional tenure-track line. This development stems from the tendency of some schools to appoint faculty to nontenure-eligible “research scientists” faculty tracks, to hire junior faculty on 100% grant funding, and to allow nontenure-track faculty to switch to the tenure track as their research career progresses. The second trend is an alteration to the tenure financial guarantee. Historically, at most medical schools, it was assumed that tenure guaranteed total institutional salary for basic scientists. Schools have begun to redefine that commitment to less than full salary to protect against financial vulnerabilities and to provide a means to reduce faculty salaries, if warranted. The third trend is increased flexibility to pretenure policies. Schools have lengthened probationary periods, revised up-or-out provisions, instituted stopping-the-tenure-clock policies and less-than-full-time appointments, and permitted faculty to switch between the tenure and nontenure tracks. These policy modifications recognize the increased professional and personal demands on faculty time.

The alchemists: a case study of a failed merger in academic medicine.

The changing environment in health care delivery and reimbursement in the United States in the late 1980s and 1990s caused a massive overhaul in the organizational structure of health care institutions. Hospital mergers were commonplace. Physician practices were bought and sold. Once stand-alone institutions developed integrated delivery systems. The academic medical community investigated and pursued a number of strategies to address changes in the marketplace, including streamlining and reengineering business practices; centralizing and integrating operations and decision making; creating separate clinical enterprises; creating new public authorities or nonprofit corporations to govern hospitals; building networks of providers; and acquiring physician practices. Perhaps the most hyped strategy was consolidation. In 1997, Pennsylvania State University’s Hershey Medical Center and Geisinger Health System in Danville, Pennsylvania, announced plans to merge into one large clinical enterprise. The merger unwound three years later. Based on extensive interviews and document analysis, this case study examines six aspects of the merger and de-merger between Pennsylvania State University and Geisinger: (1) the environment and historical context that preceded the merger; (2) the reasons for the merger; (3) the structure of the merged system; (4) the outcomes for the new organization; (5) the reasons for the dissolution; and (6) the lessons learned from this series of events.

Research centers and institutes in U.S. medical schools: a descriptive analysis.

Research centers and institutes are a common mechanism to organize and facilitate biomedical research at medical schools and universities. The authors report the results of a study on the size, scope, and range of activities of 604 research centers and institutes at research-intensive U.S. medical schools and their parent universities. Centers and institutes with primary missions of patient care, education, or outreach were not included. The findings indicate that, in addition to research, centers and institutes are involved in a range of activities, including education, service, and technology transfer. The centers and institutes the authors studied were more interdisciplinary than those included in previous studies on this topic. Most research centers and institutes did not have authority comparable to academic departments. Only 22% of centers directly appointed faculty members, and most center directors reported to a medical school dean or a department chair. A small group of centers and institutes (“power centers”), however, reported to a university president or provost, and may have considerable power and influence in academic decision making and resource allocation. Two main types of centers and institutes emerge from this research. The first type, which includes the vast of majority of centers, is modest in its scope and marginal in its influence. The second type—with greater amounts of funding, larger staffs, and direct access to institutional decisionmakers—may have a more significant role in the organization and governance of the medical school and university and in the ways that researchers interact within and across academic divisions.

The financial management of research centers and institutes at U.S. medical schools: findings from six institutions.

Purpose To explore three questions surrounding the financial management of research centers and institutes at U.S. medical schools: How do medical schools allocate institutional funds to centers and institutes? How and by whom are those decisions made? What are the implications of these decision-making models on the future of the academic biomedical research enterprise? Method Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six medical schools, which can produce extrapolations to, but not necessarily generalizable findings to, other institutions and settings. Results An examination of four dimensions of financial decision-making—funding timing, process, structure, and culture—produces two essential models of how medical schools approach the financial management of research centers. In the first, a “charity” model, center directors make hat-in-hand appeals directly to the dean, the result of which may depend on individual negotiation skills and personal relationships. In the second, a “planned-giving” model, the process for obtaining and renewing funds is institutionalized, agreed upon, and monitored. Conclusions The ways in which deans, administrators, department chairs, and center directors attend to, decide upon, and carry out financial decisions can influence how people throughout the medical school think about interdisciplinary and collaborative activities marshaled though centers and institutes.

Have First-time Medical School Deans Been Serving Longer Than We Thought? A 50-year Analysis

Purpose To describe the lengths of service of deans at accredited U.S. MD-granting medical schools from academic years 1959 to 2008 and to determine whether the median length of service of deans changed over time. Method The authors used the database of the Council of Deans of the Association of American Medical Colleges to seek data, from July 1, 1959 to June 30, 2009, on lengths of service of 842 deans and interim deans at all 125 accredited U.S. MD-granting medical schools existing in 2007. All but 8 schools verified their data, which included the date of the beginning of service, the date of the end of service, and whether the individual served in a permanent or interim capacity. Results Across five-year cohorts of the first-time deans and interim deans studied, the median length of service was 4.4 years. When the authors excluded individuals who were interim deans exclusively and focused the analysis on the 639 persons who were “permanent” deans, the median length of service was 6.0 years across five-year cohorts. Analysis of one-year cohorts of deans showed similar results (median = 6.1 years), although the medians for six of the seven most recent one-year cohorts ranged from 5.0 to 5.7 years. Conclusions Through cohort analysis, the median length of service of permanent medical school deans was longer than that found in previous studies, and it has remained relatively stable.

The impact of centers and institutes on faculty life: findings from a study of basic science and internal medicine faculty at research-intensive medical schools.

Purpose To examine the impact of organized research centers on faculty productivity and work life for basic science and internal medicine faculty at research-intensive medical schools. Method In 2005, the authors administered a questionnaire to a random stratified sample of full-time faculty in basic science and internal medicine departments at the top 40 research-intensive U.S. medical schools. The survey instrument asked faculty about the extent of their involvement in centers and institutes, the direction and extent of their activities, and their satisfaction with various dimensions of work. Results A total of 778 faculty members completed the questionnaire (72.0%). Basic science faculty with center affiliations produced more research publications and grants while devoting comparable effort to teaching as their non-center-affiliated peers. These faculty reported greater dissatisfaction in workload and in the mix of their activities. Internal medicine MD center-affiliated faculty were more productive in research activities and spent less effort in patient care and more effort in research than their non-center-affiliated peers. These faculty were more satisfied with promotion, opportunities for research, and the pace of their professional advancement. Conclusions Findings indicate that faculty from different departments and with different ranks and backgrounds interact with centers and institutes in multiple ways. For basic science faculty, center involvement appears to be an addition to, not a substitute for, their usual departmental obligations. For internal medicine MD faculty, center involvement appears to serve as an opportunity for protected effort in research away from the demands of clinical practice.

Introduction: The History and Legacy of Mission-Based Management

To understand mission-based management, we must be cognizant of history: a time before managed care and cost containment and cost-sharing. Medical schools and teaching hospitals enjoyed heady days in the decades after the rise of the National Institutes of Health and the creation of the national Medicare and Medicaid programs when their successful expansion was fueled by ample and growing revenues. A strong medical school was defined as a conglomerate of strong and everexpanding departments, which meant that institutional leaders need not pay great attention to cost-effectiveness or efficiency.