My Mistake, Their Mistake

By

Leonard Zwelling

            After
another in what has become an interminable series of dull Faculty Senate
meetings, I conversed with an old and trusted member of the clinical faculty. I
listened carefully to the complaints I was hearing. What ran through my mind
were two questions: what’s really being said and what can be done about it?

            I
could attribute the sad state of faculty morale as exemplified in my colleague’s
anger to a host of causes from the constant drive by the executives for greater
clinical revenues to the mindless overspending on new recruits and lunar
initiatives when grant money is so hard to get and the current productive
faculty could use a little of that presidential largesse. I don’t think either
unfocused revenue pushes or profligate spending and excessive costs really gets
to the heart of the problem that my friend of many years was discussing.

            I
wondered: are we no longer the leaders in salary and benefits? I don’t know
whether our faculty members take surveys of how they are doing with respect to
the rest of the country, but Research Administration, the PRS and FAA have kept
up with AAMC standards since Dr. Kripke was CAO. I don’t think take home pay or
inadequate health insurance is troubling the faculty.

            Are
our facilities not keeping up? Are you kidding? We have probably over
constructed new research space given the tight nature of the NIH budget and the
more limited ability of clinical revenues to offset the fixed costs of air
conditioning the space we already have and are bringing on line.

            What
I heard was very, very simple and it reminded me of the message I used to hear
when I was a vice president and was screwing up by paying the message inadequate
attention. It always came down to this when dealing with the faculty:

            YOU
DIDN’T ASK US; YOU DIDN’T TELL US.

“            Yep,
what we have here is a failure to communicate.

            As
an institution we have grown to an immense size but consolidated real power in
the hands of fewer and fewer people. Right now the power to get anything done
really sits with DePinho, Dmitrovsky, Burke, Leach and Fontaine—period. (Don’t
talk to me about Vice Provosts. Clinical research and the oversight of research
infrastructure are still a mess despite those positions being filled by people
who should know what to do to fix things).

            The
Division Heads and Department Chairs have been functionally marginalized. While
committees of both continue to meet, more than anything they are TOLD what will
happen not asked about what should happen. In fact, I have had a Sr. VP
complain that the Division Heads are not “communicating what they are told”
sufficiently. Imagine training for 30 years to become a Division Head and being
expected to serve as a conduit of information for people for whom you work yet who
do not understand what you do. The equating of new patient and consult visits
with actual clinical productivity is but one foolish conclusion arrived at by
the Central Committee. My friend was complaining about seeing 3 new patients in
2 days but also over 20 in follow-up. Was that not productive enough? And by
the way what made anyone on the Central Committee think faculty members control
who comes to their clinics? The one group without control of clinic schedules,
coding, and billing is the faculty.

            “What,
only new patients and consults?”

            “Do
those others not count?”

            Apparently
not according to Mr. Fontaine. At a time when the use of surrogate markers in
clinical trials to determine the activity of new anticancer agents is being questioned,
we are using surrogate markers of clinical productivity to grade the faculty.
Not real consistent are we?

            If
the folks who run the place are going to insist on not knowing all that much
about what happens in the clinics (only Burke was ever a clinical provider
here), shouldn’t they be asking the real experts what they think is important
to use as metrics of clinical productivity?

            And
once the Central Committee actually listens to experts whom they are already
paying to determine what is really important to measure, shouldn’t they tell
everyone what they will consider important to encourage those people to fulfill
the Central Committee’s goals?

            As
for instances when all you can do is tell and not ask, often, as a VP, I had to
initiate new institutional regulations because the federal government made me.
HIPAA was the biggest. By the time of HIPAA I had learned to keep a standing
advisory committee of faculty and research support staff on the ready to ask
for their input and to make sure when the feds MADE us do something, I had communicated
it to one and all in every manner possible. I tried. I did not always succeed,
but at least I cared enough to try. And the most effective way was one
department at a time. No Faculty Senate Forums. No blast emails. Is that
time-consuming? Of course, but all politics is local and what better does the
Central Committee have to do?

            As
my friend of many years and I parted, I felt the deep frustration of someone
whose service here predated mine and, frankly, far more than I, has contributed
to the saving of hundreds of human lives. Which one of the Central Committee
has done that? Answer—NONE!

            Now
remind me again what we are here for and whether my friend or the Central
Committee is doing more to fulfill the mission.

            The
blog is taking a brief holiday as number one son Richard gets married in Mt.
Pleasant, PA.  I should be back
with you next week.  Have a good
weekend. By the next time I write you, I will be on Medicare.

            Is
this a great country or what?

Leonard Zwelling