Low Morale Is the Symptom,
Not the Problem. Just Ask the Spouses
(With special thanks to a friend of long-standing)
For at least 2 years, through 4 individual surveys of faculty
psyche, the party line has been that there is a problem with faculty morale. I
disagree. Low morale, as measured by these various surveys, is no more a
problem than is fever in clinical medicine. It’s a symptom. You can lyse a
fever with Tylenol or aspirin, without knowing its cause. That does not lead
necessarily to a healthy patient. Sure, it’s important to treat symptoms such
as fever, pain, and nausea, but treating these symptoms does not get to the
problem. I believe this is true with low faculty morale as well.
So what is causing this low morale which by now is
indisputably a part of the MD Anderson culture?
First, this is not unique to MD Anderson. It’s just new
here. Most academic centers are in the throes of a crisis of confidence and
have been for several years. NIH grant money is disappearing. Clinical
reimbursements are shrinking and administrators of patient care facilities are
trying to make up for the decreased unit profit with volume to the exhausted
exasperation of the clinical faculty.
Second, the proliferation of regulations from meaningful use
to HIPAA is killing most doctors’ days. Protocols and consent documents are
growing in length to the point where no layperson could possibly understand to
what they are signing on when they enter a clinical study. The FDA’s demands of
pharma, the primary sponsor of clinical research, is stifling and costly. EMRs
are eating into days and patient-physician eye contact as well.
Third, committee and administrative work at academic
institutions is not letting up, yet the rewards for participation are minimal.
I was feeling that as a VP in 2007 and as the IACUC chair in 2012. I am
confident it has only gotten worse as time demands on faculty have gone up and
the benefits of committee service have gone down.
But more than anything else, it is the lack of personal time that is leading to
low morale. Personal time and personal fear.
American physicians, including academic physicians, are
probably the most well paid doctors in the history of the world. Their incomes
are many standard deviations above society’s mean and far above the rest of the academic world. Furthermore, as conflict of interest rules are relaxed, despite
the jeopardy with which this flirts, the opportunities for income enhancement
only grow for “thought leaders.” What is their morale problem?
The problem is that in the pursuit of money to pay for
larger houses, nicer cars and more prestigious private schools for their
children, the faculty members of academic institutions have traded the money
for time. Just ask the spouses.
There is always one more patient to see, one more grant to
write or one more paper to review. There’s another family dinner, Little League
game or school concert to miss. Even though the use of computers allows some of
work to be done at home, the attention of the faculty member is still diverted
from his or her family to the work and the spouses are growing weary. That the
faculty member is irritable and beaten up doesn’t help.
That brings us to fear. How many more faculty forums will
need to be run by Dr. DePinho and his crew at which there are no meaningful
questions and the smattering of DePinho apologists’ comments are tolerated from
false “faculty leaders.” I call them false because they are designated as
leaders not by their colleagues but by Dr. DePinho as a part of the DePinho
Loyalty Program. Everyone else in the room is afraid to say anything for fear
that he or she might vanish the following day like a Division Head in the
Low morale is a symptom. It is no more diagnostic of the
problem than a renal biopsy usually is once the glomerular filtration rate is
below 5% of normal. It’s likely to reveal dead kidney without revealing the
The cause of the trouble at Anderson is something new
because Anderson was always able to withstand outside forces by the sheer will
of its faculty and the clinical excellence of its care. Those days are over.
Reality bites and it bites on Holcombe as ruthlessly as it does in New York and
Los Angeles. To preserve the greatness of MD Anderson will require the most
steady of hands on the tiller and the most magnanimous, ethical and benevolent
of leaders. This crew ain’t it.
Low morale is a symptom, nothing more. To eradicate the
symptom, eradicate the cause.