I Am A Dinosaur

I Am A Dinosaur

By

Leonard Zwelling

My long-time boss Dr. Margaret Kripke always reminded me to leave the party while you’re still having fun. Not only did she say it, she did it. She retired from her position as Chief Academic Officer totally successful and still enjoying her job. But it was time for her to do other things on her terms.

I wasn’t as clever and had to be pushed out as a vice president and eventually as a faculty member, although I did leave a year ahead of the date I needed to so that I too could do something on my terms.

It’s a real skill to know when you are still useful to your organization and to others and when your time is up. Any time I get the idea that I still have more academic life in me, I look in the mirror and know that my time is up and that in fact, my kind is largely extinct. What do I mean?

As both a clinician and a scientist I harbored certain values that are less valued today than they were previously. But more importantly, the entire mindset of what academic medicine is has changed over the past forty years and operating according to the way I was taught would ill-serve me now.

I could never walk out of the hospital with an ill patient in my care simply because my time to work has been declared over by a clock. The one thing that did not affect what I did for my patients was the clock. New residency rules have changed this and today’s young physicians are more than able to provide care on the clock and go home when a specific hour is reached passing care off to a hospitalist or colleague. This simply was not done when I trained, but that is ancient history.

I was also taught of the vital role of basic science in the care of patients, especially in the development of new ways to detect, treat, and prevent malignancies. This seems less of an imperative now as the major research on new therapeutics seems to come from the pharmaceutical industry or from the drug industry’s affiliation with specific academic labs rather than be a benefactor of academia as a whole.

There is also a new leadership in medicine eschewing the dominance of the faculty in institutional decisions and viewing these faculty as just another group of employees where equality transcends status and the unique contribution of the faculty is not valued above that of any other worker in the academic center.

When I was young, chiefs of medicine were demi-gods ruling over the academic center. Today they are as likely to be managers of training programs with assorted chancellors and presidents ruling the roost.

This probably all took hold in the 1990s with the advent of managed care and the shrinking of clinical revenue streams making alternative revenue streams from intellectual property more critical and donations ever more crucial.

Academic physicians are probably paid more than they ever have been in the past. The differential between the income of someone in private practice and someone in academia has shrunk. But the values of those academics may have been altered in the transition.

Over the years I have come to realize that the precision, exactitude and discipline instilled in me during my training has been supplanted with a new set of values by a new generation of doctors. We old-timers were not better than they, just different. It seems good clinical care can still be had, but that the influence of science in the practice of medicine may be diminishing as basic scientists drift further from the bedside.

Of course, I could be wrong about all of this and academic medicine could be in a great place. New drugs are pouring out of the labs and what can be done with imaging today is nothing short of amazing.

Medicine has advanced and certainly left me in the dust or more likely in the La Brea tar pits of medical science.

I’m a dinosaur now, but don’t rue the changes in academia. After all, just like you, my life still depends on the progress being made in universities and cancer centers everywhere. It’s just a new dawn.