Staying Power: Challenges in raculty recruitment and retention at Emory
B y Amy Benson Brown

"We are in danger of losing our most precious resource: our scholarly capital."
Sharon Strocchia, Associate Professor of History

Lost and found
The views of recently departed and recently arrived faculty

Keeping company,
O n spousal hiring

Why Faculty Come to Emory
By Daniel Teodorescu, Director of the Office of Research

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Academic Exchange (AE): How do you think the benefits cuts will affect recruitment and retention in the medical school?

Sam Dudley (SD): I think we’ll feel it less acutely for several reasons. Generally, the chief makes the decisions in medicine. Some chiefs may be more open than others, but there’s not the same concept of an inherent right of faculty to set policy.

Another reason is that we don’t all work for the university; we work for the hospital, the clinic, Crawford Long, the Veteran’s Administration, the cdc, etc. My own benefits, for example, didn’t change at all. Yet I’m upset because I believe in the dream of the university and the possibility of this one. And I think this action and the way it was enacted will harm the relationship between the faculty and the university.

AE: According to the American Association of Medical Colleges, about fifty percent of assistant professors in medicine leave before five years. Why?

SD: That national figure reflects the reality of the clinical world. To do science is hard business. The reward structure is much more delayed, and usually there is less direct compensation to the faculty member. Also, the peer review process for journal articles and grant applications can turn into competitor reviews that are often unconstructive.

There are some other fundamental struggles, like time. You’re told to do research; however, the opportunity cost of your time is very high. Currently, clinical faculty are expected to bring in 100 percent of their salary from external sources. This is a high bar that creates an expectation set that is inversely related to the university’s investment in the faculty member. It’s a vicious circle: the floor is lowered, but the bar is raised. The clinical operation, with its immediate rewards and pressure to increase volume, is in danger of becoming just a stepping-stone to private practice for many faculty whose jobs are becoming divorced from the academic enterprise.

AE: Why is the general climate in academic medicine now so difficult?

SD: There are many reasons, but one that affects my work has to do with requirements set by the Federal Center for Medicare/Medicaid Services. There’s now a series of documentation and physical presence requirements that faculty must follow. A faculty member now must be present more frequently when routine procedures are done and spend more time in documenting the outcome, frequently duplicating trainee notes. Some of this is reasonable to ensure quality training and patient care, but it also limits time for teaching and research.

The Balanced Budget Amendment has also made doing academic medicine more difficult. Medicare used to subsidize academic medical centers for the
cost of medical training. Now they’ve cut back, so we are forced to compete with Piedmont and Northside. Now, those guys spend all day taking care of patients.
I spend part of my day teaching and researching, so of course I’ll be less efficient at taking care of patients than they are. And in general, remuneration from all sources has been reduced. This means medicine is moving to a volume enterprise. By this I mean that doctors must see more patients to make the same amount of money. This has had the insidious effect of pitting the clinical enterprise against the academic one in competing for faculty time.

AE: Why do medical faculty stay?

SD: I think academic medical faculty members, just like any other academic person, stay because they believe in the dream. Perhaps it’s about this need for intellectual stimulation on many levels. Going to a play at the Theater Emory or
a Friday performance at the Carlos Museum or finding a history professor that you love to talk with. If we go to the outside world, the metric is money. I stay in academics because I’m hoping certain things are measured in ways other than money, and I’m willing to measure my reward structure in other ways. My reward structure is salary plus some other intangible parts, including working with bright students and being part of the process of discovery.

The relationship between the university and its faculty is really inherently different than between an employer and an employee in the workplace. It relies on this absolute feeling of trust and support, a symbiosis between the two. Unfortunately, right now there’s not very much set up in the university to tell people they’re doing ok. There’s much more set up to let them know when they do poorly. Ideally for retention, the university should give faculty an umbilical cord they’d be unwilling to cut. In many cases now, I get the sense that faculty feel when they achieve something that they’ve done it in spite of the university.