Emory's New President and the Idea of a University
Thomas G. Long, Bandy Professor of Preaching

Practical Matters
Rebecca Stone-Miller, Associate Professor of Art History and Faculty Curator

Economic Challenges and the Art of Education
Geoffrey Broocker, Walthour Delaperriere Professor of Ophthalmology

A Fresh Perspective for Perennial Problems
David Carr, Charles Howard Candler Professor of Philosophy

Teaching versus Research: Does It Have to Be That Way?
Lucas Carpenter, Charles Howard Candler Professor of English, Oxford College

Becoming a Top-Tier Research University
Lawrence W. Barsalou, Winship Distinguished Research Professor of Psychology, and Elaine Walker, Samuel Candler Dobbs Professor of Psychology and Neuroscience

Ethics, Diversity, and Teaching
David B. Gowler, Pierce Professor of Religion, Oxford College

A More Positive University
Corey L.M. Keyes, Associate Professor of Sociology

Advice from the Lighter Side
Vicki Powers, Asssociate Professor of Mathematics and Computer Science

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The September issue of the Academic Exchange served as a welcome and an admonition for our new president. These poignant and pointed discussions of university life omitted many of School of Medicine’s specific tribulations. In the spirit of continuing the debate raised in that issue, I offer some observations on potential impediments to the future of the medical school.

The School of Medicine has come a long way under the leadership of Michael Johns, the executive vice president for health affairs, and Tom Lawley, the dean of the School of Medicine, since I arrived here in 1997. There has been a general focus on fiscal responsibility, targeted acquisitions, and multiple high-profile hirings, as well as an increase in grant funding, an improvement in national rankings, and strategic partnerships. Organization has been streamlined and goals met, but work remains to be done with which our new president may help.

1. Grady Hospital – While my colleagues work hard and show outstanding commitment to this hospital, the reality is that a collision of forces including billings, collections, and reimbursement trends are making it nearly impossible to have financially solvent operations at Grady. Grady’s professional and expense budgets provide funding to the School of Medicine. The dean of the medical school then provides operating funds to the school’s academic departments. The Grady clinical finances are separate from the finances of the hospital or clinic. Thus, if Grady fails to deliver, the academic departments suffer, while the Emory Hospital and the Emory Clinic are relatively spared. This burden cripples the relatively smaller budgets of the academic departments. It hurts recruitment opportunities and ongoing academic development. If the university continues to provide uncompensated service to Grady patients, then it might be wiser to equalize the burden across the hospitals, clinic, and university to prevent catastrophic budgetary problems in the academic departments. Alternatively, the university might consider a revised mix of services provided.

2. Brains vs. Buildings – For the last decade or so, the university has been on a building spree. We have or will have a new hospital in Midtown, new campuses on Clairmont and in Druid Hills, several new science buildings, a new cancer center, a new pediatrics building, and so on. These buildings were all needed. The Research at Emory Commission has suggested that it is time to match that commitment to hardscaping with an equal commitment to filling these buildings with top-notch, supported faculty. Such a commitment will take a shift in priorities from buildings to brains.

3. The Clinician/Scientist – The faculty are responsible for most of the academic output of a university. They must teach, research, and serve the institution. In the case of the clinician/scientist, service means seeing patients. As reimbursement margins have thinned, medicine has become a volume-centered enterprise, requiring each doctor to see more patients to make the same amount of money. As the faculty time is limited, the result is the demands on the clinician/scientist have increased. The demands on time are not unique to any group of faculty, but what is different is that the institution provides no salary support for a clinician/scientist. This level of support also affects the teaching mission. The medical school Dean’s Clinical Investigator program addresses this to some degree, but it is hardly enough if we want this type of faculty member.

4. The Graduate School – While we have a Graduate Division of Biological and Biomedical Sciences, it controls no faculty salaries and therefore is relatively uninfluential. The Research at Emory Commission is proposing to change that by empowering a vice provost overseeing the arts and sciences, with real salary lines to support the teaching mission. It is hoped that negotiations in hirings between the newly empowered dean and the other deans would provide sharper focus to the priorities in both teaching and research. Whatever plan comes out, now the resources are held in departments and the science and teaching are done by programs. This separation is probably not optimal.

5. Priorities – The medical school is engaged now in a strategic planning process, but many of its partners and divisions still lack clear plans for the future. We cannot be good at everything, and we do not have the money for it. Therefore, setting priorities will be important at all levels. More important still will be sticking to these priorities. For example, early plans for the new Joseph P. Whitehead Research Building were for it to house a series of interdisciplinary groups, uniting scientifically related groups in one place. Instead, the space allocation followed standard academic division lines. In part, I think this occurred because of pressure to allow more room for current investigators who were squeezed into their previous spaces. In the future, for the faculty to work at peak efficiency, such plans will need to be made, clearly articulated, supported with appropriate finances, and followed to fruition.

6. Bigger is better – Several studies show an inverse correlation of clinical volume and scientific productivity. On the other hand, while it is true that Emory Healthcare receives revenue from tuition, indirect cost recovery from grants and contracts, endowment income, and gifts, as well as clinical income, the hospitals and clinic receive revenue virtually alone from clinical income. So a heavy emphasis has been placed on capturing as large a market share as possible in order to make the academic medical center as a whole fiscally sound. Consequently, the faculty end up caught in the midst of a feud over irreconcilable priorities. While the right answer to this problem is unknown and we should credit Dr. Johns and his team for keeping us financially afloat, it may be time to reflect on the bigger-is-better effect on academics and retention of faculty. As clinician/scientists have less and less time, their science goes unattended so their patients will not. As their jobs become more similar to those in the private sector, physicians leave for the better pay. It might be reasonable to consider a different balance of clinical and academic work. Do we really need to compete directly with private hospitals and doctors, or can we have a unique market position that marries clinical skill with academic achievement? Can we really be as efficient at three chores as a private practice with one goal? Do we need to be full service, despite some programs never turning a profit? The argument for retention of services is often for the teaching mission, but many schools have sent students to well-trained community doctors for rotations when their schools have not offered something. Maybe we should think of science as an advertising budget and a way of achieving market position.

7. The Administration – The administration is here to provide the means and to empower the faculty and students to achieve their best. Too frequently in the press of regulation and paperwork, the main goals of a university are forgotten. Creating a risk and reward structure for the administration that recognizes the essential nature of the job but links it to academic productivity, which after all is why a university exists, may help clear some of the fog.

8. The Clinic – As the clinical right hand of the university, the Emory Clinic serves the public. In its ranks is an outstanding, hard-working, dedicated group of clinicians. To meet its mission, the clinic demands time from the faculty, however. This time is precious, and it needs to be considered. This is the same time needed to do research and to teach. The clinic (as well as Emory Hospital and Crawford Long Hospital) does pay money to the dean in the form of an academic enrichment fund. Perhaps these payments ought to represent the true cost of a faculty member’s time—or maybe the clinic should explicitly endorse research as one of its missions and fund it at a level comparable to that which the university does. The separate clinic administration makes setting and maintaining academic goals harder. This firewall is a hindrance to coordination of academic activity, and a more porous divide would likely enhance the university mission.

9. Emory College – Emory College and the School of Medicine seem to live in parallel universes. The college thinks the medical school has hoards of money and has sold out its academic integrity to get more. The medical school thinks the college faculty have it made with guaranteed salaries. The reality is that all faculty feel under stress and less supported than they would like. The faculty share many more commonalities than we have differences. Emory is relatively unique in that it has a medical school right next to its college. A closer union of these institutions will not result in destruction of the character of either and will enhance the mission of both.

10. Funding – When we invest in the stock market, most of us buy several stocks or a mutual fund to distribute the risk. We have not applied the same approach to our endowment, however. For practical reasons, it may be unrealistic to divest too much Coke stock, but there are other sources of untapped revenue that need to be mined. According to the preliminary draft of the Research at Emory Commission report, Emory lags behind its peers (such as the University of Chicago, Columbia Duke, and Georgetown) in bringing in unrestricted dollars to its annual fund that could be applied directly to the educational and general budget. Emory’s annual fund averages less than five million dollars annually, while other programs typically bring in millions more. This needs to be addressed. Another issue that needs to be addressed is openness of finances. While it may be that the endowment is finite and tough decisions need to be made, until the facts are laid out for all to see, skepticism will abound. The cynicism that comes from skepticism will detract from the mission.