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THE FACULTY 2000 PROJECT

This Undertaking is Initiated and Organized by the Steering Committee of the Medical Faculty Senate and the Faculty – 2000 Steering Committee, and is Directed by the Leadership of the Medical Faculty Senate.

 

Prepared September, 1999
James C. Saunders, Ph.D.
Chair, Faculty – 2000 Project

TABLE OF CONTENTS

Section Page

I. Introduction

II. The Plan

III. Faculty – 2000 Organization

IV. Faculty – 2000 Mission Statement

V. The Role of Department Heads in the Faculty – 2000 Project and Operational Principles

VI. The Dean’s Faculty – 2000 Symposium

Symposium Schedule

VII. Administrative Assistants

VIII. E – Mail Communication

IX. Clinician Educator Track and Faculty Working Group
Working Group Membership

X. Tenure Track and Faculty Working Group

Working Group Membership

XI. Working Group on Issues of Concern to Faculty with Special Opportunities
Working Group Membership
XII. Senior Faculty Working Group
Working Group Membership

XIII. Medical Faculty Senate Leadership

XIV. Members of the 1999 – 2000 Medical Faculty Senate Steering Committee

XV. Members of Faculty – 2000 Steering Committee

XVI. "The Voice of the Faculty" By: Leon Eisenberg, M.D.


I. Introduction

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Beginning in late 1997, the Steering Committee of the Medical Faculty Senate began extensive discussions which have resulted in the Faculty – 2000 Project. A recurring theme emerged among committee members; namely the ability or lack thereof among the junior faculty in the Clinician Educator Track to fulfill the academic requirements for promotion. There were other criteria, of course, but the emphasis was on scholarship as it should be for an institution characterized by academic excellence like the University of Pennsylvania.

 

At the same time, the concept of "protected time", time dedicated to the pursuit of the scholarly output required for promotion, was undergoing significant revision. Protected time is a rather paradoxical term because the School does not have the financial resources to protect anyone’s time! The entire faculty in the Medical School must earn income (either from clinical activity or from grants) to support their salary. In more flush times, when surplus resources were available in departments, allocations could be made to some faculty to carve out time "protected" for scholarly activity. There never was, nor has there ever been, a sufficient institutional resource to guarantee time for scholarly or educational activity to all Clinician Educator faculty.

 

At the same time that promotion standards were at high levels, alarming decreases in health care reimbursement rates, fueled, in part, by the Balanced Budget Act of 1997, were beginning to impact on our clinical faculty. Also, the expanded University of Pennsylvania Health System and its network of hospitals and doctors were working well as a source of referrals. The increased referral base and our superb reputation for health care delivery created a substantial increase in the patient load at HUP.

 

A high promotion standard, falling reimbursement rates (with the resulting need to work more hours in clinical activities to maintain income), and a burgeoning patient load, increased the stress on all of our faculty, but particularly among the junior faculty. The interplay of these factors is very complex, and this crude attempt to capture the flavor of the problem touches only the surface, and likely misses many points. Nevertheless, the net result was that time for scholarly and educational activity was diminishing for many of the Clinician Educators, and this was placing their promotions in jeopardy.

 

In spite of these factors, it was difficult for the Medical Faculty Senate in 1997 and 1998 to identify any hard evidence that junior faculty were in trouble. There appeared to be a substantial jump in the number of "advisory" letters being sent out by the Committee on Appointments and Promotions (COAP) after the initial three- or six-year review of many Clinician Educators. Moreover, it was impossible to gain an idea of how many Assistant Professor appointments were not being renewed at the three- and six-year review intervals because they would not make the promotion hurdle. Nevertheless, there appeared to be a process of attrition occurring, the result of which was that only the strongest candidates were coming before the COAP. Yet anecdotal evidence was mounting for a substantial "bubble" of junior faculty moving through the system with an ever-decreasing likelihood of meeting promotion requirements.

 

Our junior Tenure Track faculty, whether M.D./Ph.D. or Ph.D. appointments, were not immune to the changes occurring in medicine either. The bar for their promotion was already set high. However, the complexity of modern biomedical research was taking its toll. Increasing competition for federal support, and the requirement for producing stellar scholarship, in sufficient quantity, with an identifiable impact, meant that otherwise talented investigators were facing severe problems in generating adequate credentials within the five-year probationary period prior to their promotion review.

 

These concerns were not exclusive to the junior faculty. Mid-level faculty were also encountering difficulty in achieving sufficient scholarly credentials for promotion to full professor because of the demands for clinical service. Lurking behind all of these matters were the "quality of life" issues. The more cynical members of the faculty noted that if they could just move their families into HUP quarters, things would be better!

 

Finally, to all this must be added the perception that the corporatization of the Health System was extending the concepts of management into academic lives. The issues of academic freedom were being quietly raised.

 

In fairness, the story was not all "doom and gloom." Throughout the late nineties, the magnitude of new construction and renovation throughout the School and System was spectacular, and the expansion of the Health System was successfully moving forward. Faculty largely felt that the management of the School was in good hands. Moreover, the national recognition of Penn as a Center of Excellence in the delivery of health care and the unprecedented rise in research support, left faculty with the sense of pride that they were part of one of the world’s best academic Medical Centers.

 

Nevertheless, when the focus returned to faculty issues, strong sentiment emerged in the Medical Faculty Senate Steering Committee that it was time for the faculty to stand up and have a voice in determining its future. The Steering Committee came to the conclusion that an examination of the faculty, in terms of its roles, missions, structure and organization, was needed to determine who we are and what we ought to look like to best achieve the academic mission. In addition, faculty should take on the job of identifying strategies and tactics that would assure the survival of their academic character. It was not clear, at first, how this could be accomplished, because, in large measure, faculty are ill-equipped to undertake such a venture.

 

As these issues emerged in Steering Committee discussions, they also appeared as growing themes in the monthly meetings between the Medical Faculty Senate Leadership and the Dean, and a plan slowly emerged. Obviously, a self-directed review by the faculty of themselves could not be undertaken without the concurrence of the Dean and the Department Chairs. A project of this magnitude required careful and extensive deliberations and planning. The Medical Faculty Senate leadership was particularly sensitive to the need to be constructive, not confrontational, when presenting the plan to the Dean, Senior Administration and Department Chairs, and to emphasize the benefits of such an undertaking. After all, it was argued, our faculty and administration had developed a nationally recognized health system, had instituted the medical curriculum for the next century, and had achieved spectacular success in gaining research grant support. The faculty were obligated to examine themselves in order to assure the continued delivery of outstanding health service, while at the same time advancing the scholarly and educational traditions of a "world class" Medical School and University. This theme resonated within our administration, within the Department Chairs, the Office of the President and Provost, within the Trustees, and within the University Faculty Senate. Faculty – 2000 Project was launched.

 

The leadership of the Medical Faculty Senate can not assure our faculty colleagues that this effort will cure anything. We have provided the foundations for success, and the Dean has agreed to accept the recommendations and apply them to the normal review process used by the School of Medicine. If the Working Groups undertake their inquiries with honesty and wisdom, and produce recommendations that are both practical and beneficial, we may, indeed, be able to guarantee the quality of our academic character into the future. As a faculty we must undertake this Project and do it well, for what other choice do we have? If we do not find our own "voice" and identify our own vision for the future, there are plenty of others ready to speak and identify it for us.


II. THE PLAN

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The Organization Chart on Page 8 illustrates the overall plan of the Faculty - 2000 Project. This plan was formulated by the leadership of the Medical Faculty Senate (Drs. Guerry, Hansen-Flaschen, Herrmann, and Saunders) over an 18-month period, and was refined considerably by the Faculty - 2000 Steering Committee. This committee, assembled in September of 1998, consisted of individuals with considerable experience in the School of Medicine. The Committee developed the Mission Statement on the following page, and served to identify the themes of the Working Groups, as well as the issues they might discuss. The initial Charges to the Working Groups were formulated by the Steering Committee. The work of the Committee is currently finished, but it will reconvene to consider the plans for the Faculty Retreat, and when the process is finished, to structure the final form of the recommendations transmitted to the School of Medicine. The roles of the Department Chairs and the Dean's Symposium are outlined below.

 

The original proposal of eight Working Groups was pared down to a more manageable number of four. Each Working Group has two co-Chairs. The use of co-Chairs was to provide continuity in leadership of the meetings. In addition, it allowed us the opportunity to appoint individuals with different perspectives, which helped assure that a healthy range of opinions would be represented.

 

A call for participation in the Working Groups to the faculty netted 174 replies. This was an astounding expression of interest. Membership in each of the Working Groups was chosen to accommodate as diverse a spectrum of the School as possible. The Working Groups have between 20 and 28 members, and constitute a total of 97 faculty. Add to this the members of the Medical Faculty Senate Steering Committee and the Faculty - 2000 Steering Committee (31) who have worked on this project, and an additional 42 volunteers to the Clinician Educator Track Faculty Working Group, who were not able to be used. These latter faculty members could not be accommodated on that Group, but will be used as "sounding boards" as the deliberations about the Clinician Educators progress. Thus, about 173 faculty in the School of Medicine will, in different forms, be engaged in the Faculty - 2000 Project. This is a remarkable 14% of the School.

 

The four Working Groups are described in detail below in the Charges developed for each by the Faculty - 2000 Steering Committee. The issues for discussion are not exhaustive, but designed to provide the Working Groups with some direction. Hopefully, other issues will emerge during the inquiry and from the faculty at large. Each Group has been assigned an Administrative Assistant. These individuals and their roles are also described within. These support staff will contribute significantly to the success of each Working Group by freeing the co-Chairs to formulate agenda, organize thoughts, and lead the discussions.

 

The task of each Working Group is to identify a set of recommendations at the end of their inquiry. These recommendations should represent the strategies and tactics identified by faculty to assure their continued academic success. These recommendations may impact School and University policy, or they may impact University policies as specified in the Handbook. At this stage, the faculty needs to identify the ideas that best assure the success of faculty in fulfilling their diverse missions and roles. The only guideline in this process is that the scholarly and educational excellence of our School and its faculty be preserved and enhanced, and that this must be achieved within the context of limited financial resources. This is a tall order, but we all have to struggle with it.

 

The recommendations from the Working Groups will be presented at a School-wide Retreat to be held in February, 2000. The plans for the retreat are not yet in place. The Retreat will give the entire faculty an opportunity to comment on the recommendations and to raise additional issues or concerns.

 

The recommendations from the Working Groups, and the discussions at the Retreat, will be integrated by the Faculty - 2000 Steering Committee into a final report, which will be presented to the Dean. The report will pass through the normal review process for such documents in the School of Medicine. We will see what happens then. What is becoming increasingly clear is that the magnitude of involvement by faculty in the School with this Project means that it can not be summarily rejected.


III . FACULTY – 2000 ORGANIZATION

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Medical School Faculty Senate Leadership

Faculty - 2000 Steering Committee

Purpose: Identify Working Group Topics
Establish Specific Charges toWorking Groups
Identify Chairpersons of Working
Groups

Dean's Faculty 2000 Symposium

Purpose: Bring to Penn 3-4 Nationally Recognized Speakers to Discuss Global Issuesof Medical School Faculty Structure

Standing Comm. of Chairs

Purpose:To Provide Consultation to the
Working
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CE / Tenure / Sp. Ops / Senior
Working Groups

Purpose: Working Groups Need to:

--- Establish Background Material on Topic

--- Identify Issues of Concern to Faculty

--- Make Specific Recommendations in

School Wide Retreat in Winter of 2000

Purpose: Publicly Present Working Group Position Papers School – Wide Discussion of Recommendations

Preparation of Final Recommendations


IV. FACULTY - 2000 MISSION STATEMENT

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The Faculty – 2000 Steering Committee drafted the Faculty – 2000 Mission Statement in January of 1999. The final content areas of the Working Groups were yet to be determined at that time. The themes of the Working Groups as they evolved are somewhat different from the expression below in that the Associated Faculty, other than the Research Track Faculty, are considered only within the context of other issues. The specific wording of the Statement was not changed to reflect this difference, but nevertheless continues to capture the spirit of the Project.

Profound changes in the delivery of health care during the last decade are contributing to equally profound changes in the scholarly, educational and service missions of Academic Health Systems throughout the Nation. The University of Pennsylvania Health System has been remarkably successful in adapting to these changes and is recognized as one of the leaders in the Nation in this regard. Nevertheless, these changes have created extraordinary challenges for its faculty, academic physicians and non-physician scientists alike. Perhaps the clearest effect of the altered environment is the difficulty faced by junior faculty in meeting the increased demands for clinical service and extramural funding, while at the same time maintaining scholarly and educational productivity. It is thus timely and important to undertake a review of the role of faculty within the Health System. This undertaking is initiated and organized by the Steering Committee of the Faculty Senate of the School of Medicine and is known as FACULTY-2000.

 

The goal of this review is to develop a faculty-based vision for delivering new knowledge and outstanding health care. This goal is realized by having faculty explore and identify strategies and tactics that enable them to achieve their research and educational missions within the context of an Academic Health System that requires outstanding service and management skills in an environment of constrained financial resources. The focus of the inquiry will be the mission, structure, organization and size of the Standing Faculty (Tenure and Clinician-Educator tracks). Its scope will include the Associated Faculty (Health System Physicians and Research track) and the interactions between Standing and Associated Faculty and the Clinical Associates in the Health System. The methodologies that emerge for advancing faculty missions must work within the framework of our current faculty tracks and resources. The inquiry is open to new ideas from all quarters of the Health System and University, and will engage a large portion of the School’s faculty over the next year. The recommendations that emerge will undergo the normal review processes within the School of Medicine.

 

 


V. THE ROLE OF DEPARTMENT HEADS IN THE FACULTY – 2000 PROJECT

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Early in the Faculty - 2000 planning stages, it was recognized that interaction with the Department Chairs in the School of Medicine would be essential to the success of the project. The Chairs were approached with the idea that anything that could enhance the scholarly and educational activities of their faculty would facilitate their departmental missions. In addition, it was noted that they had a vested interest in the success of the project because they, too, were faculty members of the School of Medicine. The viability of the academic character of the faculty was as much in their interest as it was in the interest of the rest of the faculty.

 

The original plan was to see if a separate Working Group of Department Chairs could be formed. This Group would consider the same sort of issues faced by the other Working Groups, but would examine them from the unique perspective of the Department Chairs. It was hoped that they might identify issues confronting faculty that might otherwise be missed. Moreover, we wanted the Department Chairs to act as consultants, so that preliminary ideas emerging from the Working Groups could be presented to them for comment. By actively engaging the Department Chairs in the Faculty - 2000 Project, we were conveying to them the important role they had to play in this process.

 

 

In retrospect, this plan was a bit ambitious. Nevertheless, the Department Chairs have agreed to participate in the Project by acting as consultants to the various Working Groups. This is important because there may be matters that emerge in the Working Group discussions that could be fruitfully commented upon by the Department Chairs. Their preliminary thoughts on various issues might facilitate the Working Group discussion considerably. In addition, the Department Chairs have endorsed the Faculty - 2000 Project, and have contributed a series of "Operational Principles" which were deemed to be consistent with the purpose and spirit of the Project by the Faculty – 2000 Steering Committee and the Medical Faculty Senate leadership.

 

The memorandum from Richard Tannen, M. D. outlining the Operational Principles follows:

 

E-mail Message From Richard Tannen, M. D.

Dated: March 4, 1999

Jim,

The Steering Committee of the School of Medicine met on March 2, 1999 and approved the following "Operational Principles for Faculty 2000". As you will recall, this group was asked to serve as the Chair group to provide input into the process. The following were the recommendations they came up with, which I believe are consistent with the spirit and direction which the process has been taking.

 

FACULTY 2000 OPERATIONAL PRINCIPLES
  1. A commitment to and the provision of excellent education is expected of all Standing Faculty.
  2. Scholarship is the primary criterion for promotion in the Standing Faculty.
  3. The process will seek to make any recommendations for change within the framework of the current faculty tracks, which include the Tenure, Clinician Educator, Research, Associate and Adjunct Faculty Tracks and the Health System Physician appointment, which includes an appointment to the Associate Faculty Track.
  4. Virtually all faculty salary support in the clinical departments comes from faculty-generated revenue, and it is unlikely that this will change. Therefore, any changes recommended in Faculty 2000 which have faculty salary implications also will need to address a feasible source of funding.
  5. The recommendations that emerge will undergo the normal review processes within the School of Medicine.

Please let me know if you have any questions/concerns about the above.

  • Thanks,

    Dick

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    VI THE DEAN’S FACULTY – 2000 SYMPOSIUM

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     Early in the planning stage, it was acknowledged that it would be beneficial for our Working Groups to consult with senior leadership from peer institutions who are grappling with similar problems.

     

    The Dean’s active participation is critical to this endeavor. In addition to his positions as a senior administrator and tenured faculty member, he is a highly respected leader in the national Medical School scene. Additionally, this process would gain exposure to the University, and create a forum in which Penn’s faculty, through an exchange of ideas, were actively addressing those vexing faculty-related issues currently plaguing Schools of Medicine across the country. The Dean accepted this role, and the planning of the Symposium was set in motion.

     

    It was decided that four individuals from "sister" institutions (private medical schools with a composition and size similar to our own) would be invited to participate in the Symposium. The guests would be invited for a day-and-a-half visit, comprised of three major events. On November 4th, a working dinner will be held in the Faculty Lounge of the new Biomedical Research Building II/III. An overview of the Faculty – 2000 Project will be provided, followed by presentations by Chairs of the Working Groups describing the issues they are deliberating and their progress to date.

     

    The Symposium will take place on November 5th in the large lecture theater of the Biomedical Research Building II/III, and will be open to the entire Medical School faculty and interested administrators in the Medical School and Health System. Dean Kelley will moderate. Each of the guest speakers are asked to make a 40 – minute presentation followed by ample time for questions. The presentations will address how our sister institutions are dealing with the same problems we are facing here at Penn. From the point of view of the Faculty – 2000 Project, we are primarily interested in comparing our approach to faculty problems with those taken by other schools.

     

    After the Symposium, there will be a boxed lunch in the Faculty Lounge for the guest speakers, the members of the Working Groups, Medical Faculty Senate Steering Committee and the Faculty – 2000 Steering Committee. The day will conclude with a Panel Discussion consisting of our guest speakers and the Chairs of the Working Groups. The Chair of the Faculty – 2000 Project will moderate the discussion. Members of the four Working Groups are invited to this event, and will be encouraged to participate in the discussion. In this format, it is hoped that details will be revealed of how faculty in other institutions are coping with the issues the Project is addressing. The Panel Discussion will end around 4:00 PM.

     

    The invited speakers are identified below followed by a detailed schedule of the planned events.

    INVITED GUEST SPEAKERS:

    EUGENE D. BRAUNWALD, M. D.

    Vice President for Academic Programs,
    Partners HealthCare System, Inc.
    Harvard University

    LYNN A. CORNELIUS, M.D.

    Associate Dean for Faculty Affairs,
    Washington University School of Medicine

    EDWARD D. MILLER, M.D.

    Dean, Johns Hopkins School of Medicine,
    CEO, Johns Hopkins Medicine.

    HERBERT PARDES, M.D.

    Vice President for Health Sciences
    Dean, Faculty of Medicine,Columbia University College of
    Physicians and Surgeons.

    THURSDAY AND FRIDAY, NOVEMBER 4 and 5, 1999

    SCHEDULE FOR DEAN’S FACULTY – 2000 SYMPOSIUM

     

    Thursday, November 4th

    4:00 P. M. Arrival of Guests:

    Eugene D. Braunwald,
    M. D
    .Lynn A. Cornelius, M. D.
    Edward D. Miller, M. D.
    Herbert Pardes, M. D.

    At airport and/or 30th Street Train Station, the guests will be picked-upby our driver, and transported to the Four Seasons Hotel where they will be staying overnight.

    5:45 PM

    Transport from hotel to the University of Pennsylvania.

    6:00 P. M.

    Cocktails in Faculty Lounge, 14th Floor, Biomedical Research Building II/III.

    6:45 P. M.

    Dinner in Faculty Lounge, 14th Floor, Biomedical Research Building II/III.

     The dinner is attended by our four guest speakers, the leadership of the Medical and University Faculty Senates, the Dean, and Senior Vice Dean of the School of Medicine, the co-Chairs of the Faculty - 2000 Working Groups, and the Administrative Assistants to the Faculty – 2000 Project.

    7:45 P. M.

    An overview of the Faculty – 2000 Project together with Presentations by each Working Group (Each to be 10 minutes in length).

    8:30 P. M.

    Open discussion for approximately 20 minutes as well as "charge" to speakers for next day’s presentations.

    Finish

    At approximately 9:00 P. M. to 9:15 P. M., guests are returned to the Four Seasons Hotel.

      

     

    Friday, November 5th

    7:45 A.M.

    Guests checkout of hotel and are picked-up at hotel for transportation to the University.

    8:00 A.M.

    Continental Breakfast in Lobby of Biomedical Research Building II/III

    8:30 A.M.

    Dean’s Faculty – 2000 Symposium. Open to all School of Medicine Faculty - Auditorium, Ground Floor, Biomedical Research Building II/III

    8:30 – 8:35 A.M.

    Introductory Remarks, James C. Saunders, Ph.D.,Chair,Faculty – 2000 Project

    Moderator:

    William N. Kelley, CEO, University of PennsylvaniaHealth System
    Dean, School of Medicine

    8:35 – 9:15 A.M.

    Eugene D. Braunwald, M. D., Harvard University

    9:15 – 9:25 A.M.

    Questions

    9:25 – 10:05 A.M.

    Lynn A. Cornelius, M. D., Washington University

    10:05 – 10:15 A.M.

    Questions

    10:15 – 10:55 A.M.

    Edward D. Miller, M. D., Johns Hopkins University

    10:55 – 11:05 A.M.

    Questions

    11:05 – 11:45 A.M.

    Herbert Pardes, M. D., Columbia University

    11:45 – 11:55 A.M.

    Questions

    12:00 – 1:15 P.M.

    Boxed Lunch in Lounge, 14th Floor Biomedical Research Building II/III for Guest Speakers, members ofFaculty – 2000 Steering Committee, Members of all Working Groups, and Medical Faculty Senate Leadership, and Medical Faculty Steering Committee

    1:30 – 2:45 P.M.

    Panel Discussion led by Guest Speakers and Co-Chairs of theFaculty – 2000 Working Groups in Auditorium, Biomedical Research Building II/III . Members of all Working Groups and the Faculty – 2000 Steering Committee are invited toattend and participate in discussion.

    4:00 P.M.

    End of Symposium. Guests are transported to their places of departure.


    VII. ADMINISTRATIVE ASSISTANTS

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     Clause, Bonnie T. clauseb@mail.med.upenn.edu
    Coordinator of Special Projects, Office of the CEO/Dean, 1124 Penn Tower Building,
    399 South 34th Street, 19104-4385 898-0748

     

    Mulhern, Victoria vmulhern@mail.med.upenn.edu
    Director of Faculty Affairs, School of Medicine,
    M158 John Morgan Building,
    3620 Hamilton Walk, 19104-6015 898 6923

     

    Napier, Dana djnapier@mail.med.upenn.edu
    Coordinator of Special Projects, Office of the CEO/Dean,
    1125 Penn Tower Building,
    399 South 34th Street, 19104-4385 573 3221

     

    Zinser, Janet janetz@mail.med.upenn.edu
    Associate Director of Postdoctoral Programs, School of Medicine,
    M160 John Morgan Building,
    3620 Hamilton Walk, 19104-6015 573-4332

     

    The Administrative Assistants provide support for each of the Working Groups. These four individuals occupy positions of considerable importance within the School of Medicine and the Health System. They have well-developed networks which will prove invaluable in the process of seeking information needed for the deliberations of the Working Groups. The Administrative Assistants also provide important organizational support for the Co-Chairs in the preparation for meetings and the identification of agendas. At each meeting they will take minutes, which in their "raw" form will be distributed via E-mail to all members of the Working Group. From these minutes, an "Executive Summary" will be prepared in which the main points of the discussion are succinctly organized in bullet format. Sufficient detail will be provided so that the flavor of the discussion and the direction of the debate are clearly evident. When the Chairs of the respective Working Groups have reviewed this summary, it will be sent to the entire faculty as an E-mail bulletin. Comments and suggestions will be invited from the faculty on these summaries. The Assistants will also keep track of proposed recommendations as they emerge, and will bring them before the Co-Chairs when clarification or additional details are needed. The Administrative Assistants will initially prepare the draft of the final report of the Working Group. They will further oversee the preparation of the final recommendations.

     

    The Medical School has generously allocated a sufficient portion of these individuals’ activity to serve in this important and essential capacity for the Faculty – 2000 Project. The leadership of the Medical Faculty Senate is very grateful to the School and the Dean for this support.

     


    VIII. E-MAIL COMMUNICATION

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    Over a seven-month period, the entire work of the Faculty – 2000 Steering Committee was conducted by E-mail. This was truly an electronic committee. Although the Committee’s work might have been better conducted in another format, it, nevertheless, was a success. A number of lessons were learned, among them that E-mail is a marvelous tool for generating an open, unrestrained discussion, especially among very busy people, who are difficult to get together at any given time.

     

    The use of E-mail communication will be employed with our Working Groups to communicate minutes of the meetings to all members so that those not in attendance can be kept apprized of the progress. More importantly, an Executive Summary of the meetings in a more condensed form will be forwarded to the entire faculty. At the end of every one of these Summaries, a request for comments will be made. A special Faculty – 2000 E-mail address has been established so, with the click of a button, faculty can reply to the specific Working Group Summary. In this way, we hope to engage the entire faculty. The leadership of the Medical Faculty Senate does not care where the ideas come from, only that the best ideas be generated.

     


    IX. CHARGE TO THE CLINICIAN EDUCATOR TRACK AND FACULTY WORKING GROUP

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    The memorandum below lays out the charge to the Clinician Educator Track and Faculty Working Group as developed by the Faculty-2000 Steering Committee in late March. It sketches in broad terms how the Working Group might proceed, identifies some of the central issues for discussion, and the recommendations that should be prepared at the end of the process.

     

    MEMORANDUM

     

    March 19, 1999

     

    TO: FACULTY - 2000 Steering Committee

    From: Jim Saunders

    Subject: Clinician Educator Track and Faculty Working Group

     

    This memorandum outlines the Charge to the Clinician Educator (CE) Track and Faculty Working Group (WG).

     

    1. The first job of the Working Group is to define what exactly is a CE faculty member. This definition comes directly from the Handbook as a start, but then needs to be expanded into what it really is. What are the current roles and missions of this Faculty? Data on their size, extent of clinical activity and scholarly activity needs to be sought. The Administrative Assistant assigned to this Working Group can help in this. At this point the Working Group should not attempt to discuss what the CE track and faculty "ought" to look like but rather what it actually is.
    2. The WG as a whole then needs to refine the definition of a CE faculty member by discussing the following relevant issues : 
      1. What are the current criteria for appointment in the CE track? Are they appropriate?
      2. What are the current criteria for promotion in the CE track and are they well defined and appropriate? Are they adhered to? Are they stable, or do they present a "running target"? How have they changed over the last five years?
      3. How do you define the edge between a member of the CE faculty track and a member of the Tenure faculty track?
      4. What is the difference between a Health System Physician (as defined by the Associated Faculty tracks and the Clinical Care Associates) and a Clinician Educator? Is this distinction clear or is it in need of revision? Is the distinction recognized and adhered to throughout the School?
      5. What might be the impact on CEs of allowing Health System Physicians to practice at HUP?
      6. How critical is the issue of compensation for teaching for the CE faculty?
      7. What are the future roles of the CE faculty, and if it is changing is there a way to exploit the potentials?

        At the end of this discourse there should be an excellent understanding of what defines the CE faculty track along a number of dimensions. The discussion will have introduced the Working Group to the issues that impact the CEs and should even begin to carve out the shape of recommendations.
    3. The WG then needs to organize itself in such a way that the following topics will be explored further: a) the Structure of the Clinician Educator Faculty; b) the Academic and Scholarly Missions of the CE Faculty; and c) the Impact of Market Forces on the CE Faculty.

      In considering the structure of the CE faculty, the following issues have been identified by the Faculty-2000 Steering Committee and serve as points of reference or departure for discussion. They are not organized in any particular order.

     

    • Is the size of the CE faculty appropriate for its missions? 
    • Is there currently a clash between the CE faculty and Health System Physicians in their clinical activities? If so, how can this clash be avoided?
    • The issue of multiple CE tracks.
    • The issue of job security and tenure.
    • The issue of incentives.
    • Promotion issues and the duration of the CE probationary period.
      In considering the academic missions of the CEs, the following issues have been identified again as points of departure for discussion.

     

    • What is the definition of scholarship in the CE track? Should the same definition apply to all CE faculty?
    • What constitutes teaching for the CEs? 
    • What is the appropriate definition of CE productivity?
    • How do CEs best balance effort between clinic, research and teaching?
    • What is the role of mentoring for CEs?
    • How do CEs best establish research initiatives?
    • What mechanisms are available to assist CEs in interacting with basic science? Should these be expanded?
    • How can CE’s be effectively used in translational research?
    • What are the issues of compliance for CEs?
    • How do we maintain the highest level of scholarship for our CEs.
    • What exactly are the teaching missions of the CE faculty?


      Finally, in considering the impact of market forces on the CE track, the following issues have been identified as points for departure for discussion.
    • What is the impact of falling reimbursements on CE faculty? 
    • What is the impact of high overhead?
    • How do CEs maintain clinical skills?
    • What are the administrative responsibilities faced by CEs?
    • Should CE reimbursement be tied to collections, scholarly productivity, grants or the whim of the Chief or Chair?
    • What is the most effective role for Divisions and Departments for CEs?
    • How can CE’s effect clinical information transfer into the Health System?
    • What is the impact of disease-based patient care?
    • What is the impact of practice demands on CE faculty?
    • How can market forces be used to advantage?
    • As we transit from an academic to corporate culture, will there be more control exerted over CE faculty responsibilities? What are the implications of this?
    • How do faculty respond to the fact that in a grant-based society, faculty are free agents, while in a corporate-based society, the lines of authority and control are fundamentally different?
    • Will the ‘psychic income" motivating physician faculty to work in Academic Medicine lose or gain value in the future? ("Psychic income" are all those things intangible and rewarding that motivate us to work in an academic environment.)
    • What is the impact of clinical practice on the educational and research goals of the CEs?
    1. When the WG has adequately considered these issues, the process of consolidation needs to
      begin. The group needs to reach a consensus about whether or not the mission, structure, organization, and size of the CE faculty track, as defined in Step 1, are appropriate. It then needs to ask if the track is in need of changes so that its missions can be achieved more effectively. In essence, now it needs to ask what the CE track and faculty "ought" to look like in order to achieve its ends and retain its academic character?

       

    2. When a consensus on the matter in Step 4 is achieved, the group needs to look at the issues in Step 3 and ask what processes in the School or Health System help or hinder the achievement of academic and clinical success of our CE faculty. In addition, what strategies or tactics should be introduced to the CE track and faculty to assure success?

       

    3. Finally, the strategies and tactics identified above need to be formulated into a Position Paper that can be presented before the Faculty Retreat. This paper should summarize the discussions of the WG and offer recommendations to the faculty for further consideration during a School-wide Retreat in the late Winter of 2000.

     

    CLINICIAN EDUCATOR WORKING GROUP MEMBERSHIP AS OF SEPTEMBER 1999

     

    CO-CHAIRS:

     

    Hansen-Flaschen, John M. D. jflash@mail.med.upenn.edu

    Department of Medicine,
    Pulmonary, Allergy and Critical Care Division,
    HUP,
    873 Maloney Building,
    3400 Spruce Street, 19104-4283 662 6003

    Tomaszewski, John M. D. tomaszew@mail.med.upenn.edu
    Director of Surgical Pathology,
    HUP,
    Department of Pathology and Laboratory Medicine,
    6th Floor Founders Pavilion,
    3400 Spruce Street, 19104-4283 662 6852

     

    ADMINISTRATIVE ASSISTANT:

    Mulhern, Victoria vmulhern@mail.med.upenn.edu
    Director of Faculty Affairs, School of Medicine,
    M158 John Morgan Building,
    3620 Hamilton Walk, 19104-6015 898 6923

     

    MEMBERS:

    Ballard, Roberta M. D. ballardr@email.chop.edu
    Chief, Division of Neonatology Children’s Hospital of Philadelphia,
    34th Street & Civic Center Boulevard. 19104 590-1653

    Brennan, Patrick J. M. D. brennanp@mail.med.upenn.edu
    Department of Medicine, Division of Infectious Disease, HUP,
    9051 West Gates Pavilion, 3400 Spruce Street, 19104-4283 662 6995

    Bridges, Charles M. D. cbridges@mail.med.upenn.edu
    Department of Surgery, 6 Silverstein Building, HUP,
    3400 Spruce Street,
    19104-4283 349 8285

    Ende, Jack M. D. ende@mail.med.upenn.edu
    Chief, Department of Internal Medicine at Presbyterian Medical Center,
    Suite W285, 39th and Market Streets, 19104 662 8989

    Fisher, Judith M.D. judithf@mail.med.upenn.edu
    Department of Family Medicine, Presbyterian Medical Center, 6th Floor Mutch Building,
    39th and Market Streets, 19104 662 8949

    Goldfarb, Stanley M. D. sgoldfar@mail.med.upenn.edu
    Department of Medicine, Renal, Electrolyte and Hypertension Division, HUP
    100 Centrex, 19104-4283 614 0904(5)

    Guerry, Dupont M. D. guerry@mail.med.upenn.edu
    Department of Medicine, Division of Hematology-Oncology, HUP,
    Room 515 Maloney Building, 19104-4283 662 4137

    Hadley, Trevor Ph.D. trevor@cmhpsr.upenn.edu
    Department of Psychiatry, Center for Mental Health Policy and Service Research,
    3600 Market Street, Room 717, 19104-2648 662 2886

    Hirshfeld, John M. D. hirshfel@mail.med.upenn.edu
    Director, Cardiac Catherization Laboratory, HUP, Department of Medicine, Division of Cardiology,
    9th Floor Founders Pavilion, 3400 Spruce Street, 19104-4283 662-2181

    Kelley, Mark M. D. kelleym@mail.med.upenn.edu
    Chief of Medicine (111), Veterans Administration Hospital,
    Woodlandand University Avenues, 19104 823 5847

    Kochman, Michael M. D. kochman@mail.med.upenn.edu
    Department of Medicine, HUP, Division of Gastroenterology, 3rd Floor Ravdin Building,
    3400 Spruce Street, 19104-4283 662 3546

    Kolansky, Daniel M. D. kolansky@mail.med.upenn.edu
    Department of Cardiology Services, HUP, Cardiovascular Division, 9th Floor Founders Pavilion,
    3400 Spruce Street, 19104-4283 662 2178

    Liu, Grant M. D. gliu@mail.med.upenn.edu
    Department of Neurology, Division of Neuro-Ophthalmology, HUP,
    3 West Gates Pavilion, 3400 Spruce Street, 19104-4283 349 8460

    Mastroianni, Luigi M. D. lmastroianni@obgyn.med.upenn.edu
    Department of Obstetrics-Gynecology, HUP, 106 Dulles Building,
    3400 Spruce Street,
    19104-4283 662 2970

    McCarthy, David M. D. davidmcc@mail.med.upenn.edu
    Department of Medicine, HUP, Division of Cardiology, Suite 800 Penn Tower Building,
    399 South 34th Street, 19104-4385 662 2460

    Mollman, Joan M. D. jmollman@mail.med.upenn.edu
    Department of Medicine, HUP, Division of Neurology, 3 West Gates Pavilion,
    3400 Spruce Street, 19104-4283 662 2613

    Seltzer, Vivian Ph.D. seltzer@caster.ssw.upenn.edu
    School of Social Work, School Of Medicine, Department of Human Development
    and Behavior,
    3701 Locust Walk, 19104-6304 898 5538

    Spinner, Nancy Ph.D. spinner@mail.med.upenn.edu
    Department of Pediatrics, Children’s Hospital of Philadelphia, Division of Genetics,
    1006 Abramson Research Center,
    3516 Civic Center Boulevard, 19104-4399 590-4177

    Steinberg, David M. D. drsteinb@mail.med.upenn.edu
    Department of Orthopaedic Surgery, Penn Hand Specialist, 8th Floor Penn Tower Building,
    399 South 34th Street, 19104-4385 662 3344

    Szapary, Phillipe M. D. szapary@mail.med.upenn.edu
    Department of Internal Medicine, HUP, 9th Floor Penn Tower Building,
    399 South 34th Street, 19104-4385 662 3400

    Szuba, Martin M. D. mszuba@mail.med.upenn.edu
    Department of Psychiatry, Division of Depression Research,
    3600 Market Street, 19104-2649 898 4301

    Tino, Gregory M. D. gregtino@mail.med.upenn.edu
    Department of Medicine, HUP, Lung Center, Pulmonary and Sleep Outpatient Practice,
    3rd Floor Ravdin Building,
    3400 Spruce Street, 19104-4283
    662 3202

    Volpe, Nicholas M. D. nickvolp@mail.med.upenn.edu
    Department of Ophthalmology, Division of Neuroscience, Scheie Eye Institute,
    51 North 39th Street, 19104 662 8042

    Weber, Randal M. D. rsweber@mail.med.upenn.edu
    Department of Otorhinolaryngology: Head and Neck Surgery, 5 Ravdin – ORL,
    HUP, 3400 Spruce Street, 19104-4283 662 4665

    Weinstein, Gregory M. D. gsw@mail.med.upenn.edu
    Department of Otorhinolaryngology: Head and Neck Surgery, 5 Ravdin – ORL,
    HUP, 3400 Spruce Street, 19104-4283 349 5390

    Zager, Eric M. D. zager@mail.med.upenn.edu
    Department of Medicine, HUP, Division of Neurosurgery, 5th Floor Silverstein Building,
    3400 Spruce Street, 19104-4283 662 3497

     


    X. CHARGE TO THE TENURE TRACK AND FACULTY WORKING GROUP

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    The memorandum below lays out the charge to the Tenure Track and Faculty Working Group as developed by the Faculty - 2000 Steering Committee in late March. It sketches in broad terms how the Working Group might proceed, identifies some of the central issues for discussion, and the recommendations that should be prepared at the end of the process.

     

    MEMORANDUM

     

    March 20, 1999 

    To: Faculty - 2000 Steering Committee

    From: Jim Saunders

    Subject: Charge to the Tenure Track and Faculty Working Group

     

     

    The Charge to the Tenure Track and Faculty Working Group (WG) should be structured in the following way.

      

    1. Like the Clinician Educator and Faculty WGs, the process needs to begin with a thorough definition of the tenure track and faculty. What are the missions, structure organization and size of this faculty? The Handbook, of course, defines the tenure track, and additional input might be sought from School and University administrators. Beyond that, the question needs to be asked if the Handbook definition actually fits what the nature of the track and faculty really are. The missions and roles of faculty in this track need to be explored. It is important that the questions asked at this stage of the process focus on what exactly is the tenure track and faculty, not what they "ought’ to be.

        

    2. The WG then needs to thoroughly explore the following issues, and, where necessary, data should be collected to provide empirical support for particular matters. The Administrative Assistant assigned to this Working Group can be used effectively in this regard. The issues below are not exhaustive, nor are they organized in any particular order. They were identified by the Faculty-2000 Steering Committee as points of departure for discussion. Other matters may arise, and when this happens, they should be placed on the agenda.

      

    • What exactly does it mean to be a tenured faculty member in the School of Medicine? 
    • Is the size of the tenured faculty appropriate for the nature of its missions?
    • How would tenured faculty feel if faculty in the CE track gained academic parity with them in issues of job security or in the decision process for promotion?
    • How is "productivity" defined for this faculty? Is compensation geared to this productivity?
    • Is the structure of our tenured faculty, organized in departmental units, but present in basic science and clinical departments, institutes and centers, appropriate?
    • Are tenured faculty in clinical departments treated differently from tenured faculty in basic science departments?
    • What sort of incentive plans can be devised for tenured faculty in Basic Science Departments?
    • Are the current criteria for promotion in the tenure track stable, appropriate, and adhered to?
    • Is the current 7-year probationary period for promotion in the tenure track a realistic duration, given the expectations placed on junior faculty, the complexity of attaining grant support, and the conduct of modern biological science?
    • Are these promotion criteria administered fairly to all candidates and has there been a "running target" with the passage of time?
    • Should the income generation for tenured faculty with regard to amount of salary support, level of overhead generated, or even percent time committed to sponsored research be specified in a more structured manner? What is the mechanism for determining this level and do faculty have a voice in that process?
    • What is the role of unfunded research for faculty in the tenured track?
    • Is the mentoring process for junior tenured faculty effective and appropriate for this faculty?
    • How is scientific productivity and grant support maintained throughout the career of tenured faculty?
    • How do we distinguish the roles and missions of a tenured faculty member from a CE faculty member heavily committed to research?
    • Is the "Psychic Income" for the tenured faculty, which refers to those intangible things that motivated individuals pursue in an academic career in science, liable to increase or decrease in future years? How can the value of this "Psychic Income" be enhanced?
    • How will the lines of authority and control impact on the tenured faculty as the Medical Center transits from an academic to a corporate culture? Will the "free agent" status of tenured faculty in our current grant-based society undergo significant changes in the future? What would be the implications of these changes?
    • How can the basic science endeavors of tenured faculty be better utilized in the Medical Center to achieve translational research?
    • How do compliance issues impact tenured faculty?
    • Is financial feedback on grant statements adequate and clear enough for individual investigators?
    • Is the infrastructure for grant preparation, processing, and administration adequate at the departmental level?
    • Is there adequate feedback on animal and IRG issues? Are protocols efficiently processed?
    • Is there adequate monitoring of lab safety and health?
    • In the matter of academic freedom and responsibility, is the responsibility side well understood?
    • Do faculty understand the responsibilities of lab management?
    • What exactly is the teaching role of the tenured faculty in medical and graduate education?
    • As new technologies for instruction are implemented, will there be a dwindling need to have students in lecture halls as verbatim notes, video taped lectures, and web site materials expand?
    • Is there a "paradigm shift" in teaching on the event horizon? This shift would rely on mentoring of students by faculty in small-scale interactions on specialty topics, and might come to replace large-scale lecture hall presentations?
    • If the two points above are true, the impact on tenured faculty need to be considered in light of the traditional roles of teaching.
    • If the process of instruction is changing, what are the implications for compensation for teaching?
    • Should the obligations for teaching activity be structured in a more defined or formalized manner for tenured faculty?
    • What is the nature of compensation for teaching in the tenure track? Whatever it is, do tenured faculty understand it?
    • What really are the contributions to promotion for teaching in the tenure track?
    • What is the impact of Graduate Group teaching for the tenured faculty?

     

    1. At this point, the definition arrived at in step 1 above, concerning what the tenure track and faculty are, needs to be integrated with the discussion of the issues raised above to ask what the tenured track and faculty "ought" to look like. The phrase "ought to look like" may sound vague, but this consideration needs to be concerned only with what it takes to preserve outstanding scholarship and instruction within an environment that is conducive for faculty growth, and which is resilient to the challenges of our changing Academic Medical Center.

        

    2. When there is a consensus about the structure, mission, organization and size of the tenure faculty, the WG needs to begin the task of asking what processes within the School of Medicine and broader Health System serve to facilitate or hinder this faculty. To this end, strategies and tactics need to be developed in the form of recommendations that will assure the maintenance of the academic character and success of the tenured faculty.
    3. Finally, a Position Paper must be prepared in which the deliberations of the WG are commented upon, and which presents and justifies the final recommendations concerning this faculty. This document will be presented at the Faculty-2000 Retreat to be held in the late Winter of 2000.

     

     

     

     

    TENURE FACULTY WORKING GROUP MEMBERS AS OF SEPTEMBER, 1999

     

     

    CO–CHAIRS:

     

    Sterling, Peter Ph.D. peter@retina.anatomy.upenn.edu
    Department of Neuroscience, School of Medicine,
    123 Anatomy-Chemistry Building, 19104-6058 898 9228

    Rubin, Harvey M.D./Ph.D. rubinh@mail.med.upenn.edu
    Department of Medicine, Division Of Infectious Disease,
    536 Johnson Pavilion,
    3610 Hamilton Walk, 19104-6073 662-6475 (Lab) 662-6475

    ADMINISTRATIVE ASSISTANT:

    Zinser, Janet janetz@mail.med.upenn.edu
    Associate Director Postdoctoral Programs, School of Medicine,
    M158 John Morgan Building,
    3620 Hamilton Walk, 19104-6015 573-4332

     

    MEMBERS:

     

     

    Brayman, Kenneth M.D. brayman@mail.med.upenn.edu
    Department of Surgery, HUP,
    4th Floor Silverstein Building, HUP,
    3400 Spruce Street, 19104-4283 662-2094

    Bucan, Maja Ph.D. bucan@pobox.upenn.edu
    Department of Psychiatry, School of Medicine,
    111A Clinical Research Building,
    415 Curie Boulevard, 19104-6141 898-0020(1)

    Costarino, Andrew M.D. costarin@mail.med.upenn.edu
    Department of Anesthesiology, Children’s Hospital of Philadelphia,
    34th Street and Civic Center Boulevard, 19104 590-1871

    Cox, Malcolm M.D. mcox@mail.med.upenn.edu
    Office of Network & Primary Care Education, School of Medicine,
    1207 Blockley Hall,
    418 Guardian Drive, 19104-6021 898 9579 (v)
    573 7013 (f)

    Detre, John M.D. detre@mail.med.upenn.edu
    Department of Neurology,
    HUP, 3 West Gates Pavilion,
    3400 Spruce Street,
    19104-4283 349-8465

    Dinges, David Ph.D. dinges@mail.med.upenn.edu
    Department of Psychology, School of Medicine,
    1013 Blockley Hall,
    418 Guardian Drive, 19104-6021 898-9949(51)

    Douglas, Steven M.D. douglas@email.chop.edu
    Department of Pediatrics, 1211 Abramson Research Center,
    3516 Civic Center Boulevard, 19104-4318, 898-1978, 898 3561

    Feldman, Harold M.D./MSCE hfeldman@cceb.med.upenn.edu
    Center for Clinical Epidemiology and Biostatistics, School of Medicine,
    717 Blockley Hall,
    418 Guardian Drive, 19104-6021 898-0901

    Felix, Carolyn M.D. felix@kermit.oncol.chop.edu
    Department of Pediatrics, Division Of Oncology,
    902B Abramson Research Center,
    3516 Civic Center Boulevard, 19104-4318 590-2831 590 4622

    Goldman, Yale M.D./Ph.D. goldmany@mail.med.upenn.edu
    Director, Pennsylvania Muscle Institute,
    D700 Richards Building,
    3700 Hamilton Walk, 19104-6083 898-4543 8984543

    Guttentag, Susan M. D. guttentag@email.chop.edu
    Department of Pediatrics,
    416G Abramson Research Center,
    3516 Civic Center
    Boulevard, 19104-4399 590-2806

    Hess, Marilyn Ph.D. hess@pharm.med.upenn.edu
    Department of Pharmacology, School of Medicine,
    M102 John Morgan Building,
    3620 Hamilton Walk, 19104-6084 898 6631

    Kimmel, Stephen M.D./M.S. skimmel@cceb.med.upenn.edu
    Center for Clinical Epidemiology and Biostatistics, School of Medicine,
    717 Blockley Hall,
    418 Guardian Drive, 19104-6021 898 1740

    Kleyman, Thomas M.D. kleyman@mail.med.upenn.edu
    Department of Medicine, Renal Division, School of Medicine,
    700 Clinical Research Building, 415 Curie Blvd., 19104-6144 898 5177

    Kopf, Gregory Ph.D. kopf@mail.med.upenn.edu
    Center for Research on Reproduction & Women’s Health, School of Medicine,
    Room 1315 Biomedical Research Building II/III,
    421 Curie Boulevard, 19104-6142
    573-4780

    Lee, Virginia Ph.D. vmylee@mail.med.upenn.edu
    Department of Pathology and Laboratory Medicine,
    HUP, 3rd Floor Maloney Building,
    3400 Spruce Street, 19104-4283 662-6427

    O’Rourke, Donald M.D. orourked@mail.med.upenn.edu
    Department of Neurosurgery,
    HUP, 5 Silverstein Building,
    3400 Spruce Street,
    19104-4283 898 2871

    Salzberg, Brian Ph.D. bmsalzbe@mail.med.upenn.edu
    Department of Neuroscience, School of Medicine,
    234 Stemmler Hall
    3450 Hamilton Walk, 19104-6087 898-2441

    Sehgal, Amita Ph.D. amita@mail.med.upenn.edu
    Department of Neuroscience, School of Medicine,
    232 Stemmler Hall
    3450 Hamilton Walk, 19104-6087 573-2985 898-1177 (Lab)

    Simmons, Rebecca M.D. rsimmons@mail.med.upenn.edu
    Department of Pediatrics, Children’s Hospital of Philadelphia,
    414 Abramson Research Center,
    3516 Civic Center Boulevard, 19104 590-3796

    Stevens, Rosemary Ph.D. rstevens@sas.upenn.edu
    Department of History & Sociology of Science,
    Room 324 Logan Hall,
    249 South 36th Street, 19104-6304 898 7601
     

    Wand, A. Joshua Ph.D. wand@mail.med.upenn.edu
    Department of Biochemistry-Biophysics, School of Medicine,
    415 Anatomy-Chemistry Building,
    36th Street and Hamilton Walk, 19104-6059 573-7288

    Weissman, Drew M.D. dreww@mail.med.upenn.edu
    Department of Medicine, Division Of Infectious Diseases,
    536 Johnson Pavilion,
    3610 Hamilton Walk, 19104-6073 614 0291

     

     


    XI. WORKING GROUP ON ISSUES OF CONCERN TO FACULTY WITH SPECIAL OPPORTUNITIES

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    The memorandum below lays out the charge to the Working Group on Issues of Concern to Faculty with Special Opportunities as developed by the Faculty - 2000 Steering Committee in late March. It sketches in broad terms how the Working Group might proceed, identifies some of the central issues for discussion, and the recommendations that should be prepared at the end of the process.

      

    MEMORANDUM

     

    March 21, 1999

    To: Faculty - 2000 Steering Committee

    From: Jim Saunders

    Subject: Charge to the Working Group on Issues of Concern to Faculty with Special Opportunities

  •  
  • The Charge to this Working Group (WG) should be structured in the following way.

     

    1. This WG needs to evaluate issues of concern to women, minority, husband/wife team, and practitioner scholar faculty. In addition, the missions and structure of the Research Faculty track should also be reviewed. Like the Clinician Educator and Tenure Working Groups, the process needs to begin with a thorough definition of the faculty under consideration. This definition is not with regard to the appointment title (those matters will be dealt with by the Clinician Educator and Tenure Working Groups), but rather along the lines of how large each of these cadres are and how they are distributed throughout the School and Health System. The Handbook provides the current definition of the Research Track. If these faculty cadres have special academic or scholarly missions, they too need to be identified at this stage. The end point for this Working Group is to offer a set of recommendations that identify strategies and tactics for these faculty members that can be used as blueprints for success.

       

       

    2. The WG then needs to thoroughly explore the following issues, and where necessary collect relevant data to provide empirical support for particular positions that may emerge later in the deliberation. The issues listed below were identified by the Faculty-2000 Steering Committee and are not meant to be exhaustive or organized in any particular order. They serve as points of departure for discussion. Other matters may arise, and when this happens, they should be placed on the agenda.
       
      • How effective are departments and faculty in the recruitment and retention of women, minority, and husband/wife team faculty? 
      • What mechanisms can be identified to better assure the retention of women and minority junior faculty?
      • Does the School provide a proactive and aggressive environment that supports all junior faculty, especially women and minorities?
      • Should special efforts be identified to help assure outstanding scholarly productivity and achievement for women and minority faculty?
      • Does support by the School of Medicine for such projects as FOCUS on Women’s Health Research and the Center for Excellence on Minority Health target appropriate issues for women and minority faculty?
      • Should there be greater flexibility in defining faculty job structure for women and husband/wife team faculty?
      • Should there be School- or University-wide networks to assist in the recruitment and retention of minority faculty?
      • Should women and minority faculty be more involved in the recruitment and retention of women and minority faculty?
      • Should evidence be accumulated to assure salary parity for women and minority faculty?
      • Is there any evidence of a distinction for women and minority faculty in the process of promotion?
      • The other Working Groups are discussing the definitions of faculty "productivity". Is or should productivity be defined any differently for these faculty cadres?
      • Is there a problem faced by women and minority faculty because they are called upon disproportionately to provide service to the School because of the need to fill quotas or provide "balance" in committee work? If this is a problem how can it be dealt with?
      • Should women and minority faculty be mentored in a way that caters to their special needs?
      • Do recruitment processes for husband and wife team faculty coordinate this process properly? Should this process be coordinated across the campus or just in the School of Medicine? How can the School provide additional support for this process? Should the spouse be considered a "freebie" in team recruitment?
      • How can couple recruitment be made a positive marketable process for the School? Does it provide a fund-raising opportunity for the School?
      • Faculty often discuss "Quality of Life" issues these days. How do "quality of life" issues impact on women, minority, and husband/wife team faculty?
      • The extension for faculty who have had a child during the probationary period from Assistant to Associate Professor by one year was a very enlightened response by the University. Are there other issues that are similarly related to the extension of the probationary period that might facilitate the success of junior faculty?
      • What impact would the establishment of "Day Care" within the School and Hospital have on faculty?
      • Does the School view parental leaves as a natural occurrence in the life of faculty and encourage them as a non-detrimental event to career development?
      • What is the current definition of the "Practitioner Scholar" faculty, and what roles do they play in the School?
      • Are the requirements for appointment and promotion appropriately defined and well understood for this faculty?
      • How is "productivity" defined for this faculty?
      • What are the current missions of the Research Track faculty.
      • Is promotion in the Research Track fairly defined and consistently administered?
      • How is "productivity" defined for the Research Faculty Track? Is that definition appropriate?
      • Should the prohibition on teaching be maintained for the research faculty?
      • How do we distinguish between faculty in the Tenure and Research Tracks?
      • Should the Research Track be part of the Standing Faculty?
      • Is it necessary to have a Research Track faculty? Do they fill an identifiable need within the School and Health Systems?
    3. At this point, the definitions for women, minority, husband/wife team, practitioner scholar and research track faculty, arrived at in step 1 above, need to be integrated with the discussion of the issues raised above. The outcome of this integration should be an assessment of the needs faced by these faculty groups and a sense of how these needs ought to be addressed in creating an environment conducive to faculty growth.

    4. When there is a consensus about how these needs should be addressed the WG must begin the final task of asking what processes within the School of Medicine and broader Health System serve to facilitate or hinder the success of this faculty. To this end, strategies and tactics should be developed in the form of recommendations that will assure the maintenance of the academic character and success of these faculty groups.

       
    5. Finally, a Position Paper must to be prepared in which the deliberations of the WG are commented upon, and which presents and justifies the final recommendations concerning this faculty. This document will be presented at the Faculty-2000 Retreat to be held in the late Winter of 2000.

     

     

     SPECIAL OPPORTUNITY WORKING GROUP MEMBERS AS OF SEPTEMBER 1999

     

     

    CO-CHAIRS:

    Driscoll, Deborah M. D. driscold@mail.med.upenn.edu
    Department of Obstetrics-Gynecology,
    HUP, 573 Dulles Building,
    3400 Spruce Street, 19104-4283 662-7503

    Johnson, Jerry M.D. jcjohnso@mail.med.upenn.edu
    Center of Excellence on Minority Health, Ralston-Penn Center,
    3615 Chestnut Street, 19104-2676 898-3893

    ADMINSITRATIVE ASSISTANT:

    Napier, Dana djnapier@mail.med.upenn.edu
    Coordinator of Special Projects, Office of the CEO/Dean,
    1125 Penn Tower Building,
    399 South 34th Street, 19104-4385 573 3221

     

    MEMBERS:

     

    Abbuhl, Stephanie M. D. abbuhl@mail.med.upenn.edu
    Director, Department of Emergency Medicine,
    HUP, Ground Floor Ravdin Building,
    3400 Spruce Street,19104-4283 662-6963

    Battistini, Michelle M. D. mbattistini@mail.obgyn.upenn.edu
    Clinical Practices, Department of Obstetrics-Gynecology,
    HUP, 5th Floor Penn Tower Building,
    399 South 34th Street, 19104-4283 349-8401

    Bernhard, Eric Ph.D. bernhard@mail.med.upenn.edu
    Department of Radiation-Oncology, School of Medicine,
    185 John Morgan Building
    3620 Hamilton Walk, 19104-6055 898-0078

    Catella-Lawson, Francesca M.D. francesca@spirit.gcrc.upenn.edu
    Department of Medicine,
    HUP, Center of Experimental Therapeutics, GCRC,
    160 Dulles Building,
    3400 Spruce Street, 19104-4283 662-2293

    Gaiser, Robert gaiserr@mail.med.upenn.edu
    Department of Anesthesia,
    HUP, 1110 Penn Tower Building,
    399 South 34th Street,
    19104-4385 662-2401

    Greenberg, Joel Ph.D. greenberg@cvrc.med.upenn.edu
    Department of Neurology, School of Medicine,
    429 Johnson Pavilion,
    3610 Hamilton Walk, 19104-6060 662 6351

    Jensen, Pamela Ph.D. jensenp@mail.med.upenn.edu
    Department of Dermatology, School of Medicine,
    242 Clinical Research Building,
    242 Curie Boulevard, 19104-6142 898-0174

    Kinosian, Bruce M.D. brucek@mail.med.upenn.edu
    Department of General Medicine, School of Medicine,
    1230 Blockley Hall,
    418 Guardian Drive, 19104-6021 573-9623

    Leonard, Debra M.D./Ph.D. debraleo@mail.med.upenn.edu
    Department of Pathology and Laboratory Medicine,
    HUP, Director of Molecular Pathology Laboratory,
    7103 Founders Pavilion, 3400 Spruce Street,
    19104-4283 662-6550

    Nicolson, Susan M.D. nicolson@email.chop.edu
    Department of Anesthesia,
    Children’s Hospital of Philadelphia,
    34th Street & Civic Center Boulevard, 19104-4399 590 1874

    Palevsky, Harold M.D. palevsky@mail.med.upenn.edu
    Department of Medicine, Division of Pulmonary, Allergy and Critical Care,
    Presbyterian Medical Center,
    Suite 441 Philadelphia Heart Institute Building,
    39th & Market Streets, 19104-2699 662-8585

    Robinson, Michael Ph.D. robinson@pharm.med.upenn.edu
    Department of Neuroscience Research, School of Medicine,
    502 Abramson Research Center,
    3516 Civic Center Boulevard, 19104-4318 590-3839 (Lab) 590-2205

    Silberg, Debra M.D./Ph.D. silberg@mail.med.upenn.edu
    Department of Medicine, School of Medicine, Division of Gastroenterology,
    600 Clinical Research Building,
    422 Curie Boulevard, 19104-6144 898-0157

    Spratt, Kelly Anne DO,FACC kspratt@mail.med.upenn.edu
    Department of Medicine, Director, Women’s Cardiovascular Health,
    Prebyterian Medical Center,
    4th Floor, Philadelphia Heart Institute Building,
    39th and Chestnut Streets, 19104 662-9067

    Steinberg, Annie M.D. drannie@mail.med.upenn.edu
    Department of Psychiatry & Pediatrics, Children’s Seashore House,
    Children’s Hospital of Philadelphia,
    34th Street and Civic Center Boulevard,
    19104 895-3806

    Vandenborne, Krista Ph.D. kvandenb@mail.med.upenn.edu
    Department of Rehabilitation Medicine,
    HUP, 5 West Gates Pavilion,
    3400 Spruce Street, 19104-4283 349-8503

    Weinstein, Susan Pae M. D. weinstei.@oasis.rad.upenn.edu
    Department of Radiology,
    HUP, 1 Silverstein Building,
    3400 Spruce Street,19104-4283 662-6726
     

     


    XII. CHARGE TO THE SENIOR WORKING GROUP

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    The memorandum below lays out the charge to the Senior Faculty Working Group as developed by the Faculty - 2000 Steering Committee in late March. It sketches in broad terms how the Working Group might proceed, identifies some of the central issues for discussion, and the recommendations that should be prepared at the end of the process. 

    MEMORANDUM

     March 21, 1999 

    To: Faculty - 2000 Steering Committee

    From: Jim Saunders

    Subject: Charge to the Working Group on Senior Faculty

     

    The Charge to the Working Group (WG) on Senior Faculty should be structured in the following way, and, on the whole, it is much simpler than those for the other WGs.

     

    1. This WG needs to evaluate issues of concern to faculty nearing the end of their academic careers. The process should begin with a thorough discussion leading to a definition of what the term "senior" faculty means. The current definitions and procedures associated with the retirement process need to be understood, and the Handbook and input from Human Resources can provide important guidelines. The WG needs to consider the present options available to faculty as they near the end of their careers, and determine if these options are the same or different for faculty in the CE, Tenure or Research tracks. How do faculty actually deal with these options, and is there a discrepancy between the ideal end-of-career process and what actually happens? How do departments in the School actually deal with senior faculty? The ultimate goal for this WG is to identify strategies and tactics by which: a) faculty can reach the end of their careers with a sense of dignity and accomplishment; and b) the School can most effectively utilize the talents of senior faculty.

        

    2. The WG then needs to thoroughly explore how various departments, both clinical and basic science, treat senior faculty. How do they deal with the financial problems that arise when faculty begin to lose income-earning power from clinical practice or grant supported research. It might be important to collect relevant data on the age distribution of current standing faculty to determine if a "bubble" of senior faculty is moving through the School. It is important to identify when this retirement age "bubble" will hit. The Administrative Assistant assigned to this Working Group can assist in this data collection. Tenure and CE faculty at the Associate or Full Professor levels should further differentiate these data. These data will be essential in determining the magnitude of the problem facing the faculty and the School. The issues identified below then need to be discussed. They are not exhaustive, and serve as points of departure for discussion. Other matters may arise, and when they do, they should be placed on the agenda. 
      • How does the School currently educate faculty on the process of ending their careers? Is this effective, and do faculty know all the potential options?
      • How might increased publicity and accessibility be achieved for retirement education programs for faculty?
      • How can faculty retirement planning be initiated early and be presented as an attractive, planned, and personal choice activity?
      • Should there be a system of faculty representatives in each department trained and informed about retirement options?
      • Is it true that the "phase-out" service plans are widely unknown by the faculty?
      • Is it true that "early retirement" plans exist but are also largely unknown by the faculty?
      • Should there be retirement planning sessions organized and sponsored by the Medical School Faculty Senate?
      • What is the current definition and scope of age discrimination?
      • What efforts are made to avoid cases of age discrimination by the School?
      • Are faculty compensation plans at retirement sufficiently strong, or should they be strengthened?
      • Can departments be identified that make the transition for senior faculty a positive experience? How do they accomplish this?
      • What sort of culture clashes might occur as more junior faculty, especially in clinical departments, end up supporting an ever-growing cadre of senior faculty?
      • Are there special teaching responsibilities that can be assumed by senior faculty that fill niches otherwise unfilled?
      • How can the School best utilize the talents of senior faculty? Should they assume a more intense mentoring role? Should they be used for fund raising?
      • How can we effectively tap into the years of effective research experience by senior faculty in a way that facilitates the research careers of junior faculty?

    3. At this point, the definitions of how senior faculty actually enter the process of finishing their academic careers, arrived at in Steps 1 and 2 above, need to be integrated with the discussion of the specific issues raised above. The outcome of this integration should be an assessment of how senior faculty choose their retirement options, what actually happens to senior faculty, and what, indeed, are the needs of these faculty.

       

    4. The discussion should then focus on how the needs of senior faculty should be addressed. The WG must begin the final task of asking what processes within the School of Medicine and broader Health System serve to facilitate or hinder the activities of senior faculty. To this end, strategies and tactics should be developed in the form of recommendations that will assure a smooth transition at career end. These recommendations should seek to preserve the academic character of this faculty, and identify mechanisms by which their long years of experience can be utilized by the School in a most effective and appropriate manner.

       

    5. Finally, a Position Paper must to be prepared in which the deliberations of the WG are commented upon, and which presents and justifies the final recommendations concerning this faculty. This document will be presented at the Faculty - 2000 Retreat to be held in the late Winter of 2000.

    SENIOR FACULTY WORKING GROUP MEMBERS AS OF SEPTEMBER, 1999

     

    CO–CHAIRS:

    Goldfine, Howard Ph.D. goldfinh@mail.med.upenn.edu
    Department of Microbiology, School of Medicine,
    301C Johnson Pavilion,
    3610 Hamilton Walk, 19104-6076 898-6384

    MacGregor III, Rob Roy M.D. macgregr@mail.med.upenn.edu
    Department of Medicine, HUP, Division of Infectious Disease,
    536 Johnson Pavilion,
    3610 Hamilton Walk, 19104-6073 662-3565

    ADMINISTRATIVE ASSISTANT:

    Clause, Bonnie T. clauseb@mail.med.upenn.edu
    Coordinator of Special Projects, Office of the CEO/Dean,
    1124 Penn Tower Building,
    399 South 34th Street, 19104-4385 898-0748

     

    MEMBERS:

    Berman, Peter M.D. berman@email.chop.edu
    Division of Pediatric Neurology,
    6th Floor, Wood Building, Children’s Hospital of Philadelphia,
    34th Street and Civic Center Boulevard, 19104-4399 590-1719

    Blasco, Luis M.D. lblasco@mail.obgyn.upenn.edu
    Division of Obstetrics-Gynecology,
    HUP, 106 Dulles Building,
    3400 Spruce Street,
    19104-4283 662-2977

    Chalian, Ara M.D. chaliana@mail.med.upenn.edu
    Department of Otorhinolaryngology: Head and Neck Surgery,
    5 Ravdin-ORL,
    HUP,
    3400 Spruce Street, 19104-4283 349-5559

    Chin, Alvin M.D. chinalvi@mail.med.upenn.edu
    Cardiac Center, Division Of Cardiology,
    Room 2215, Children’s Hospital of Philadelphia,
    34th Street and Civic Center Boulevard 19104-6017 590-1820

    Conahan, Thomas M.D. tconahan@mail.med.upenn.edu
    Department of Anesthesia,
    HUP, 401 Ravdin Courtyard,
    3400 Spruce Street,
    19104-4283 662-3746

    Cope, Constantin M.D. cope@oasis.rad.upenn.edu
    Department of Radiology,
    HUP, Ground Floor Ravdin Building,
    3400 Spruce Street, 19104-4283 662-3003

    Davies, Helen Ph.D. daviesh@mail.med.upenn.edu
    Department of Microbiology, School of Medicine,
    201A Johnson Pavilion,
    3610 Hamilton Walk, 19104-6076 898-8733

    Downes, John M.D. downes@email.chop.edu
    Department of Anesthesia & Critical Care,
    Children’s Hospital of Philadelphia,
    Room 9329,
    34th Street and Civic Center Boulevard, 19104 590-1862

    Edwards, McIver M.D. mwedw@mail.med.upenn.edu
    Department of Anesthesia,
    HUP, 1106 Penn Tower Building,
    399 South 34th Street,
    19104-4285 662-3775

    Elder, David MB, ChB, FRCPA elder@mail.med.upenn.edu
    Department of Pathology and Laboratory Medicine,
    HUP, 6th Floor Founders Pavilion,
    3400 Spruce Street, 19104-4283 662-6503

    Esterhai, John M.D. esterhai@mail.med.upenn.edu
    Department of Orthopedic Surgery,
    HUP, 2nd Floor Silverstein Building,
    3400 Spruce Street, 19104-4283 349-8689

    Evans, Audrey M.D. evansa@email.chop.edu
    Division of Oncology, 902 Abramson Research Center
    3516 Civic Center Boulevard, 19104 590-2250

    Kozart, David M.D. kozart@mail.med.upenn.edu
    Department of Ophthalmology,
    Scheie Eye Institute, Suite 505,
    51 North 39th Street, 19104 662-8045

    Lindstrom, Jon Ph.D. jslkk@mail.med.upenn.edu
    Department of Neuroscience, School of Medicine,
    217 Stemmler Building,
    3450 Hamilton Walk, 19104-6074 573-2859

    Nass, Margit Ph.D. margitn@mail.med.upenn.edu
    Department of Radiation-Oncology, School of Medicine,
    B10 Anatomy-Chemistry Building,
    36th and Hamilton Walk, 19104 898-5768

    Potsic, William M.D. potsic@email.chop.edu
    Department of Otorhinolaryngology,
    Children’s Hospital of Philadelphia,Wood Center, Room 1323, 1st Floor,
    34th Street and Civic Center Boulevard 19104-4399 590-3450

    Ramsden, Elsa Ed.D. ramsden@mail.med.upenn.edu
    Post Office Box 507,
    Shawnee-on-Delaware, PA 18356 (610) 499 1278
    (610) 499 1231 (FAX)

    Solomon, David M.D./Ph.D. dsolomon@mail.med.upenn.edu
    Department of Neurology, School of Medicine,
    425 Johnson Pavilion,
    3610 Hamilton Walk, 19104-4285 898-3153

    Steinberg, Marvin M.D. marvin@mail.med.upenn.edu
    Department of Orthopedic Surgery,
    HUP, 8th Floor Penn Tower Building,
    399 South 34th Street, 19104-4385 662 3340

    Stunkard, Albert M.D. stunkard@mail.med.upenn.edu 
    Department of Psychiatry, Room 734,
    3600 Market Street,
    19104-2648 898-7314

     


    XIII. MEDICAL FACULTY SENATE LEADERSHIP

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    HOWARD C. HERRMANN, M.D. (Cardiology) Chair: 1999 - 2000

    DUPONT GUERRY, M. D. (Hematology/Oncology) Chair: 1996 - 1997

    JOHN HANSEN-FLASCHEN, M.D. (Pulmonary/Critical Care) Chair: 1997 - 1998

    JAMES C. SAUNDERS, Ph.D. (Otorhinolaryngology) Chair: 1998 - 1999

    ALAN WASSERSTEIN, M. D. (Renal Division) Chair Elect: 2000 – 2001

     


    XIV. MEMBERS OF THE 1999 – 2000 MEDICAL FACULTY SENATE STEERING COMMITTEE

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    Secretary: David A. Asch, M. D. Medicine

    Secretary Elect: Joan M. VonFeldt, M.D. Medicine

    Basic Sciences:

    Roland G. Kallen, M.D./Ph.D. Biochemistry/Biophysics
    Ann R. Kennedy, D. Sc. Radiation Oncology
    Randall Pittman, Ph. D. Pharmacology
    Timothy R. Rebbeck, Ph.D. Biostatistics and Epidemiology 

    Clinical Sciences:

    Stephanie B. Abbuhl, M.D. Emergency MedicineKevin D. Judy, M.D. Neurosurgery
    Gary R. Lichtenstein, M.D. Medicine
    Joseph S. Savino, M.D. Anesthesia

    At – Large:

    Jonathan A. Epstein, M.D. Medicine
    Allan Gottschalk, M.D. Anesthesia
    Matthew H. Rusk, M.D. Medicine
    Gregory S. Weinstein, M.D. Otorhinolaryngology

     


    XV. MEMBERS OF THE FACULTY – 2000 STEERING COMMITTEE

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    Chair:

    JAMES C. SAUNDERS, Ph.D. (Otorhinolaryngology)
    5 Ravdin-ORL/4283
    898 7504 E-mail:
    saunderj@mail.med.upenn.edu

    ARTHUR K. ASBURY, M. D. (Neurology)
    3 West Gates Pavilion/4283
    662-2629/3360 E-mail:
    asbury@mail.med.upenn.edu

    CAROL DEUTSCH, Ph.D. (Physiology)
    D204 Richards Building/6085
    898 8014 E-mail:
    cdj@mail.med.upenn.edu

    DAVID E. ELDER, M. D. (Pathology)
    6 Founders Pavilion/4283
    662 6503 E-mail:
    david_elder@pathla.med.upenn.edu

    JACK ENDE, M.D. (Medicine, Presbyterian)
    Presbyterian Medical Center
    662-8989 E-mail
    ende@mail.med.upenn.edu

    DUPONT GUERRY, M. D. (Hematology/Oncology)
    7 Silverstein Building/4283
    662-4137 E-mail:
    guerry@mail.med.upenn.edu

    JOHN HANSEN-FLASCHEN, M.D. (Pulmonary/Critical Care)
    873 Maloney Building/4283
    662 6003 E-mail:
    jflash@mail.med.upenn.edu

    HOWARD C. HERRMANN, M.D. (Cardiology)
    9 Founders Pavilion/4283
    662-2180 E-mail:
    herrmann@mail.med.upenn.edu

    FREDERICK S. KAPLAN, M. D. (Orthopedic Surgery)
    2 Silvertein Building/4283
    662 8727 E-mail:
    fkaplan@mail.med.upenn.edu

    THOMAS W. LANGFITT, M. D. (Management) (Ex Officio)
    Wharton School, 405C Lauder-Fisher Hall, 256 South 37th Street/6330
    573-4659 E-mail:
    langfitt@management.wharton.upenn.edu

    S. BRUCE MALKOWICZ, M. D. (Urology)
    1 Rhoads Pavilion/4283
    662 7330 E-mail:
    malkowic@mail.med.upenn.edu

    JOAN MOLLMAN, M.D. (Neurology)
    3 West Gates Pavilion/4283
    662 2613 E-mail:
    jmollman@mail.med.upenn.edu

    VICTORIA MULHERN (Faculty Affairs)
    M158 John Morgan Building/6015
    898 6923 E-mail:
    vmulhern@mail.med.upenn.edu

    PETER C. NOWELL, M. D. (Pathology)
    M161 John Morgan Building/6082
    898 8061/8066 E-mail:
    nowell@mail.med.upenn.edu

    ALAN C. ROSENQUIST, Ph.D. (Neuroscience)
    120 Johnson Pavilion/6060
    898-4286 E-mail:
    rosenqui@mail.med.upenn.edu

    VIVIAN C. SELTZER, Ph.D. (Human Development and Behavior)
    School of Social Work, 3701 Locust Walk/6214
    898 5538 E-mail:
    seltzer@caster.ssw.upenn.edu

    ROSEMARY STEVENS, Ph.D. (History and Sociology)
    School of Arts and Science, Logan Hall, Suite 303/6304
    898 7601 E-mail:
    rstevens@sas.upenn.edu

      


    XVI. WHERE IS THE VOICE OF THE FACULTY?

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    This was scanned from Dr. Eisenberg’s original FAXed text, so there may be some mistakes. It is an entertaining article, quite insightful, yet remarkably germane to our Faculty - 2000 Project.

    Jim Saunders

    By
    Leon Eisenberg, M.D.
    Presley Professor of Social Medicine
    And Professor of Psychiatry, Emeritus
    Harvard Medical School
    Department of Social Medicine
    Boston

    Revision: May 24, 1999

    Presented at a Special Meeting of
    the American Association of University Professors
    on Academic Values in the Transformation of American Medicine
    Omni Parker House Hotel
    Boston, MA
    May 22, 1999

    May 20-23, 1999

     

    I have entitled this address "Where Is the Voice of the Faculty?" to convey my dismay at how the prerogatives once exercised by faculty have been almost entirely usurped by administrators with relatively little protest from faculties as Academic Health Centers (AHCs) try to cope with a competing "medical market place."

    I considered another title for this talk: "Who Is Minding the Store?" to convey my dismay at the wrong-headed decisions made by AHC administrators without participation by faculty, and, so far as I can tell, without much oversight by any other group. Boards of Trustees, supposed to function as fiduciaries for the public, seem to be asleep at the switch, responding only after the train wreck, as seems to have been the case in the Allegheny fiasco.

    With neither question do limply that a more central role for faculty would, in and of itself, have assured a better outcome. During the past fifty years, all of us, faculty, administrators and trustees alike, have fed the exponential increase in health care costs; in the process, we created a pot of funds irresistible to corporate entrepreneurs. In the era of cost-plus reimbursement, neither physicians, nor administrators, nor trustees spoke up for the public interest to exercise restraint on growth. The Willie Suttons of Wall Street saw money for the taking in health care; and take it they did. They were able to siphon off tens of billions of dollars. Our failure to seek common ground with our patients allowed investors and managers to take charge of the health care system. There is simply no way for us to defend patient care, teaching and research if we join the battle with the entrepreneurs on their turf and on their terms.

    Simply put, health as a social good cannot be allocated effectively by the invisible hand of the market Do I exaggerate? Last week, under the headline "Oxford Health Turnaround is Still a Work in Progress," the New York Times reported that Oxford, to quote the story, "has backed away from the brink of bankruptcy by shedding thousands of loss-making members and raising premiums"(Freudenheim 1999). For those who need a translation, "loss-making members" means sick people. Who were shed? Medicaid and Medicare enrollees, the poor and the elderly, the vulnerable citizens that community-rated insurance should shelter.

    Market Medicine

    Fifteen years ago, in a prophetic paper, John McKinlay, a sociologist, and John Stoeckle, an internist, wrote about the "proletarianization" of the American physician That is, as the doctor loses control of the means of production, he becomes a wage laborer subject to the control and incentives of the owner-managers of the commodified health system Admittedly, we are well-paid proletarians, but we have lost control of our working conditions. With growth in size of the ARC, organizational centralization has become more prominent; decision-making is ever further removed from the sites where physicians care for patients. Physician-executives become more like executives and less like physicians as they rise in the hierarchy. Tics between the medical school, the university and the AHC are becoming more tenuous as some schools sell off their teaching hospitals and other hospitals expand into service Systems. Hospital behemoths, too large to be governed efficiently in the first instance, "merge" - whatever merge means in one or another case - into even larger entities.

     

    How simple the past now seems! If my memory does not betray me, I dimly recall that the Massachusetts General Hospital was governed by a General Director who was expected to review major policy decisions weekly with a General Executive Committee on which all service chiefs were represented, and with an Executive Committee of the Board with elected staff representatives. It was no love feast; there were fierce arguments; I lost a number of battles; but all voices were heard. How quaint that memory seems today!

     

    Department chairs no longer control faculty appointments. When the CEOs of the hospital corporation buy up physician practices and community hospitals, the doctors whose practices are acquired automatically receive faculty appointments. Apart from their varying degrees of competence as clinicians, many chose the practice mode because they lacked interest in, and skill at, teaching. Providing nominal faculty appointments for them dilutes the meaning of such appointments. It adds to the unfairness of exacting teaching commitments from career teachers who carry the burden at personal cost. Decisions about salaries and benefits, once (more or less) the prerogative of the chair and executive committee of each department, now are made by the executives of the hospital physicians' organization, who represent the corporate interest in keeping the bottom line in the black rather than in achieving academic, clinical, or research goals. Some wag recently described a Department Chair as a person who gets the bad news from the CEO and passes it on to the faculty.

     

     

    Faculty find themselves over-burdened and constantly busy at paper work. Morale at teaching hospitals is lower than I can recall during my 50 years in academic medicine at Penn, Hopkins and Harvard. Clinicians Complain that the satisfactions they sought in choosing academic careers are eroding. To my dismay, colleagues report that they are happy none of their children are going into medicine! My wife and I are happy that three of our children have done so. I am astonished by how many physicians in their 50's and early 60's are longing to retire from clinical medicine once financing permits. What a striking change! When I was on the General Executive Committee of the Massachusetts General Hospital in the early 1970s, the problem we faced at all too frequent intervals - was how to persuade superannuated colleagues, whose skills were failing, to give up active practice.

     

    Demoralization is virtually universal, although each medical community has its own laments. At Harvard Medical School, the fission and fusion of its teaching hospitals into two mega-behemoths and several residual free-standing independents competing with each other, has destroyed excellent joint fellowship and service programs and has replaced collegial relationships with strife over, forgive the despicable phrase, "covered lives."

     

    Clinicians complain that they can no longer offer their patients the time necessary to make them active participants in their own care. They no longer have the "luxury" of consulting with colleagues about the complexities and challenges of the clinical conundrums they face. Because they are expected to generate clinical income, the time they devote to teaching is regarded as a debit item by the Division Chief. Indeed, although medical schools give more lip service to the importance of teaching for promotion than they did a decade or two ago, the one unequivocal recognition of time spent teaching is a smaller check at the end of the pay period because clinical income has declined. Teaching hospitals are hemorrhaging cash; clinicians are being pressed to bring in more patient income. The messages are direct, not subtle: teach less; teaching is not remunerative; see more patients per clinical session; we have to remain competitive.

     

    Just how widespread these concerns are among faculty and students evident from a study reported in the March 25th issue of The New England Journal. Simon and his colleagues (1999) surveyed a national sample of medical students (506), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S medical schools to determine their views of managed care. Expressed attitudes were uniformly negative. A sizeable majority rated fee-for-service medicine better than managed care in terms of patient access, ethics, doctor-patient relationship, continuity of care, chronic illness care, and care at the end-of-life. Faculty members and deans reported that managed care had reduced the time available for teaching and research and had reduced income.

     

    Physician disparagement of the extent of access, continuity, and quality of care for patients with chronic illness in MCOs echoes the complaints of their patients. Medicare patients in MCOs disenroll at high rates once they become sick and find out that services are difficult to obtain, a phenomenon Morgan and his colleagues (1997) have labeled "The HMO Revolving Door - The Healthy Go in and the Sick Go Out."

     

    Faculty have lost control but so has Academic Health Center management. To increase market share in dealing with insurers, academic medical centers went into a virtual frenzy of buying up medical practices. Sale prices included a lump sum up-front for practice size plus several years of salary guaranteed at about what the physicians had been earning. In just about every venue where that strategy has been adopted, the result has been a net loss of tens of thousands of dollars per doctor per year for the duration of such contracts. Why? For one thing, doctors who had been hustling in order to maintain their incomes in the face of the fee reductions from third party payers slowed down their pace once income was not at risk For another, loss of control over thc practice environment by the imposition of central management and billing alienated the practitioners and introduced new inefficiencies. How did so many smart medical executives buy the Brooklyn Bridge at the same time'? As best as it can be reconstructed, it was the result of advice from management consulting firms with no understanding of medical practice.

     

    As I see it, "we" are becoming clones of "them" in trying to compete in a winner-take-all poker game where they control the cards. They screen out the sick and the poor; they abjure teaching and research; they buy political influence in Congress and State Houses; and they wrap themselves in the American flag as they trumpet the virtues of the market-place - that is, so long as they continue to be winners. If profits thin out, it's off to selling used cars again!

     

    There is simply no way at all over the long run that an academic health science center can maintain excellence in clinical care, serve impecunious patients, teach students and residents, advance the science of medicine and compete for price with hospitals that do not teach or do research and are willing to provide care no better than they need to, so long as they can do so at a profit (36). What is the evidence for my claim?

     

    Analysis of extramural grant awards reveals an inverse relationship between penetration of the "medical market" by managed care organizations and the likelihood that medical schools situated within those "market areas" compete successfully for NIH awards (37). Potential investigators in such schools have less "protected time" because they are obliged to carry greater patient care responsibilities (38). Competition in health care markets squeezes out funds AHCs have (in the past) earmarked to support research. It reduces the time practitioners give to charity care (Fletcher 1999). Institutional support for unsponsored research in the most competitive markets was less than half that in the least competitive markets. Costs at academic medical centers are about 44% higher than those for non-teaching hospitals because of teaching intensity (39). Without substantial subsidies from an all-payer fund, academic medical centers will be non-starters in a competitive medical market place.

     

    Bill Danforth, Chairman of the Board of Washington University at St. Louis, has reminded us that universities are not business enterprises:

     

    "Some in business foresee a work force with loose, and even temporary, ties to organizations. Universities spring from a different culture. Faculty are citizens of their institutions as well as employees, citizens who deserve loyalty of the institution even as the institution asks for theirs ..."

    "Whether universities adapt successfully to the present environment will. in my view, depend on whether individual faculty members correctly read the needs of the era and take personal responsibility for the success of their institutions. I can think of nothing more important or rewarding than to help preserve our research universities for the next generation so that they may continue to represent the highest aspirations of the American people."

     

    Bill Danforth, you will have noted, emphasizes reciprocity: loyalty of institutions toward faculty and loyalty of faculty toward their institutions. Loyalty is in short supply today.

     

    As the behavior of the Academic Health Center emulates that of the MCO, is the game worth the candle? There is an old story of a nudist traipsing through the streets of London. Espying him from a distance, a Bobby shouted Out: "Halt!" The nudist began to run. The Bobby pursued him as fast as he could but began to fall behind because of his heavy equipment. As he discarded his helmet, his billy club, his overcoat his speed increased. When all his clothes were off, he caught the miscreant. However, it was no longer clear who was upholding law and who was violating it. Are "we" on our way to such a victory?

     

     

    The Incompatibility of the World of Medicine with the World of Business

     

     

    In the first book of The Republic. Socrates avers that:

     

    "Medicine does not consider the interests of medicine, but

    the interest of the body.. no physician, insofar as he is a

    physician, considers his own good in what he practices,

    but the good of his patient..."

     

    Socrates knew that physicians needed (and wanted) to be compensated. The art of medicine, he noted, is accompanied by another art; "the art of pay." Sadly enough, all of us know physicians far more dedicated to the art of pay than to the art of medicine. But the fact that some are corruptible does not alter the ideal physicians should follow. Socrates added that medicine is "not the art of receiving pay (simply] because a man takes fees when he is engaged in healing."

     

    Contrast that ideal with the pragmatics of the market place, as enunciated by the high priest of laissez~faire capitalism, University of Chicago Professor Milton Friedman (1). He proclaims that:

     

    "Few trends could so thoroughly undermine the very foundations of our free society as the acceptance by corporate officials of a social responsibility other than to make as much monev for their stockholders as possible." (boldface added) (p.133).

     

    Pragmatism is replacing idealism in the Academic Health Center. What works, we are told, is what matters. Some colleagues see nothing wrong with a market economy in medical care. They have become as adept at referring to "covered lives," "consumers," and "providers" as my generation was at using the quaint terminology of "patients" and "doctors." Words matter; words embody values Consumers had best beware of sellers; patients must be able to trust doctors. Providers are adepts of the art of pay, physicians adepts of the art of medicine.

     

    I make no bones about it. The Surgeon General of the United States should be urged to stamp every investor-owned managed care policy with the warning: "For-profit care is dangerous to your health." If that statement sounds like hyperbole, I remind you that Columbia-HCA, the largest for-profit hospital chain1 had to sack its CEO in response to a federal criminal investigation of its practices (28, 29). An FBI affidavit charges that Columbia/FICA defrauded Medicare of tens of millions of dollars through its home health operations (30). The corporation maintained two sets of books, one for its own accounting purposes and a second set to justify overcharges to the government. It pressured its doctors to invest in its hospitals so they would have a financial stake in referrals; it provided cash bonuses to its executives if they met financial targets (31,32).

     

    The most recent scenario in the spreading saga of mismanagement and corruption is the bankruptcy of the Allegheny Health Systems (AHS) and its captive medical school, the grandly named "Allegheuy University of the Health Sciences." In the year before the collapse, Allegheny's top three officers received $ 1 million or more in annual salary. Nineteen of the 100 best paid health executives in the Philadelphia area worked for AHS, fourteen of them earning more than $500,000 each.

     

    The CEO of AHS, S-S. Abdelhak, sent a memo to his top lieutenants "to remove up to $70,000,000 from Philadelphia area endowments to pay bills; they were to borrow from "various temporarily restricted endowments" and use the money "for cash needs." Just how much was taken illegally from endowment income is still being determined. Why were there no whistle blowers? Hospital executives, academic administrators and key faculty were paid so well they kept their mouths shut!

     

    Where were the Trustees, the representatives of the public interest, while the executives who kept purchasing new hospitals enriched themselves with large salaries? The tale should give us all pause as our own institutions buy up hospitals and practices at a loss, add administrative layers and usurp faculty prerogatives. In fairness, the Allegheny trustees did pay some attention to what was happening. In the weeks before the system filed for bankruptcy, it quadrupled the value of liability insurance policies covering its Board of Directors and system officials (Goldstein 1998). Newspapers reported that loans from Mellon banks were repaid in the months before bankruptcy. It is, undoubtedly, a coincidence that several Mellon bankers are on the Allegheny Board.

     

    The "Good Old Days" Were Not Good for Patients

     

    This is not a nostalgic plea for the resurrection of fee-for service medicine. The "good old days" were not good old days at all for far too many patients. Alone among industrialized countries (42), the United States has tolerated and continues to tolerate large numbers of people who have no health insurance (currently estimated at 45 million) or who are underinsured (29 million) Eleven million of the uninsured are children (43). Those children are twice as likely to have no regular physician and are four times more likely to go without needed care than children with insurance (44). In Uwe Reinhardt's (45) trenchant words: "The United States ... openly countenance(s) the practice of rationing health care for millions of American children ... by the parents' willingness and ability to procure charity care in their role as health care beggars."

     

    The way medical care had been provided under fee-for-service was skewed toward doing too much and too often by a reimbursement scheme which systematically undervalued cognitive services and disproportionately rewarded procedures. The cost of care rose at an insupportable rate. It had been just under 6% of the GDP in 1965; by 1997, total health care outlays had risen to about 14% of the GDP (52). The sky-rocket was fueled by fee-for-service reimbursement for physicians and cost-plus reimbursement for hospitals. Neither academics nor practitioners complained until the health system was so awash in money that entrepreneurs, looking for easy ways to enrich themselves, came upon the new source. Now, managers reign supreme; doctors have become workers in "care" factories. Plans grow richer - and doctors get bonuses for withholding care. Trust in doctors, a key ingredient in care, is being eroded.

     

    The Impending Demise of For-Profit Managed Care

    Radical change is on its way. The for-profit fantasy of fat profits and low costs has burst. The large sums squeezed out of the system have proved to be one-time things based on cutting back excess bed capacity, reducing physician/patient ratios and controlling referrals and bed use. Profits have fallen; bankruptcies are on the increase; credit ratings are lower. Just one week ago, the Boston Globe reported (Pham 1999) that all of this state's major health insurers reported operating losses for the three months of this year; the largest, Harvard Pilgrim Health Care, posted a $22 million loss. All estimate premium increases of 5 to 10%, however, with no plans to pay their doctors more. Several large physicians groups, Apex in Portsmouth, Nil, and Partners in Boston have cancelled contracts with Tufts Health Plan.

     

    The much-vaunted boast of MCOs as moderators of rising costs of health care has turned hollow. Spending reached one trillion dollars in 1997. Once again, it is growing faster than the rest of the economy; at present rates, it is projected by the Health Care Financing Administration to reach $2.1 trillion, or 16.6% of the UDP, by the year 2002 (59). At the same time, insurance coverage is eroding; the proportion of Americans without insurance increased from 14.2% in 1995, to 15.3% in 1996 and 16.1% in 1997; the number who are underinsured grows even faster (60). Surely, this is intolerable and change will follow. What is not self-evident is what will be left in its wake. The shape of the future will depend in part on whether we continue to emulate business tactics or join forces in a coalition to support the health of the public.

     

    Having cited The Republlc, let me turn to The Laws; that is, with Plato's description of commodified care. Plato contrasts two categories of doctors, slave doctors and free doctors;

     

    "Slaves -. are almost always treated by other slaves who either rush about on flying visits or wait to be consulted in their surgeries. This kind of doctor never gives any account of the particular illness of the individual slave, or is prepared to listen to one; he simply prescribes what he thinks best in the light of experience as if he had precise knowledge, and with the self-confidence of a dictator. Then he dashes off on his way to the next slave-patient, and so takes off his master's shoulders some of the work of attending the sick. The visits of the free doctor, by contrast, are mostly concerned with treating the illnesses of free men his method is to construct an empirical case history by consulting the invalid and his friends; in this way he himself learns something from the sick and at the same time he gives the individual patient all the instruction he can. He gives no prescription until he has somehow gained the invalid's consent; then, coaxing him into continued cooperation1 he tries to complete his restoration to health. Which of the two do you think makes a doctor a better healer, or a trainer more efficient?..."

     

    Which of the two methods is it to be? Will doctors continue to be coerced to prescribe without listening to the sick and to dash off to the next patient at the behest of their masters or will they be able to learn from the sick, obtain their consent, offer instruction, and try to restore those who are ill back to health?

     

    The passage sounds almost prescient but that is because we read ourselves into the language. Having employed overheated rhetoric, let me caution against it. We doctors are not slaves, even if we have lost some degrees of freedom we enjoyed a decade or two ago. We are not proletarians or, if you insist we are, we are remarkably well-paid proletarians.

     

    But we are adrift. We allow ourselves to be buffeted from all sides because we have lost sight of what should be our primary goal: protecting the health of the public rather than protecting the rights or the income of the profession (except in so far as conditions of practice affect health care delivery).

     

    Specialists and generalists continue to fight over income streams; both are manipulated by managers. Clinicians complain that medical school resources are spent on basic scientists; basic scientists lament their lower salaries and their dependence on securing research grants while medical schools expect them to teach but pay them little or nothing for doing it. Yet, all of us, specialists, generalists and basic scientists are committed in principle to medical education, an educational process which requires the best efforts of each of us in a cooperative rather than competitive mode.

     

    By all means, Academic Health Centers should cut out waste and maximize efficiency. We have waited far too long to get on with that job. However, precisely because we teach and because we do research and because we emphasize excellence in clinical care, our costs will remain higher, we cannot compete for price with medical institutions that do none of the three. We have to become political activists to get that message to the general public. We have to make it clear to our elected representatives that medical education and research ought to be supported by a tax on the entire health care system. The more we focus on the health of the public and submerge our parochial interests, the more believable we will be.

     

    Faculty must organize and demand participation in decision-making. Generalists and specialists, basic scientists and clinicians have to confront differences, recognize that all of us are in a common enterprise, and rally to the defense of academic values.

     

     

     

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