Striking a nerve. Apparently, Orac takes exception to I said a few days ago:

Dr. Kevin’s comment revealed a common misconception of what it is really like to work in academic medical centers that is common among physicians in private practice . . . If you’re in academia for any length of time, you become aware that many private practitioners appear to have some sort of stereotypical picture of us academicians sitting in our “ivory towers” sipping lattes, thinking deep thoughts, reading journals, doing seemingly arcane experiments, and not having to deal with the reality or nitty-gritty of the “real world” of taking care of patients . . . Indeed, I have news for Dr. Kevin: Medical academicians have been operating in the “real world” for at least a decade now. It began back in the 1980’s, when HMOs and managed care rose to become the dominant means of paying for health care, and accelerated throughout the 1990’s. Before then, it was quite possible for clinical departments to build up impressive surpluses from clinical revenue that they could devote to research because it was generally accepted that academic institutions were more expensive and less efficient because of their research and teaching missions, and insurers and the government were willing to pay extra. However, as the bottom line became more and more important, as insurers and third party payers ceased to differentiate between academic and nonacademic health care providers, the financial squeeze became more and more pronounced. Worse, because of our research and teaching missions, it is almost impossible for academic medical centers to operate as efficiently as private medical centers, putting them at a competitive disadvantage for managed care contracts, as I’ve been learning from the prolonged discussions of finances and contracts that dominate nearly every Department of Surgery faculty meeting at my institution. Add to that the responsibility as tertiary care centers to accept and care for the sickest (and therefore often less profitable) patients and the frequently high rate of uninsured patients cared for in university medical centers, and it becomes clear that the “ivory tower” of academic medicine is something that has all but faded into legend.

No offense meant. I sympathize with the plight of the academic physician – with the continual dual pressures of research funding and the financial “bottom-line”. It just seems that many of the suggestions proposed by our “leaders in academia” seem so impractical that one can’t help but to feel that academic physicians are out of touch with the real world.

Orac gives a final word.


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