University Times

Sheldon Adler, whose forced resignation as the No. 2 administrator in Pitt's School of Medicine has become a cause cel-bre in and outside the school, said he hopes his dismissal won't distract people from what he called "the real issues" at stake for medical faculty.

"The discussion shouldn't be about me or George [Michalopoulos, interim medical school dean] or [UPMC Health System President] Jeffrey Romoff. It should focus instead on the marked decline in shared governance within the medical school in recent years, certain compensation issues affecting the faculty, and the threats posed to our educational mission by the proposal to transfer the [University of Pittsburgh Physicians] practice plan from the medical school to UPMC." Medical faculty are scheduled to discuss those and other issues at a meeting today, Feb. 19, at 5:30 p.m. in Scaife Hall Lecture Rooms 5 and 6.

A large turnout is expected, but Adler said he couldn't make any other predictions about the meeting. "It could be a reasonable debate," he said. "There could be motions made or there could be no particular outcome. It could degenerate into name calling — I hope not, but there's a lot of pent-up anger, paranoia and concern among the medical faculty right now.

"Personally, I don't think there's any place for yelling and name-calling. If we can't keep our cool in an argument, we've lost the high ground." Adler lost his job as senior associate medical dean last week. In a Feb. 4 telephone conversation with Adler, Interim Dean Michalopoulos asked for his resignation by the end of that week.

A day earlier, Michalopoulos had participated in an often-heated Faculty Assembly discussion of the UPMC Health System's planned acquisition of the University of Pittsburgh Physicians practice plan as a wholly owned subsidiary. See story in the Feb. 5 University Times.

Assembly members also discussed a related plan to cut the salaries of some 1,000 non-tenure stream medical faculty by 10 percent during each of the next three years. Medical faculty were told they could make up for the reductions, and earn additional income, by seeing more practice plan patients.

What prompted the Faculty Assembly discussion was a memo to Michalopoulos from five medical faculty members dissatisfied with the pay cuts and UPMC's absorption of the school's practice plans.

The five faculty members sent Adler two copies of their memo on Jan. 20, requesting a faculty meeting to discuss the changes. The memo-writers asked that the meeting be held within five weeks of their request, in keeping with the medical school's plan of organization.

One copy of the memo was signed by the five faculty members. The other copy was unsigned. Saying they feared reprisals by the administration, the signatories asked Adler to forward the unsigned copy to Michalopoulos.

But Michalopoulos insisted on seeing the signed copy too. He told Faculty Assembly he wanted to verify its authenticity, and that he was reluctant to call a faculty meeting on the basis of an anonymous memo. Adler gave Michalopoulos the signed copy.

Later, a memo detailing a private conversation between Adler and Michalopoulos was circulated among medical faculty. Michalopoulos told Faculty Assembly the memo violated his right to confidentiality.

Michalopoulos also argued for delaying a full faculty meeting until after an already-scheduled series of departmental meetings to discuss the practice plans' transfer to UPMC.

But Assembly members rejected the interim dean's argument. They approved a resolution calling on Michalopoulos to hold the schoolwide meeting by late February, in keeping with the school's plan of organization.

Although the Assembly resolution wasn't binding, Michalopoulos agreed to the request.

It was the following day that Michalopoulos called for Adler's resignation — a move University Senate President Gordon MacLeod called "demoralizing" to faculty and "a great mistake." Michalopoulos and Pitt senior administrators have declined to comment on the ouster. At the Feb. 9 Senate Council meeting, Chancellor Mark Nordenberg said he would not talk about Adler's dismissal "both out of a sense of professional propriety and because each of the individuals involved is someone for whom I have feelings of deep respect." Nordenberg said that, based on what he knows of the situation, Adler's dismissal "would not fit into the retaliatory category." The chancellor said of Michalopoulos, "I have not seen anyone in a comparable position who has been a stronger defender of the academic mission and the faculty's interests." Senior Vice Chancellor for Health Sciences Thomas Detre also declined to comment on Adler's resignation.

Adler told the University Times: "Too many people at this University are trying to equate having a disagreement with disloyalty. That's what I'm concerned about.

"I don't know why George [Michalopoulos] does what he does," Adler added. "But I do know that, for me, this wasn't a personal thing. I was around when we recruited George years ago as a professor and chairman of pathology. I've worked with him for years, and I respect him." Adler, who will retain his faculty position as a full professor of medicine, urged colleagues not to view the school's administrators as good guys or bad guys. Nor should they think of UPMC leaders "as some sort of Darth Vaders," he said. "I know there's a pervasive feeling in the medical school that casts people from UPMC as villains, but that's simplistic.

"I believe the medical school should and must work with UPMC in the future," Adler said. "We need each other. The significant concern is, how do we reconcile the two institutions' missions and make sure that neither entity is subservient to the other?" If UPMC and its dollar-focused leaders take control of medical school revenues, the school's core academic mission could suffer, Adler said. "The main reason I'm in favor of the practice plans remaining within the school, and not being transferred to UPMC, is that I'm afraid [the latter move] will marginalize education and research.

"The peril is that money will become the sole driving force, and faculty will recognize that the rewards system is for money-generation, not for excellence in education or even in research that isn't tied to money." Adler, who joined the faculty in 1966, said he's seen a marked decrease in shared governance between medical administrators and faculty since the mid-1970s. "Especially in the last decade, there has been an acceleration in the loss of shared governance. Faculty feel that they are no longer significantly involved in decision-making," he said.

Medical faculty lack access to information they need to judge the pros and cons of a UPMC takeover of Pitt practice plans, according to Adler.

"For all I know, if I were privy to the budget numbers and what the alternatives are, I would come to the conclusion that the practice plans should be transferred to UPMC. I doubt it, but I'm hesitant to say what's right or wrong without that kind of information." Some loss of shared governance was inevitable, Adler said, given the seven-fold increase in medical faculty members (most of them ineligible for tenure) during the last two decades. "When you add that many people, especially from outside the tenure stream, it's bound to have a negative effect on collegial decision-making," he said.

But the situation didn't have to deteriorate as badly as it has, Adler insisted. And it's no good, he said, blaming managed care, with its threats to medical schools and academic medical centers.

"Managed care — which, in my estimation, should be called managed cost; it has little to do with care — is being used by some people as a tool to make money the bottom line in health care," Adler said. "It was inevitable that changes and hard decisions would have to be made, unpalatable ones at times. But we didn't have to see the deterioration of shared governance we've had at this medical school. It's not this way at a number of other places around the country."

— Bruce Steele