University Times

Next week, School of Medicine professors will elect a new, seven-member committee that's intended to represent faculty interests as University and UPMC Health System officials work out details of a unified Pitt physicians practice plan.

The new committee's mission was spelled out in a motion approved at a March 24 medical faculty meeting, and endorsed by Faculty Assembly on April 7.

See text of the motion on page 5.

But that mission seemed less clear following a discussion among faculty and administrators at the April 13 Senate Council meeting.

Chancellor Mark Nordenberg welcomed what he called "appropriate interaction" with the new committee, but said the motion focused too much on sharing documents.

"It may well be, as is true at this moment, that our discussions [of a unified plan] are far ahead of any document-drafting that accompanies that effort," Nordenberg said.

Medical professors had asked Pitt's administration to let the faculty committee see "all pertinent documents" related to the planned University of Pittsburgh Physicians unified plan. UPP is being formed through a merger of the 17 previously independent Pitt faculty practice plans of the School of Medicine plus the dental school's practice plan.

Representatives of Pitt, UPMC and UPP are negotiating a new financial relationship through which the health system would absorb UPP.

Given the intensified competition among health care providers and related factors such as declining Medicare reimbursement rates for physicians, few medical professors have argued publicly against a unified Pitt practice plan with closer ties to UPMC.

But during a series of meetings this term — including a Feb. 19 meeting attended by some 1,000 medical faculty and students — professors said UPMC's takeover of the Pitt practice plans threatens to create a system that rewards faculty only for generating clinical revenue, thus undermining the medical school's teaching and research.

Professors also complained that most of the school's 1,370 faculty members have been kept in the dark about UPP negotiations.

Faculty and administrative members of Senate Council clashed over both of those issues this week.

"We seem to be making teaching and research less lucrative than clinical work" for medical faculty, said psychology professor James Holland.

He cited a plan to cut salaries of nearly 1,000 clinical medical faculty by 10 percent over each of the next three years. Faculty were told they could make up the cuts, and earn additional income, by seeing more patients.

Holland called the system "very troubling" and a threat to the medical school's academic mission.

Chancellor Nordenberg told Holland, "I share your values on this," but the chancellor also stated that: * One of the task forces that first outlined UPP more than a year ago concentrated on academic issues. Dermatology department chairperson Brian Jegasothy headed the task force, which included faculty members as well as administrators. "I did have discussions about these [academic] issues" with the task force, Nordenberg said.

* Faculty duties and revenue sources are "markedly different" for the medical school compared with other Pitt schools. Nordenberg, a former dean of the School of Law, compared his old school with the School of Medicine. While the law school enrolls about 740 students and employs fewer than 50 full-time faculty members, the School of Medicine has approximately 700 students and 1,370 full-time faculty.

And while law professors' salaries are paid by student tuition and Pitt's state appropriation, those two revenue streams are only "minor sources" of financial support for medical faculty, the chancellor said.

* Although communication could be improved, "I do think there has been a genuine commitment on the part of many within the medical school to communicate" with faculty about UPP negotiations, Nordenberg said.

Thomas Detre, senior vice chancellor for Health Sciences, said "a cast of dozens" of clinical department chairpersons and professors have been drafting and reviewing UPP bylaws and related documents over the last eight months.

Currently, lawyers for Pitt and UPMC are studying the documents, he said.

A UPP proposal is not in final draft form yet, Detre said.

Assistant Chancellor Jerome Cochran, a key participant in the current negotiations among Pitt, UPMC and UPP, denied the existence of "some mystical, magical process being undertaken, in the course of which people who have vested interests [in UPP] are being excluded." Cochran added, "The thought that the people involved in the clinical departments have no sense of where they are, what the external environment is, where they're headed and what's the best step to take for where they're headed, is to me a little bit absurd." Clinical department chairpersons and faculty have discussed plans for the unified practice plan in meetings with UPP President Richard Barron, chairperson of the radiology department, Cochran noted.

"Through that process, they [faculty and chairpersons] have had much more opportunity to analyze these issues than by any other process the University or the School [of Medicine] could choose to impose." Cochran said he believes "only a small percentage" of clinical faculty oppose plans to create UPP as a UPMC subsidiary.

Dental professor John Baker suggested that Cochran was missing the point of the recent School of Medicine motion calling for an elected faculty committee: to ensure faculty participation in the current UPP negotiations.

Cochran replied: "There were only, what — 150, 175 faculty at that meeting [where the motion was adopted]? Obviously, somebody has some satisfaction with the existing process…" Earlier in the meeting, Senate Vice President Nathan Hershey said it was "somewhat misleading" for Pitt administrators to downplay the importance of sharing UPP draft documents with faculty.

In January, Hershey said, the Provost's office sent letters to untenured medical faculty, asking them to agree to sign new contracts in the future — in effect, requesting that they pledge to sign a document they hadn't seen yet.

Provost James Maher disagreed with that description of events.

According to Maher, the Provost's office sent letters to medical faculty whose contracts were up for renewal Jan. 15, informing recipients that the terms of their future contracts were likely to change because of anticipated changes in medical school finances.

Letters signed by Maher, interim medical Dean Micha-lopoulos and the faculty members' department chairpersons were sent before the Jan. 15 deadline, telling faculty that the dean and their chairperson intended to renew their contract "but were not yet in a position to specify the terms of that contract," the provost said.

"That was a good faith effort to give them [faculty up for renewal] the most information that could be made available at that time about the question of whether or not their contracts would be renewed," Maher said. "No one was given that letter who did not need notice of renewal." q At the April 7 Faculty Assembly meeting, several professors expressed concern that the proportion of tenured faculty in the School of Medicine will continue to shrink as the UPMC Health System expands.

Anesthesiology professor Nicholas Bircher protested, "For every hospital that is purchased by UPMC, there are another slew of faculty titles passed out" — nearly all of them clinical appointments outside the pipeline for tenure.

As the relative number of traditional academic faculty members diminishes, Bircher said, the medical school's commitment to teaching and academic research could fade. "There will rapidly become nobody in the tenure stream" in the School of Medicine, he said.

The number of non-tenure stream faculty in the medical school rose from 142 (32.3 percent of the school's total full-time faculty) in 1974 to 944 (68.8 percent) in 1996, according to Pitt's Office of Institutional Research.

Only clinicians with Pitt faculty titles can refer patients to UPMC hospitals. So, it's in UPMC's interest to appoint more faculty, refer more patients and generate more revenue, Assembly members said.

After Monday's Senate Council meeting, Chancellor Nor-denberg and Provost Maher emphasized that UPMC cannot appoint Pitt faculty members.

Each faculty appointment must be initiated in the appropriate academic department, approved by the dean, and then by the provost (and, in the Health Sciences, also by Senior Vice Chancellor Detre), the administrators said. Maher confirmed that physicians must have Pitt faculty titles to refer patients to UPMC Presbyterian, UPMC Montefiore, Eye & Ear and Western Psychiatric Institute and Clinic. But at the growing number of UPMC-affiliated hospitals outside Oakland, physicians don't need Pitt faculty titles in order to refer patients, he said.

"Sometimes, [Pitt medical school] department chairs will recommend faculty titles for physicians at those affiliated hospitals," the provost noted.

"In those cases, the proposed appointment would come up through the normal academic process."

— Bruce Steele