University Times

Since Jan. 1, School of Medicine faculty with clinical duties have been jointly employed by Pitt and the recently formed University of Pittsburgh Physicians (UPP) practice plan.

Depending on their job duties and their departments' policies, clinical faculty earn varying portions of their salaries from the University and from UPP. The latter is a subsidiary of UPMC Health System and is independent of Pitt.

So, what happens if a clinical faculty member's academic responsibilities (teaching, research, advising students) conflict with his or her clinical duties (treating patients, thereby generating revenue for the health system)? That question — and other, equally complex ones — inspired a Feb. 1 Senate Council motion that would have called on Pitt's administration to turn over "any and all affiliation agreements between the University and the UPMC Health System (including those directly made with its subsidiary, UPP)" to two groups: the University Planning and Budgeting Committee and an ad hoc committee of medical professors.

Senate Council voted 16-8 to table the motion, at the suggestion of Provost James Maher. Earlier in the meeting, Chancellor Mark Nordenberg had warned that he would not comply with the motion's request for full access to Pitt-UPMC documents.

As a tabled motion, however, it will be the first order of business at the next Senate Council meeting, scheduled for March 22.

Nordenberg offered to meet with faculty to answer specific questions about UPP and the Pitt-UPMC relationship. The chancellor also reiterated what he's been saying at meetings of medical faculty, Senate Council and other campus groups for the last year: He's spent more time as chancellor dealing with Pitt-UPMC relations, and faculty concerns about UPP, than on all other issues combined.

But as for giving faculty access to "any and all" Pitt-UPMC affiliation agreements, Nordenberg said: "As a matter of general practice, I do not consider contracts between the University and other organizations to be public documents.

"When we enter into a vending contract with Pepsi-Cola, we don't disclose the contents of that document. And in this case, we are operating in an environment [in the health care business] that is every bit as competitive." The Senate Council motion had been introduced by Council member Nicholas Bircher, a clinical faculty member who serves on the medical school's faculty ad hoc oversight committee. Medical professors elected the oversight committee last year to represent faculty interests in UPP negotiations.

UPP officially became the school's sole clinical practice plan on Jan. 1. It was formed through a merger of the medical school's 18 previously independent practice plans.

Bircher argued that Pitt's senior administration should turn over all Pitt-UPMC affiliation agreements to the ad hoc committee and to the University Planning and Budgeting Committee (an advisory group of administrators, faculty, staff and students) "for the purpose of informing them of the precise nature of the joint employment status of clinical faculty within the School of Medicine." Bircher said clinical faculty have had "extraordinary difficulty" in getting straight answers to questions about their dual roles as employees of both UPP and Pitt — and potential conflicts of interest between those roles.

Reading from his Council motion, Bircher noted that Pitt has required some clinical faculty, "as a condition of their continued faculty appointment, to sign letters of faculty reappointment without detailed knowledge of what is contained in the recently concluded affiliation agreements between the University and the UPMC Health System, upon which their reappointment is allegedly based." Under the Pitt-UPMC affiliation agreements, announced in general terms last September, the health system pledged more than $1 billion to Pitt over the next 10 years. That's about the same amount UPMC provided to Pitt during the last decade.

Most of the money will support the medical school's clinical departments. But $12.5 million will go annually to the office of Arthur Levine, who became Pitt senior vice chancellor for Health Sciences and dean of the medical school on Nov. 1.

"This is discretionary money which I can use for developing new research programs and other academic initiatives in the Health Sciences," Levine said.

One element of the new Pitt-UPMC affiliation that isn't in final form yet is the wording of UPP employment contracts, which all clinical faculty will be required to sign. Levine said: "The plan is for these to be signed by all the [clinical] faculty by the beginning of the next fiscal year, July 1." Levine, Chancellor Nordenberg and Provost Maher emphasized the financial and programmatic advantages to Pitt of its relationship with UPMC. They also noted UPMC's fiscal health in contrast to the bankruptcy of Allegheny General's parent corporation, the Allegheny Health, Education and Research Foundation (AHERF).

Pitt medical faculty commonly make six-figure incomes by supplementing their faculty salaries with clinical income earned at UPMC hospitals, Nordenberg also noted.

Comparing Nicholas Bircher to education professor Mark Ginsburg, another member of Senate Council, Nordenberg said: "Nick and those in his department [of anesthesiology] make more money than Mark and those in his school not because they teach more, not because they see more students and handle more classes or, necessarily, write more papers — but because there has been this opportunity to generate income that someone in the School of Education or someone in the Department of English does not have." With an enrollment of about 700 students, the School of Medicine employs some 1,400 faculty members. "You can see how different it is from any other school at the University," the chancellor said.

In contrast, the Faculty and College of Arts and Sciences employed 844 full- and part-time faculty in fall 1997, while enrolling nearly 10,000 full- and 1,000 part-time students.

UPMC leaders would be cutting their own throats if they undermined the medical school's teaching and academic research, Levine maintained.

Academic medical centers such as UPMC must charge higher fees than community hospitals, he said. "The only way they can rationalize those higher charges, in the mind of the public, is to offer something that a community can't offer. And that 'something' depends heavily on excellent research and teaching.

"The reason you go to an academic medical center is to be closer to cutting edge diagnostic and therapeutic modalities and, hopefully, more effective remedies than you would get at a community hospital. To maintain its competitive edge, UPMC must support the academic activities of the medical school," Levine said.

After the Council meeting, Bircher and past University Senate President Gordon MacLeod said they don't doubt the honesty and good intentions of Nordenberg, Maher and Levine.

"It's UPMC and its leadership that we have our doubts about," MacLeod said.

— Bruce Steele