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March 5, 1998


UPMC Health System's influence and affluence threaten the academic mission of the University of Pittsburgh's School of Medicine. Together, UPMC Health System and the medical school constitute our academic medical center. They should be encouraged to work together. But so far, the great majority of School of Medicine faculty members have been excluded from the design and development of the University of Pittsburgh Physicians (UPP) clinical practice plan.

UPMC Health System's influence has been felt in recent weeks as faculty and students from the School of Medicine openly anguished over an action taken by the University's administration. Sheldon Adler, senior associate dean of the School of Medicine and an outstanding medical educator, was precipitously ousted from his longstanding administrative position. Although University officials offered no explanation for the action, the ouster seemed to relate to a call from some faculty members for a meeting to discuss whether the University would give control of a Unified Practice Plan to the UPMC Health System and whether the latter's demand for increased income generation from clinical practice would impinge upon teaching and research. Adler's unseemly dismissal strikes at the heart of academic freedom and ethics in medical education.

While there's room for argument on how to support medical education in the era of managed care, the University's concerns must continue to focus on the future of teaching, training and research and on their corollaries of intellectual curiosity, discovery and creativity. On the other hand, there should be absolutely no argument about the importance of freedom of speech in the academic community.

Despite its close links to the University at the Board of Trustees level, the UPMC Health System now appears to be more influenced by corporate managers, re-engineering consultants and money managers rather than by scholars, humanitarians and professionals selected by their peers who have long advocated accomplishment, dedication and ethical behavior in advancing medical care. These latter characteristics are under siege in our academic medical center.

The new breed of self-styled lay leaders at the helm of UPMC Health System appears to be obsessively concerned with income generation from clinical practice and, understandably, not so concerned about teaching and research. These leaders do not observe the same precepts as their academic forebears who created a superb medical education and training system. By stressing a top-down brand of corporate commercialism, they limit the faculty's access to a longstanding tradition of preserving high quality medical care. Witness the overwhelming faculty opposition to the UPMC Health System taking control of clinical practice as expressed at a recent faculty meeting to discuss the UPP.

Using the excuse that it must be prepared to compete with for-profit corporations, our once-esteemed academic medical center has been led into agreements to own, merge or affiliate with several for-profit subsidiaries, many private practices, and a plethora of community hospitals of varied quality. UPMC Health System, trading on the University's good name, has insinuated a large number of for-profit and non-profit subsidiaries, corporations and partnerships into working relationships with the faculty. As examples of UPMC Health System's affluence, it bought a for-profit Medicaid HMO for about $10 million. It also owns a for-profit health insurance company and plans to use it to compete with commercial health insurance carriers. Millions more were spent when it purchased a 20 percent interest in a for-profit Medicare HMO from Highmark Blue Cross Blue Shield. UPMC Health System also has a holding company that owns or has entered into partnership with an investor-owned commercial pharmaceutical distributing company, a for-profit home health care agency, and a for-profit company that sells physical therapy services. Acquisitions of other for-profit entities are under consideration.

These for-profit entities can impact negatively upon faculty and student attitudes at the University of Pittsburgh School of Medicine. In fact, the mission statement by Students for Health Care Reform at the University of Pittsburgh states: "The corporatization of the health care system should not compromise the level of patient care, and incentives to do so should not be introduced or maintained." It is high time to halt profit-making that affects medical education and training in our academic medical center. At the very least, faculty and students should be allowed to share in making decisions affecting their careers and livelihoods. By avoiding strife such as that created in the School of Medicine by UPMC Health System's present policies and practices, the University will help to maintain public confidence in higher education. It could also help medical students to revive the idealism in our system of medical education. Gordon MacLeod, professor in the Graduate School of Public Health and clinical professor of medicine, is president of the University Senate.

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