A single mission for academic medicine: improving health.

MISSION STATEMENTS CAPTURE AND EXPRESS THE heart and soul of an organization. Mission may be defined around function—a statement or declaration of fundamental purpose or strategic direction. A mission statement may offer the organization’s definition of vision and values, or it may articulate an inner calling or vocation to pursue an activity or perform a service. In all cases, mission statements ultimately attempt to answer one question: What does an institution or organization seek to achieve? In 1497, the first known academic chair of medicine in the English-speaking world was established at King’s College in Aberdeen, Scotland. Its mission was the “pursuit of health in the service of society. Five centuries later, academic medicine has lost sight of this mission. It is critical that academic medicine now return to the original meaning and mission. Some argue that the mission of academic medicine is to improve human health via the advancement of knowledge. More frequently, leaders of academic medicine describe a tripartite mission consisting of education, research, and clinical service. Although the time allocated to each of these mission components by individual faculty members may be uneven, it is now generally assumed that the contemporary mission (or missions) of an academic health center consist of teaching, research, and clinical practice. For example, in his 2008 address as president of the Association of American Medical Colleges, Kirch reiterated the importance of balance among these 3 missions. Similarly, the mission statements of many medical schools and academic health centers list the 3 interrelated missions. In the first “modern” mission statement at King’s College, the chair of medicine was assigned a single mandate: the pursuit of health for all. Although this remains the ultimate raison d’être of all health care professions, adherence to this mission on the part of academic medicine continues to be carried out using the tripartite-mission model: teaching the next generation of physicians, performing research to advance the understanding of human biology and the practice of medicine, and providing direct health care for individual patients and populations. These activities have waxed and waned in relationship to one another in academic settings, with clinical care predominating prior to the Flexnerian era, giving way to a research focus after World War II, and again shifting to clinical care in recent years as public support for academic health centers has declined. Education has maintained a constant, if sometimes tenuous, role in the academic health center. These 3 activities are connected and interdependent in fundamental ways that are, at their core, independent of finances. Medical students learn the foundations of basic science from researchers; medical students and residents learn their clinical skills under the tutelage of clinicians; research depends on the clinical setting for testing hypotheses and conducting safe experimentation to advance knowledge; clinical care, in turn, evolves and progresses through the knowledge that results from research. Over time, these 3 activities have developed interdependent financial relationships as well. When these activities are treated as a single 3-part mission or 3 connected missions, they are in danger of becoming ends in themselves rather than activities that support a common purpose. Furthermore, although the demands on faculty imposed by this tripartite model are significant, the expectation has developed that faculty members will excel in all 3 missions. From this expectation, the concept of the triple-threat faculty member has evolved into an accepted standard for academic medicine. Whether it was ever possible for more than a small number of productive and highly efficient individuals to achieve excellence in all 3 activities, the triple threat has in recent years been seen increasingly as endangered and counterproductive. Petersdorf and Turner observed nearly 15 years ago, “It cannot be done. ” For too long, faculty have been expected to achieve substantial productivity in all 3 realms to advance in their careers. This understanding has led some to conclude that the triple-threat model is inefficient and that an alternative, more efficient model of specialization is required in which each faculty member specializes in 1 or 2 areas.