The speedups and rollbacks being introduced into ordinary medical practice by the for-profit health maintenance organizations and their like seeped into the academic health centers. University hospitals had to cut costs, fill more beds, and empty them more quickly. Clinicians had to see more patients. As these pressures increased, previously overlooked educational and professional issues began to surface, raising the possibility that the entire structure of medical education might have to be revamped. Teaching and research quickly felt the squeeze.
Fewer clinicians are willing to teach.
Moreover, as Arnold Relman notes, even those who do teach no longer have enough time with individual patients to train their students properly. Nor, as Thomas Andreoli points out, do they have the time or inclination to pursue research. Meanwhile, the infusion of corporate values that Leon Eisenberg and others decry is eating away at the social as well as the scientific mission of academic medicine. It is also threatening academic freedom. Nancy Olivieri refused to cover up the dangerous side effects of a drug she was studying, the pharmaceutical company that produced the drug almost got her fired.