That, Cerra acknowledged, is the most common complaint that he has heard from those who leave. Although few people outside the school realize it, the university has long paid its doctor-professors only a fraction of the salaries that they actually make, about a third on average, according to Cerra. But not anymore. Today, with HMOs and Medicare squeezing doctor payments, the departments are having a tougher time balancing their budgets. So the professors, much like doctors in private practice, have to work more time in the clinic and see more patients just to earn what they used to. .
Market forces rule It was a clash just waiting to happen.
HMOs, of course, had a mandate to rein in skyrocketing costs, and nowhere were costs higher than teaching hospitals. Historically, academic medical centers always charged more, to cover the extra time and effort involved in training young doctors. And yet managed-care officials have insisted that they can't be exempt from the market forces that affect everyone else in medicine. In that position, he said, he'll have to worry about balancing the budget. We're a victim of the marketplace.