Reexamining the Physician Scholar–Professional Organization Relationship

      Physician faculty at most medical schools are expected to establish a “national reputation,” often in part through scholarly contributions to national nonprofit professional organizations. Yet, those who generate most of their income through clinical work and teaching (ie, clinician scholars, clinician educators) find it increasingly difficult to volunteer their time and effort to these organizations compared with their historical colleagues. Those receiving salaries, fixed or based on billings/collections or work relative value units, have increasingly limited discretionary time off-site, and protected time on-site, for such endeavors. Travel issues (connecting, delayed and canceled flights, fewer travel options) add further to the cost of committee and meeting work. Employer-provided travel funding is a fraction of its former level, having totally disappeared at many institutions, whereas support from healthcare-associated industry has been banned or severely limited by some employers as an apparent conflict of interest, leaving the physician scholars to provide their own out-of-pocket travel support for many such activities. Colleagues have less uncommitted time to provide coverage of clinical duties during off-site meetings. Simultaneously, the physician contributor's responsibilities per activity have mushroomed by the need to address a host of regulatory and quality requirements (securing copyright releases, adhering to standardized formatting, preparing educational goals and hand-outs, composing assessment questions, validating statistics, and reviewing and rewriting test questions).
      The net result finds a few hours of inexpensive 1980s commitment has become many days of 2009 work and considerable personal financial expense. Junior faculty, paying educational loans and supporting young children, are particularly hesitant to make such commitments despite a mandate to establish national reputations.
      Nonprofit professional organizations also suffer under growing financial pressures. Although some may provide nominal honoraria for such work, many are unable to even fully reimburse travel and per diem expenses. The largely uncompensated labor (writing, expert opinion and review, presentations) provided to such organizations by physician scholars frequently comprise the very products (continuing medical education products, certification courses, examination) by which the organizations are financially sustained. Information checking, assuring freedom from commercial bias, vetting of ideas and presentations done by individuals and committees, and a host of other necessary activities would be unsustainable if the work of physician volunteers were fully compensated at a competitive market rate. Continued productivity of professional nonprofit organizations is dependent on the continued contributions of outside physician scholars.
      Through the present torrential academic and financial climate change, the need for such scholarly products has never been greater. Medicine increasingly strives to define and measure competence, while keeping growing numbers of health care providers updated on the explosive growth in scientific/clinical knowledge and expanding regulatory and statutory requirements for health care delivery. It follows that those who live and work daily on the cutting edge of their professional fields will be sought to fulfill these needs for expertise. But how can the cost—in time, effort, and dollars—be made more affordable, so those willing and capable can continue to contribute in this environment? As is the case with most complex issues, responsibilities are broadly borne and solutions will require cooperation from all stakeholders.
      Professional organizations must take the lead. Full use of web-based technologies (virtual meetings) can provide much of the interaction of face-to-face conferences without the expense and time of interstate travel. Shorter, more focused physical meetings used only for those issues truly requiring such interactions should be considered. Flexible scheduling to include weekend meetings would reduce the need for physicians to cancel income-generating clinical activities at home, while meetings held in geographically centralized locations or at airport hotels and conference facilities could reduce overall meeting time and associated costs. Continuing education credit should be provided for participation in these projects as an additional compensation. Administrative support for the work (eg, performing literature searches, obtaining copyright releases, formatting goals and objectives, preparing slides and formatted graphics) should be provided by the organization as a routine business expense. Whenever possible, compensation should be increased to fully cover travel expenses and some honoraria to defray the income sacrificed by the participating faculty. Organizations also could consider forming a consortium to maximize their bargaining position for low-cost hotels and travel.
      Medical schools and teaching hospitals also need to contribute. Referring physicians, as much customers of tertiary academic medical centers as the patients they send, often consider it advantageous to refer their complex patients to nationally recognized experts, conveying the reputation of such experts to their patients. Indeed, national scholarly recognition is often used by health care organizations to advertise the quality of experts at their hospitals and clinics. Academic institutions also can specifically identify these scholarly activities as meeting some promotion, tenure, or compensation criteria, placing them more on par with service toward other traditional academic missions, perhaps developing a schema of “relative value” for national activities with teaching, research, clinical care, and administration; such a change would increase the return-on-investment for the physicians' national work.
      The consumers of these products—test takers seeking certification, practitioners wanting to learn the latest treatments—need to acknowledge the value of the physician scholar and the scholarly products they produce. Whenever possible, consumers should support those nonprofit organizations which give them the best educational value for their dollar, avoiding the lure of popular tourist sites and gourmet meals that too often drive their selections.
      Finally, the physician faculty themselves must be part of the solution. Physicians typically enter the health care field out of a perceived responsibility to contribute more to society than possible through most other professions. Work with national organizations is a force multiplier, enlarging the impact of each effort to help more patients (through fellow providers) than possible through direct clinical care alone. In short, contributing to continuing medical education activities, board and other certification examinations, and committee and advocacy work for nonprofit organizations is simply an important part of being an academic physician.
      Where to start? Perhaps beginning with small steps: by nonprofit professional organizations to reduce the cost to faculty contributors on whom they depend; by medical school and hospital employers to make it a bit easier for those willing and so gifted to make the greater contributions; by the consumers to reward quality in the products they purchase; and by both established and younger physician scholars to make the extra sacrifice to do more.