Thoughts on funding and support for medical schools (part 2): Learning from Dental Schools

Jul 19 2017 Published by under Uncategorized

Everyone, at my little almost-MRU, at other real MRUs, etc, says "Higher Education is in crisis". Yet, in my over 40 years experience, higher education is always in crisis. There is always a fiscal problem. And while everyone says "really, truly, NIH was in trouble now", and there are numbers to back it up right now, there have been other times when NIH is In Trouble. [aside: one of the issues olde fartes, greybeardes, and blue hairs are not inclined to worry, is that this wolf has been called over and over and over. That doesn't make the response "this happened before" right, factually or morally. But it may explain part of that response].

This situation reminded me of when I was a newbie faculty member in a Dental School. Back then, the distant past, before you were born, most likely, Dental Schools were In Crisis. Historically, going back to the 60's, Dental Schools had never gone the "NIH" route as it was called back in the lush days of 30% paylines. And as a result, they were much smaller than med schools, in budget and number of faculty, and, in general, research scope. Medical schools had hospitals, but Dental schools had clinics. As a result, as I pointed out here (part 1), they were much more tuition dependent, especially at private schools with no state subsidy. That is one reason why some dental schools closed in the 80s & 90s. Here is an article about dental school closings, but in the context of the future of Vet Schools. That there were more seats in dental school than total applicants, meant that the classes were being filled with people lower and lower on the admissions list. Whether these people would be "good" or "bad" dentists was not, to my knowledge, ever studied.

Since then, some new dental schools have opened. These are not necessarily scholarly places, but places focused on training people to be dentists. The folks I know who teach in them are teachers, first and foremost. Seed money? Lab space? Not so much.  The ones that closed were more scholarly places, including Emory, Northwestern, Georgetown, Wash U, Loyola, Fairleigh Dickinson. They were private schools, with no state subsidies, and budgets to balance. There was, and still is, lots of talk about demand to be in the profession as a driver of professional school success. Those discussion are informing the future of law schools right now. For medicine, that demand will always be relatively high, and acceptance rates relatively low.

I do not think that the causal root of any crises in medical schools will have the same basis as the historical basis of dental school crises. The problems in medical schools (and likely universities in general) will more likely come from the other parts of the equation that add up to total income. If NIH budgets are being cut, if the state universities are looking at reduced subsidies, those parts of the equation are going to be the problem. Now, there is talk that NIH funding will just be held at previous levels, and thus may or may not translate into problems for med schools. After all, its the same, right? But if that money is sequestered into Olde Fartes, and not supporting younger people, then growth will be absolutely impossible. If more and more young researchers enter the system, as the Big Dog schools feel they must "grow or die", funding at previous levels will be a problem.

There was talk, back in the mid-90s, well after I had left the Dental School where I started, that the closing of some schools had eased the pressure on others. Will some medical school close, too? I have heard scuttlebutt that one of the second tier medical schools in my state is in sufficient fiscal trouble that the State Legislature is considering just that. It won't be from lack of students and demand for the profession. It will be from the other parts of the equation, including, as many of my wonderful readers have pointed out, the expansion of the administration, and the costs associated with that (but you know, I heard the same damn thing in 1986 at the Dental School).

So implications for us ants on the ground? Well, to start with, closing schools means even less jobs. It means more people leaving the system earlier on, and less mouths at the trough in the Asst. Prof. instar. We are back to the argument about where the sorting and selection should occur. Less students? Yes that would likely mean fewer people later on. The argument that everyone should have a shot a being a researcher, a professor, etc, has defensible points. Admit them all and let , who? how? at what point? sort them out? But if the limits aren't imposed at the levels before tenure, they most certainly will get enforced there. And frequently enforced by people who, while they are very sad you didn't get funded and therefore tenure, in the end make decisions based on the fiscal health of the university.

These problems are not new. I got a master's degree in a small, intense program at a good school that invested, in the beginning, in the dream of a faculty senior person. There were 3 faculty, one BigDog emeritus who had been enticed to retire there (from whom I took some of the best seminars of my life), and 10-12 graduate students, many of whom had turned down the big places to go to that program. It was intellectually exciting, and changed how I do science. In fact, I think had I not been in that program, I would have left academia. I was not ready for prime time at that point. But, as these things happen, the program fell apart, one jr prof left, Uni admin changed and declined to replace this person, so the senior person was ripe for recruiting, and left.  I went on to Big Name Place for my PhD, and everyone in that program landed on their feet. I give big props to senior person, who worked hard to make sure every student found a home somewhere (and a very large percentage of those students are still out there being scientists). The program was great, better than great, but without admin support it died.

So what are we to make of the administration? I do not know a single researcher/professor who does not have complicated thoughts and feelings about the administration. Actually, that's not true. I have a wonderful marvelous, now tenured colleague, here at almost-MRU, who would say to me: Potnia, my thoughts are not complicated or conflicted. I hate the fuckers. Ah. Part 3 to come. Soon. Real Soon Now.



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