Thoughts on funding and support for medical schools (part 1)

Jul 19 2017 Published by under Uncategorized

Nobody thinks of medical schools as being particularly poor, or in financial trouble. Yet one comment  in an older post, together with a meeting I went to a few weeks ago, got me thinking.

Many people (here, IRL) are outraged that the university would try and make money on postdocs. Although I crashed the meeting to hear about the postdoc stuff, there was another presentation, first, from the chief financial officer. Because this is such a small place, people like the CFO do come talk to the faculty, which was not true of other, larger places. I have found that in MRU, policy, budgets and implementation strategies come down from on high to the plebs. Here, there is at least an effort to share information, although one's ability to actually do anything about it may be just as limited as in the Big Important Universities.

This presentation was based on percentages and compared a number of public medical schools, and some private ones thrown in for contrast. There is an awful lot that can be said about this, stuff that impacts me, the younger faculty I care about, and as a bell weather signal for the future in general. I want to make two points, one data analytic and one substantive about funding. But they're linked.

The statistical point is that he presented percentage data: where the money comes from divided into broad categories. One really needs to see the absolute data as well as the percent data. The broad categories were: tuition, research, state subsidy, and medical income (hospital/professional fees). The biggest difference was the percentages attributable to tuition and state subsidy (large in small schools) vs. research income (large in bigger schools).  The percentages may vary, but the absolute number is close to a constant across schools of all sizes. Tuition and class size are variable. But bigger places tend to have higher tuition and smaller classes, and it works out to a narrow range in the end, certainly the same order of magnitude in dollars. The state subsidy varies, but not greatly. It is a subsidy per student, so while it varies, it will be roughly the same dollar amount. [I want to set clinical income aside for a moment, and just take a look at research. There are many different models, with hospitals separate from med schools, etc etc, and without more information it makes this part of the equation difficult to assess].

So if you look at the percentages, they vary tremendously across Universities, pretty much a function of a size. But I bet that the size of the budgets vary by an order of magnitude. That means if one component is a constant in absolute dollars, that order of magnitude is shifted to the other components. Bad data analysis.

But even looking at the percentages, research is a much smaller part. So the money guys wring their hands and say "the researchers aren't doing enough". But of course, per capita, we are. We are just much fewer in number than at the Big Places. Of course this doesn't translate into policy to either: hire more researchers or provide better support the ones we've got. No, this is part of a justification for developing a two-set faculty: BigDog researchers, who bring in >80% of their salary, and teachers, who teach the equivalent of 18-20 credit hours per term (ie two big med school classes, each term). The model of the teacher/scholar is in danger.

But this is not the end of the analysis. As always, context is important, in this case political context.  States are actively, hostilely, and with total conscious intent, reducing their subsidies to public higher education, including professional schools. It is not a matter of "the states being successful" in reducing contributions. They are being successful at this.

Which actually brings up another point: control of state legislatures is overlooked. But it is critical.  It is critical for being able to call a constitutional convention (and get rid of such pesky things as same sex marriage, birth control, and voting rights). It is critical for support of "extra stuff", like education, clean water, and public prisons. Some of the states, such as Wisconsin, make headlines, when they do headline-making things (like try to get rid of tenure). But as far as I can tell, these trends are pervasive, even in democratic controlled states.

The data for my state, and my tiny medical school are out there with an in your face message: state support has been reduced, consistently, significantly, no matter what percentage or absolute number you look at. If tuition is capped by the states  (which it is here, and in many other states), and the subsidy is being reduced, the difference has to come from somewhere. States, unlike the federal gov't, have bigger problems if they run in the red, and they by and large do not let their univerisities do so. There are many sequellae, many implications, many problems that arise from this. There are people who say that public higher education is not necessary. They say that private schools do a damn good job; let them do it. Private schools have their own issues, which may ultimately translate into the same bottom line issues: the world is changing. We, little ants on the ground, see the part about reduced funding success, NIH grant demographics, extended postdocs. But the issues are greater. As the mother of one of my trainees said at her child's (same-sex) marriage: just because this is possible today, we cannot be complacent.



5 responses so far

  • Anon says:

    You are absolutely right about states reducing subsidy and capping tuition even in Democratically controlled states. Unfortunately, I worry that this is a national trend -- governments no longer think higher education is a public good worth funding -- and are happy to pass the burden on to the public. At the same time, many public universities, especially the one I work at, have increasing administrative bloat. Administrators are expensive, breed more administrators, and are essentially un-fireable and not accountable to anyone at a public university; this leads to higher costs and less money for the actual mission of the university -- teaching and research. Administrative bloat is also often used as an excuse by state legislators to reduce the state's contribution even further.

    It's particularly unfortunate that this development comes at a time when people really need higher education. Automation is killing many low-skill jobs, and chances are, even the lowest skill jobs in the future are going to require a college degree. Which you cannot get unless your parents made a significant investment in you to begin with.

  • JL says:

    Sure admin is expensive, but cutting admin without cutting requirements is hell. Admin can be extremely helpful.

  • Irate PI says:

    The admins at my state school's college of medicine have been on a tour visiting all of the different department faculty meetings in recent months. They have this great idea to double our NIH funding. When asked what the plan is, they look at us like we're idiots and say, "We will DOUBLE our NIH funding level!" Then they give us a list of strategic scientific areas that are literally the names of the departments. This "strategic plan" was two years in the making and the brilliant deanlet in charge hasn't had a grant or an original thought in 20 years and makes 500k a year (probably paid by NIH indirects). Of course, we all know the actual plan is that junior PIs will be squeezed out, and even more expectations will be placed on the senior PIs to do more with less (like paying tuition for our postdocs!). There is something very wrong in academia and it's getting worse and worse.

    • Anon says:

      Yes, believe me, I understand! Our deans and deanlets, who multiply by the dozen every year, and make 500K per year, are exactly of this calibre and have similar plans for the faculty.

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