Friday, July 30, 2010

Stories from the Clippings

University Of Oregon Medical School Hospital

Quarrel Aired...

Conflict always makes good news and conflict making the news at the University of Oregon Medical School was no exception, in fact, it was the rule. Any who have followed the blog or view the online exhibits, have read about a few; and since in this blog, I am writing about what was written in the news, conflicts will undoubtedly come up. This does not speak ill of the institution but illuminates the spirit of perseverance in the face of adversity that has seen the University through all manner of difficulty.

The building of the University teaching hospital on the hill, presented a conflict of interest concerning the University mission first envisioned by the second dean of the school, Kenneth A. J. Mackenzie. His vision was a medical school perched high above the pollution and hub-bub of northwest Portland, dedicated to education, to providing health care to the people of Oregon and to encourage research. Two current policies of the school were first, to maintain a volunteer faculty made up of private practice physicians who provided teaching without fee and secondly, the admittance to the hospital of non-revenue producing patients who, by their presence, supported the school's philosophy of instruction.

In 1955, just before the dedication of the new hospital, news reporters began to pick up on a quarrel that was taking place between the Oregon state board of higher education and local medical societies. As was reported, this argument was not unique at UOMS but existed nation-wide. The root of the problem was that medical schools, to date, had relied solely on volunteer teaching provided by local practitioners. UOMS was no exception. The state board of higher education was suggesting, no not just suggesting, it had proclaimed a "policy of replacing volunteer staff with full-time staff in key positions." This trend could be seen at other medical schools and had previously taken place in schools of law, but private practitioners balked at the idea.

The hitch was that the most qualified physicians could not obtain university salary scales comparable to what was possible in the private sector. Dr. John Richards, Oregon's Chancellor elect at that time, had conducted a survey soliciting responses from medical schools throughout the country that showed that instructors were being employed on a "geographic full-time basis"; a phrase that meant that instructors were allowed to use clinical space at the university in order to conduct their private practice to supplement their academic salary.

Those who were proponents of this arrangement pointed out that the most qualified would be drawn to teaching and that the population would still have access to his/her substantial skill. Private practitioners, however, who wished to remain only in private practice and provide service without fee to the school, questioned the "propriety of competition in private practice by a paid member of the medical school staff". The suggestion made by the opponents to this geographic full-time basis arrangement was that if full time paid staff wished to continue in private practice, they should be required to set up their offices off the hill.

The stand taken by the Oregon state system of education was that faculty members should be allowed to set up private practice at the University, thus allowing students direct access to a wide range of patients. Those physicians would be required to be available at all times for academic service, as well as pay for their own supplies, materials and secretarial services.

But besides the conflict of teaching theory and economic interest, the state board had decided to provide for some paying patients at the hospital; the so called "ugly head of socialized medicine" was rising. The school did not expect to fill its full time positions without the inducement of pay and the opportunity to run one's practice on site. The Medical society felt that allowing paying patients to be treated in the hospital (a tale for another day) would be the "tail that wags the dog". But legislators were in search of revenue and a self-supporting hospital seemed logical. This was already happening in other parts of the country. But Oregon was not so keen on the idea of the school entertaining revenue-producing patients.

Could there be a meeting of minds that would bring the state's system of higher education and the members of the medical society together?

The saga continues…

article referenced: f1_p61_a1

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