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Ann Thorac Surg 2001;72:9-12
© 2001 The Society of Thoracic Surgeons

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Editorial

From art to science: a fairy tale? The future of academic surgery

Address reprint requests to Dr de Leval, Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond St, London WC1N 3JH, England
e-mail: marc.deleval@gosh-tr.nthames.nhs.uk

Presented at the Symposium "Panta Rhei," as part of the 14th Annual Meeting of the European Association for Cardio-Thoracic Surgery, Heidelberg, Germany, Oct 8, 2000.

There is still a continuing debate as to whether the same individual can excel as a surgeon and as an academic. According to the dictionary, academic means "excessively concerned with intellectual matters and lacking experience of practical affairs." In that sense, an academic surgeon is an antinomy, and this view would no doubt be shared by many pure scientists and intellectuals, including our physician colleagues. It is only if we acknowledge the humble level of our intellectual pursuits that one can talk about academic surgeons. With that reservation, I should like to address a few of the many challenges that the academic surgeon faces in the new millennium.

The portfolio of the academic surgeon is made up of four equities: clinical practice, research, education, and administration [1].

Clinical practice

First and foremost, the successful academic surgeon must excel as a practicing surgeon. I do not dispute the fact that surgeons of average technical ability have made significant academic contributions. There is no doubt, however, that to play a leading role in academic surgery, an academic institution must retain the most talented surgeons. By and large, academic institutions care for the most complex and higher-risk patients. In addition, academic institutions are training the next generation of surgeons. In an ideal world, those trainees should benefit from the talents of the best technical surgeons. Unfortunately, these goals are not always fulfilled, for a number of reasons.

Academic health centers no longer enjoy the position of power and prestige they have held in the past. The traditional financial support of education and research through cross-subsidization, using clinical revenues, has resulted in less competitive, more expensive academic institutions. As a consequence, managed care organizations have diverted primary, secondary, and sometimes even tertiary services away from academic institutions to less expensive nonteaching institutions. Funding of nonclinical . . . [Full Text of this Article]

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