The Demise of my Teaching and the Methodist Program

Indiana is one of the 16 states with only one medical school (Indiana University School of Medicine). It’s funding is from taxes appropriated by the state legislature. The medical school’s primary mission is to produce physicians to care for citizens of Indiana. This has always complicated how private hospitals and physicians interact (town vs. gown) with the medical school.
For years, the medical school looked on all physicians in the surrounding communities patronizingly, which caused an acrimonious relationship.
The medical school had a group of hospitals the IU Hospital Group that was part of it’s clinical base, but with so many students it had to use several private hospitals for junior and senior clinical rotations. These rotations gave the students a perspective on how physicians in private practice ( the real world ) delivered health care. And these experiences influenced some students to choose post graduate training at some of these hospitals (i.e. Methodist, St Vincent’s, etc).
As one of the faculty at Methodist, I was instrumental in a number of potential candidates choosing us because of their exposure to advanced laparoscopic surgery. This influenced their choice in the resident matching program by ranking us #1 to the chagrin of IUSM. This produced a degree of acrimony and because the process of program accreditation required an on site recertification visit every 4 years, Methodist was cited for not having a full time Gyn Oncologist by the site reviewer and when one was recruited the IU OB/GYN Department Chair(an Oncologist) would not offer a clinical professorship to the prospective candidates apparently knowing that The American Council of Graduated Medical Education ( ACGME ) required that specialty directors be clinical professors. But in the mid 1990’s a new sub specialty Urogynecology was recognized as one of the required specialties to join Ob/Gyn, Reproductive Medicine, Maternal Fetal Medicine and Oncology. Dr Benson, the program, director of the Methodist program, was one of the pioneers to form the specialty and Methodist became the 1st accredited fellowship in the country under his direction. This produced a bargaining point with IU since they did not have this required service and were unable to meet the new requirements set by ACGME. This forced an agreement between the two programs and talk of integrating the programs began.
IUSM took 7 candidates/ year and Methodist 4/year. An agreement was made that any applicant that chose either program as their 1st choice would spend 75% of their rotations on a chosen campus. And when the 1st group graduated in 4 years the programs would be completely merged. This was a complex administrative dance requiring formation of a combined resident education committee with alternating the chairmanship between the two program directors yearly.
Bare with me because the details of this arrangement produced vexation as to function and how funds were allocated and revenue from fees for service assigned.
Because institutions with approved residency programs receive government funding of approximately 30k /resident/year for the service that is provided for Medicare and Medicaid. It became a financial issue as to what funds supported salaries for staffing residents. The University using full time employees (FTE’s) and Methodist both FTE’s and volunteer staff who donated their fees for service to the program. As in most things, money became an issue. Also it should be noted that the Dean at a medical school controls the funds like a fiefdom and there is a Dean’s tax assessed each Department Chair to which all faculty contribute. A custom that those of us at Methodist were not about adopting and Methodist Hospital Inc. was not about to split funds with IUSM. I know this is probably a little more than you want to know but it is important to understand what transpired next, because it had a huge affect on the direction medicine took and how it is being taught and practiced in the USA today.
Let me digress for a bit. When physicians are self employed it behooves them to be efficient and productive, but there is no incentive for salaried physicians to be equally motivated. This became one of the obstacles to any integration of the philosophies of the two institutions. A second impediment was that historically medicine was taught by mentoring and a new paradigm was being develop called evidence based knowledge. And though I agreed in principal with some of it’s merits teaching was losing it’s luster for me
What happened next led to the dissolution of the Methodist Residency program, a merger with IUSM and led to the end of my teaching career.
The changes made I came to really dislike and in the end both Dr Benson and my positions as full time faculty at Methodist were dissolved.
To finish out my schedule to retirement consisted of the mundane position as a physician in the Methodist HealthNet clinics which was basically a 9 to 5 job that I came to detest. And the program merger eventually help pave the way to the formation of a bigger consolidation, the formation of Clarian Health Services. The story of this will be in a following chapter.