Trying to understand your current environment or thinking about changing medical centers? Consider these exploratory questions.

All Academic Medical Centers (AMCs) are different so asking questions about organizational relationships is expected and the only way to learn how structure affects you...

1.      Is the medical school owned by a parent university?

Why is this important? It may affect the speed and flexibility of what the medical school can do to achieve its mission. . . it is also another set of board members to satisfy and potentially, another expense to support from medical school pro-fee revenues.

2.      Does the parent university own the teaching hospital?

Why is this important? If the parent university or medical school owns the teaching hospital, profits from patient care revenue and fees generated from hospital technical services contribute to a bottom line which may be used to accomplish the medical school mission. It also makes clinical service arrangements with the hospital easier to develop and manage.

3.      Is there a health science division that includes the medical school, nursing school, and dental school?

Why is this important? It could be a help or hindrance - depending on clout within the organization and financial solvency. A health sciences division that encompasses several health related schools is usually a financial and political force within the university structure. However, if one school within the health sciences division has a deficit or continuing need of financial support, other schools may have to indirectly contribute through a health sciences tax. At minimum, the level of bureaucracy at the health sciences level needs to be supported in some fashion.

4.      Who owns the faculty Practice Plan where you practice - the medical school or the physicians themselves? Once you know who owns it, who gets to vote on things like raising the deans tax or buying a new billing system?
 
Why is this important? All of the ~124 faculty practice plans are governed differently  - so understanding your situation is important. Begin by determining how votes are cast - does the dean have an overriding vote? Is the faculty practice plan president appointed by the dean of the medical school and defacto, working first for the medical school and secondly for the practicing physicians? When counting the votes of the practicing physicians, does every department have an equal vote or are votes weighted by the number of faculty within any given department? The questions are endless, but your efforts should target understanding how the clinical organization is governed. (If you are involved in an interdisciplinary center, all of these questions apply).

5.      Depending on the AMC, a particular mission - teaching - research - clinical care - may be emphasized over another; do you know the emphasis of your AMC?

Why is this important? Missions sometimes conflict as expenditures are prioritized and any given Institution wants to be known for a particular area, which may or may not be your teaching, research or clinical specialty.

6.      When your division, department, interdisciplinary center cannot meet budget, which part of the multi faceted med center enterprise will provide financial support?

Why is this important? There are times when you may not be totally self supporting, either because of programmatic expansion, reimbursement changes or other reasons. If you are thinking about joining another Academic Med Center, it is better to know up front where you can turn when your department or center is financially strapped.