A few weeks ago, following the collapse of the attempted merger/acquisition of University of Louisville Hospital by private interests, a respected member or the community asked me how we had arrived at a point where the advocates of the takeover failed so miserably to understand the critical issues of concern to the public. I attempted an explanation, but there is no simple answer to this complex issue. Here is the reply I offered.
“I too have been disappointed, but not entirely surprised at how the merger debacle has turned out so far. I am not sure it is over yet: I fear University will continue to pull in old vouchers to get what it wants. I do however have some ideas of how the stage was set. Some 25 or more years ago, then- President Swain spoke of making the University more accountable to the community. I could see nothing wrong with that at the time. I agreed, and still do. Even when President Swain assumed a term as Chair of the Louisville Chamber of Commerce, I was not unduly concerned. I do not think even he would have predicted such an act of civic engagement would lead to what we have now– a capture of the University by the business community and a substitution of educational and medical ethic by business ethics and goals. These are not the same thing. When the Chamber formally focused on making healthcare one of two major areas of business development, the path was set and traditional academic control was lost.
When I was a lobbyist for UofL and working to obtain major University funding, my job was easy because the highest priority of UofL and the Louisville business community were identical. The success of that enterprise can be measured by counting the number of new research buildings as opposed to the number of new teaching facilities. It was here that I began to realize that things were going wrong. Emblematic of what was happening is the response of the then Dean of the School of Medicine to a friendly question asked in a public hearing by a legislator that was intended to bolster political support for another $100 million of research money. To supplement the theme of economic development that predominated in the discussions, the legislator prompted the Dean along the lines of: “and all these new senior professors will be teaching our students, right?” The answer was accurate but carefully evasive: “the students will be exposed to the new faculty.” In my subsequent experience, our medical students had no idea who these new faculty were: they were not hired to teach, but to be actors in a new commercial University research enterprise. I witnessed business lobbyists begin to tell University Presidents that it was their job to help them with their business plans and to provide them with individual continuing professional education. Some faculty stopped publishing their research to avoid compromising their business interests. Thinking I was on their “side,” faculty confided to me their enthusiasm for making large financial fortunes from their faculty status and taking the shortcuts needed to achieve that goal. Since some faculty were already making seven-figure salaries from their clinical activities, their expectations of a permissive University were realistic. It has been downhill from there in my opinion.”
I finished with some personal comments not appropriate here. I am posting my thoughts more publicly now because I believe the underlying question is immensely important and must be considered as the community works thorough the many University-related issues on the public table now and to come including how to care for the medically indigent. What should our public university be, who should it serve, and who should set its priorities? I think the University of Louisville is moving in the wrong direction and I do not think I am alone in that view.
Peter Hasselbacher, MD