The precipitous decline of academic medicine in the United States.

The recent coronavirus pandemic has made us more aware of the gradual decline of academic medicine. Although much has been written about the systemic problems in medicine and academia (mostly in the context of burnout and well-being), the problems in academic medicine extend well beyond these concerns. Structural problems in academic medicine exist within all parts of its tripartite mission: education, clinical care, and research. With clinical care, there are tedious requirements for documentation in difficult-to-navigate electronic medical record systems, demands on productivity in the form of ever-increasing allocated Relative Value Units (RVUs), and senseless demands from managed-care organizations. All of these clinical demands reduce the time for teaching, which, ironically, university deans expect us instructors to increase. Similarly, education has been increasingly regulated by what has been referred to as the “medical-education industrial complex.” Regulatory agencies have introduced changes with possibly negative consequences and no evident benefit. The promise that the new accreditation system would make residency training programs easier to manage has not materialized and, actually, the opposite appears true. In addition, unfunded mandates of questionable value have been introduced, such as the Clinical Skills Verification examination. Academic research—at least in psychiatry—has been experiencing an “intellectual crisis,” leading to the conclusion that “evidence-based medicine does not appear to provide an adequate scientific background for challenges of clinical practice in psychiatry and needs to be integrated with clinical judgment.” Some argue that the scope of evidence-based medicine is limited and should be combined with practice-based evidence in making clinical decisions. And despite the glow that research funding brings to investigators and administrators, the sad fact is that, for the institution, research is a money loser. The pandemic has lifted the veil on even more serious threats to academic medicine. In a recent article, Johns Hopkins University Professor Richard Balon, MD Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology Wayne State University Detroit, Michigan, USA