Clinician-teachers are responsible for the basic functions that make an academic hospital run – caring for patients and teaching – and thus play a pivotal role in upholding the mission and values of these institutions.
It is thus surprising to see that clinician-teachers are under-represented at core University of Toronto and hospital leadership positions despite comprising more than one-third of all full-time faculty.
Positions within departments of medicine are defined by the proportion of time devoted to clinical activities, teaching and research. Clinician-teachers at the University of Toronto spend 60-75 per cent of their time in clinical activities and teaching. In comparison, clinician-scientists have 70-80 per cent of their time protected for research activities and their value is measured by publications and research grants.
Data from 1996-2004 reveals that National Basketball Association teams led by coaches who were either star players or had long playing careers won more games. Does it not follow then that experience and “street” credibility in hospital governance would lead to better outcomes?
There is indeed evidence that clinician participation at strategic decision-making tables results in better quality of care and improved cost containment. Individuals who have been at the front lines are more likely to be seen as credible change agents, and their experience could provide more practical and robust solutions. Clinician-teachers work and thrive in an environment that fosters the characteristics required for effective leadership: knowledge of the health-care environment (street credibility); communication and relationship management; time, conflict and resource management; and problem solving. As mentors and educators, they excel at setting direction and influencing others. The evidence shows that policies set by clinical leaders are more readily adopted by staff, and that improved credibility can lead to recruitment of talented personnel. Clinical leadership plays an important role in high quality patient care and has been shown to improve hospital performance.
Academic institutions and hospitals have failed to effectively measure and quantify the value of clinician-teachers. Mastery in patient care and education has not been given equal weight to what has traditionally been more valued in academic institutions, research grants and publications. It has been well established that clinician-teachers do not get promoted at the same rates as clinician-scientists, while the proportion of clinician-teachers who achieve the rank of full professorship is significantly lower.
COVID-19 has unearthed the fragile and broken status of our health-care system and will force us to rethink how we deliver care and education. Academic centres, hospitals and governments would benefit greatly from a larger presence of front-line clinicians in positions of influence and leadership.
The time has come to insist that the inclusion of the front-line clinician and teacher be seen as crucial in the leadership governance of hospitals and universities.