July 24th, 2012

The Academic Squeeze Play

CardioExchange welcomes this guest post from Dr. Westby Fisher, an electrophysiologist practicing at NorthShore University HealthSystem in Evanston, Illinois, and a Clinical Associate Professor of Medicine at the University of Chicago’s Pritzker School of Medicine. This piece originally appeared on his blog, Dr. Wes.

If you want to succeed in academic cardiology, get a federal grant for research.

Better yet: get a few well-paid industry grants, too.

These days lower-paid academic cardiologists are finding it tougher to find protected time for research and speaking because grants are harder to come by, and money from their academic center is getting tight. For instance, the National Heart, Lung and Blood Institute (NHLBI) of the NIH no longer accepts the investigator-initiated innovative research grant program (R21), which was an important source of funding for researchers and has cut funding lines for established research funding grants (R01) from a 15% to a 10% acceptance rate. Medical device and pharmaceutical companies are also feeling the financial squeeze from diminished demand for their devices and boutique drugs — not to mention higher fees for the right to sell them in the U.S. Even worse, the federal government has less need for innovation in cardiology now but more need for “demonstration projects” for health care reform.

It’s hard to write passionately about health care reform when your real gig is writing about cardiovascular drugs or devices.

And cardiology is still a procedural field that pays hospital systems pretty well. This presents another tough reality for academic cardiologists: They have to generate revenue somehow. Cash-strapped hospitals across the country are looking at challenged bottom lines. They are turning the heat on their revenue pipelines — all of them. Since cardiology is one of those pipelines, the days of stroking one’s chin while researching sarcomeres has quickly evaporated to clinical productivity clauses.

And for academic cardiologists once content to research and pontificate about treatment strategies, they are learning the cold-hard reality that speaking gigs and guideline writing doesn’t generate revenue for their centers.

But there’s still an out — a way forward for academic cardiologists everywhere, if you will.

In the increasingly competitive and evolving health care markets of America, there is a need for brand name doctor-managers: Folks with marketing marquis value can drive clinical referrals to more clinical centers while serving as intermediaries between hospital administrators struggling to mesh newly hired cardiology groups with their former core cardiologist-employees. How successful these poster children for health care innovation will be in their newly created positions remains to be seen, but the demand is there and the migration’s on. Lucrative pastures await for fairly low-paid academic cardiologists as health care consortiums grapple for ways to differentiate themselves from their competitors.

So like the mice in “Who Moved My Cheese,” academic cardiologists are beginning to make their move, and no ivory-tower academic medical center is safe.

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