“Have a seat, Dr. Cutter,” offered the assistant dean.
Alex chose the chair at the end of the small, glossy mahogany conference table, the room insufferably stuffy, the warm air spiced with the bitter smell of coffee that surely had been on the hot plate way too long. Four professors, two with their white shirtsleeves rolled up and ties loosened, lab coats draped haphazardly over the backs of their chairs, stared at Alex as if he was the star witness in a murder trial. The one female, a biophysicist with gray hair and big glasses, was the one Alex was least familiar with.
“Thank you for taking time from your schedule to discuss this important matter of Dr. Waters’s replacement. Would you like some coffee, a glass of water?”
He would’ve loved some coffee, but this stuff smelled like toxic waste, the sheen on the surface making it even scarier. He envisioned the fluid eating through the Pyrex pot and then continuing on through the floor. “No thanks, I’m good.”
“Well then,” said the spokesperson, “let’s get on with it. Please tell us the strengths and weaknesses of the department.” Three of the interviewers sat back almost in unison, pens readied over notepads.
Alex cleared his throat. “The department’s overwhelming strength is a strong culture of academics. By this I mean Dr. Waters provided us with a clear departmental mission. That has been to teach and conduct impeccably honest research. It’s very much the same as the NIH’s program to produce teacher investigators.” He paused, marveling at his off-the-cuff pithy summation of a complex dynamic. “The only weakness—if it can be considered one—is, unlike other departments, our emphasis is on quality research instead of high patient throughput.”
The chair of the committee nodded sagely. “I’d like to explore that particular issue a bit, if I may. If the goal of a department is to train neurosurgeons, isn’t a high clinical volume desirable?”
Certainly a loaded question, Alex thought as he paused to consider his answer. “True, but only if the mission of the residency is to produce cutting neurosurgeons. Although the country does need neurosurgeons, it also needs teacher-scientists if we are to have any hope of advancing the art. This rare species can only come from a department devoted to producing academic clinicians.” He felt passion moving his words in much the same way as a senator delivering a campaign speech. “We produce tomorrow’s leaders. Competent clinicians who, in addition to practicing medicine, have the investigatory skills necessary to raise our art to the next level. Enough residencies already exist to turn out a steady supply of surgeons, but only a handful produce true academicians.” He felt as if Waters was patting him on the shoulder saying, “Atta boy!”
“Very admirable, Dr. Cutter,” interjected the biophysicist. Alex thought her name was Linda Lehman—or something close to that—but wasn’t sure, and he couldn’t read her name tag. “But the hard reality of this day and age is that particular idealistic philosophy had merit years ago when the feds had enough money to pour funding into biomedical research. Recently, and in the foreseeable future, Congress’s health funding has stayed constant, which means that after factoring in inflation, the money allocated for research is actually shrinking. Bottom line is that medical schools—especially state schools like ours—find themselves in a deficit. Which means that clinical departments, like yours, must generate the dollars needed to keep the school afloat. We can’t, and shouldn’t, rely so heavily on grants and contracts that can dry up faster than the Mohave Desert. Or do you have another opinion on how to solve such fiscal problems?”
This was a hot button for many of the clinicians. “In other words,” Alex answered, “it’s the job of the surgical departments—and not tax dollars—to support the overhead and salaries of non-revenue-generating departments in a state medical school?”
She smiled. “Bluntly speaking, yes.”
Alex felt his muscles tense. At the moment, an argument would be counterproductive. “It all comes down to one thing: if the state wants a medical school, tax dollars should fund it, not the surgeons whose primary job is to train more doctors and to do research.”
“Yes, but we’re getting off into the weeds with this discussion,” the chair broke in. “I’d prefer you address the initial question: If the primary goal of a medical school is to train physicians and surgeons, isn’t it in our best interests to do just that?”
The biophysicist held up her hand to indicate she wasn’t finished. “If your department is primarily concerned with research, how can you possibly expose your residents to enough clinical material to produce competent graduates?”
Alex saw his position rapidly eroding. Clearly, the committee had decided where to focus their search, and it was toward a strong clinician. They were now simply going through the motions of asking for the input of the current faculty. “With the exception of some very tricky surgeries—aneurysms or AVMs for example—neurosurgery is, to be blunt, quite rote. It’s piecework. How many subdural hematomas does a resident need to remove before being competent at that? Ten? Fifty? A hundred? Speaking strictly for me, my fifteenth didn’t teach me anything more than did my tenth. On the other hand, learning to design a research protocol has taught me a lot about critical thinking. I submit that critical thinking benefits a neurosurgeon more than does purely manual skills.” He knew his argument fell on deaf ears, but felt compelled to give it anyway.
The one to the chair’s right, an older professor Alex recognized as a thoracic surgeon, said, “I don’t agree with you, Alex. Things happen on the wards and in the operating room, sometimes strange things, and they always seem to pop up at the damndest times. Having to deal with them and get the patient through unscathed provides a richness of clinical experience that simply can’t be taught from a textbook or lecture. We learn from doing and observing. Seeing an attending handle tricky, sometimes novel, situations that arise when least expected is an invaluable learning experience. Or do you disagree?” The older man’s bushy eyebrows rose, accentuating the question.
Another loaded question, one he’d be a fool to disagree with. Alex nodded. “You have a good point.” He wanted to circle back to his original argument but knew it’d be beating a moribund horse. If there was one thing Waters had instilled in him, it was intellectual honesty. That was the most important facet of Waters’s training program. He hated the thought of a hard-driving clinician destroying such an important aspect of the established culture.
“As much as I find this conversation stimulating,” the chair said, “we’re held hostage to our schedule. Sadly I must move this interview along. Are there any members of the present faculty you believe to be a suitable replacement for Doctor Waters?”
He thought of Ogden’s desire to take command. “No, sir.”
“Is there anyone on the present faculty you would not want to see become the new chair?”
Thank you, Jesus! “Yes, sir. Doctor Ogden.”
The chairman’s eyebrows arched again. “Oh? Why is this?”
“A chairman needs to be the strongest team player on the faculty. If he isn’t, he won’t get the best performance from the others. Doctor Ogden is not a team player.” He believed this to be true.
One of the committee members began tapping a pen on his notepad. “Isn’t Dr. Ogden well respected in national neurosurgery circles?”
“Yes, but only because his older brother—who’s very well connected—has promoted him.” Alex doubted his words would make much difference, but you never knew,…
“There any outside candidate you’d recommend?” the chair asked.
“I haven’t really given it much thought.” True. “Sorry, I guess that doesn’t reflect well on my preparedness for this meeting, but I’m still having a hard time wrapping my head around the idea of Dr. Waters not being chairman.”
The hematologist asked, “How about you? Are you looking for the job?”
Alex chuckled. “No way.”
The chair nodded sagely. “How about Richard Weiner; do you know him?”
“Dick?” he said, surprised. He considered that a moment. Young, aggressive, a surgeon who also ran a research project. In fact, very similar research to his own. “Yeah, sure, I know him. We share the same research interests.”
“Your thoughts about Dr. Weiner?”
Alex’s immediate thought was Dick was too junior to handle the tenured full professors in the department. It would certainly be a struggle, especially to deal with Baxter and Ogden. “He’s only marginally more senior than I.”
“Yes, but would he be a good replacement?”
“I don’t have any firsthand experience with his administrative capabilities. I guess I’ll have to pass on that.” A foreboding morphed in Alex’s gut. Clearly, the committee was considering Weiner a hot contender. And if he got the job …
Couldn’t possibly happen. Dick’s way too junior.
Right?
“Thank you for your time, Dr. Cutter.”