“As the workforce has changed over time, from industrial to office, old definitions really didn’t address a lot of the issues in the contemporary workplace, including nonprofits like universities,” explains Charles H. Kaplan, an attorney in the Labor and Employment Department of Thelen Reid Priest in New York. “The new regulations made a lot of changes in rules, to make it easier for employers to determine who is and who is not exempt from overtime pay.”

The DOL revised the tests to determine whether white-collar employees are exempt from the Fair Labor Standards Act (FLSA) minimum wage and overtime requirements. The duties tests have been made more efficient. The computer employee exemption was given its own section in the regulations.

At the University of Missouri, about 1,200 employees–less than 5 percent of its workforce–were made nonexempt following the new regulations. The changes occurred across all operating departments, including admissions, employee benefits, information technology, and first-line supervisors in facilities and academic labs, according to Bill Edwards, director of compensation at the university.

Of Syracuse University’s (N.Y.) 4,600 staff members, about 50 were affected by the changes, mainly because they worked part-time. Thirty-five were given a raise, or their work schedule was increased in order to make their hours commensurate to the $455/ weekly salary level. Fifteen employees were reclassified as nonexempt since the departments did not need them to work additional hours, or didn’t have the money budgeted to pay them more.

The new rules’ greatest impact at Syracuse has been on the school’s graduate assistants. The new salary level is a “substantial” increase over the previous one, notes Roger Casanova, director of Compensation Administration at Syracuse. The salary level for exempt employees has been raised to $455, compared to $155 under the old rules. Syracuse had decided that all graduate administrative assistants would be nonexempt. Graduate research assistants were surveyed last fall to determine their actual duties and hours, then Casanova and his department determined which ones would become nonexempt and which would remain exempt.

“Thirteen-hundred graduate student assistants were on a paid salary basis as exempt. When the new pay level came in at $455/week, relatively few met that criteria,” explains Casanova. “The graduate administrative assistants were all reclassified to nonexempt, and some of the graduate research assistants were treated as nonexempt. About 700 graduate teaching assistants were exempt from the salary level test. Very few of the graduate students were affected, including the graduate administrative assistants, who continued to receive a regular monthly salary. They are restricted to working 20 hours a week, and we put procedures in place to assure that they are paid minimum wage plus a premium wage if they work more than 40 hours a week.”

The employees who were directly affected by the new pay rules at the University of Missouri were given a nine-month window to make the change to their new status. The university allowed them to remain on the monthly payroll, although it required manual processing of overtime hours.

“The effects of the FLSA changes on our support operations are just now being realized in areas such as recruiting, conference support and IT user services. We are reviewing policy limits on Compensatory Time Off to better accommodate seasonal peaks and valleys in work schedules,” says Edwards. “Additional part-time staff is being considered to minimize the financial impact of having to pay for extended coverage previously provided by exempted employees. Due to the University’s tight budget, we have not felt the full impact of these changes in such areas as off-site training and conference attendance.”

The University of Missouri committee that was convened to review the review of employees and job titles incurred about 500 staff hours, but many more hours were actually spent studying job documentation and making individual determinations. The appeal process has just begun, according to Edwards.

Many dire predictions were made when the DOL announced its intentions to overhaul the overtime pay rules, but they have not come to pass, says Kaplan.

“Contrary to some concerns from organized Labor that changes would result from employees being exempt from overtime pay, it looks like the actual impact of the rule may have been to enlarge the number of people who are eligible for overtime,” he explains. “The new regulations actually make it more clear who is and is not eligible for overtime pay. The bottom line is that the new regulations are probably easier to apply.”

* Subtle, natural course changes are seen as most effective.

* Students are trained to respond to “all events,” not just specific attacks.

* Efforts are under way to enable benchmarking by other institutions.

The bioterrorism training program at the University of Pittsburgh School of Medicine, among the first of its kind in the nation, has been described as a model by the Washington, DC-based Association of American Medical Colleges (AAMC) during its recent annual meeting.

The program integrates level-appropriate content throughout the four-year medical school curriculum, placing the appropriate content into existing courses and evaluations. Students are taught how to identify, triage, and treat patients exposed to biological, chemical, and radiological terrorism, emerging infectious diseases, and environmental pollution. They also are taught about food and water source safety, the impact of pharmaceutical treatments, terrorist hoaxes, and technologic threats to the continuity of public and health services.

Officials from the school currently are working to help foster benchmarking in other medical teaching facilities in an effort to better prepare health care professionals to deal with potential future biodisasters.

“This type of content has always been included in med school curricula,” notes John D. Mahoney, MD, assistant dean for medical education. “But when I learned about it in the `80s, it was as history–anthrax was about sheep handlers, and the military worried about chemical weapons. Military medical school had hundreds of hours of classes, while we had snippets.”

But when Mahoney developed the current curriculum, he brought to the process his background as an emergency physician and toxicologist.

“Disaster response is about getting out there and getting your hands dirty. I was used to thinking about all of the bad things that could happen–and helping our hospital plan for them. As we headed toward Y2K, as the rest of the country was increasingly worried about threats of chemical weapons, I felt we should cover them in our curriculum,” he explains.

Mahoney’s first steps were deliberately gradual. The first move involved one hour in the classroom and a couple hours of independent work, blended into the usual curriculum. “We brought it into the clerkship in internal medicine in 2000, just like any other subject,” Mahoney notes. “We did it quietly–on purpose. We wanted to quietly introduce the subject as an ordinary topic of 21st century medicine. As such, the students accepted it as a reasonable thing to learn about.”

The first course began in July 2000. “More than a year later, the anthrax attacks occurred, and students were saying, `It’s a good thing I learned this,’” Mahoney observes.

In August 2002, the school rolled out an “all-threats” approach. “If a hospital has a disaster plan, and it is specialized for anthrax–well, we may never see another anthrax attack; the next time it may be plague,” Mahoney explains. “It’s even far more likely a bus will crash or we’ll have several cases of West Nile happen–or there’ll be a GI outbreak on cruise ships.”

Accordingly, two key principles are employed to bring out the curriculum:

* Prepare for all things.

* Make preparedness part of the normal fabric of studying medicine, and reinforce that message again and again.

“It’s the same approach as, say, the one used when a nurse in triage hears a cough,” Mahoney says. “They will think TB. They won’t panic, but they’ll think of it.”

Level-appropriate content is inserted into courses in the context in which it makes the most sense. “For example, if there’s not enough vaccine to go around, who should get it? That sounds like an ethics course,” Mahoney points out.

“We’re not going to have daylong seminars or even hour-long seminars,” he continues. “We will infiltrate the introductory courses with a small bit of content. Naturally, the infectious disease course will get a fair bit, but every course will get something. In the applied clinical pharmacology course, which is an advanced course, we might teach about the mechanism of action of chemical agents and antidotes, and so on.”

Another consideration would be the public health aspect: How does a community cope with an outbreak? “Part of what we’re teaching doctors is to get them to know their role in a disaster,” Mahoney explains.

“Doctors are used to thinking they are in charge, but in a disaster, it may be the mayor or a soldier. Also, they are used to treating a patient. We need to teach a community perspective,” he points out. As part of the introductory course, students go into a community and learn to understand its needs.

The key premise of the new approach, says Mahoney, is that every physician has the potential to be the first one to encounter a given situation, but not every physician is a specialist in infectious disease.

“Accordingly, we need to make every one sufficiently knowledgeable so that they can be the proverbial canary in the coal mine,” he observes. “They need to be able to recognize that there’s something odd going on, and to know what to do–for example, call the infectious disease department. If all we achieve is getting first responders up to that level, we will have done a lot.” Now, Mahoney is helping to spread the approach to other institutions.

The best way to get more Blacks into the legal profession is for historically Black colleges to create more law schools, says Dr. Frederick Humphries, president and CEO of the National Association for Equal Opportunity in Higher Education (NAFEO).

Top universities typically have medical, law, engineering and business schools, and steps should be taken to establish such programs at historically Black universities, Humphries told an audience of Black federal judges late last month during a discussion about the role of Black colleges in diversifying the legal bar.

Humphries said only six of the nation’s 100 historically Black colleges have law schools, including Texas Southern University’s Thurgood Marshall College of Law.

“What I’m going to work on is to try to establish at least seven new law schools in historically Black colleges or universities,” he told the Houston Chronicle.

The discussion was part of the fifth biennial conference of the Just Beginning Foundation, a national association of federal Black judges. About 80 Black judges attended the conference, organizers said.

TSU law professor John Brittain, former dean of the law school, said the percentage of Black federal judges is higher than that of Black lawyers in the nation. About three percent of all lawyers are Black and about seven percent of all students in law school are Black.

Houston federal District Judges Vanessa Gilmore, who was hosting the conference, said 110 of the nation’s 795 federal judges are Black, or about 14 percent of the total.

“The goal for all of us is to have a judiciary that people can look to as a place where justice can be dispensed,” Gilmore says. “There’s appearance of fairness when the judiciary is seen as representing a cross section of America.”

Arizona educators could begin a test ban on soft drinks and junk food on eight public schools next year, a move encouraged by the American Academy of Pediatrics. The state Board of Education will vote at its Jan. 26 meeting whether to ban the sale of junk food and soft drinks as part of a pilot program at four elementary schools and four high schools during next school year. The schools will be selected from a pool of volunteers at the Jan. 26 meeting. Easy access to soft drinks at school has been blamed, in part, for an increase in the number of overweight children.

At the same time, schools rely on the thousands of dollars the vending machines bring in to pay for student activities like student council and clubs. Some local schools are already testing the waters by eliminating soft drinks from machines and others are on the brink of offering only water and fruit drinks.

“Each 12-ounce serving of a carbonated, sweetened soft drink contains the equivalent of 10 teaspoons of sugar,” according to a report released Monday by the American Academy of Pediatrics. “Sugared soft drink consumption has been associated with increased risk of overweight and obesity, currently the most common medical condition of childhood.”

WHAT: Manufacturer of personalized doctors’ scrubs for children

WHO: Jacquelyn Aven of MiniScrubs Inc.

WHERE: Naperville, Illinois

WHEN: Started in 2002

SEEING A SICK CHILD ON TV INSPIRED Jacquelyn Aven to start her business. The little one, who’d spent a lot of time in the hospital, had on child-size scrubs. According to Aven, 38, the medical uniform seemed to make the child feel better, like he was a part of the team.

Aven knew countless kids–both in the hospital and out–would love to wear doctors’ scrubs of their very own in the same material and colors worn by real doctors. A mom herself, Aven was expecting her second child while starting up this part-time venture. However, she soon discovered that it would be no simple task to find a manufacturer willing to make the child-and infant-size scrubs with a high-quality material.

“I thought this was going to be the easiest thing,” Aven recalls. “It’s a great idea, and there are already adult scrubs on the market.” Learning by trial and error, Aven found a manufacturer who could make the scrubs to the specifications she needed–big enough to fit over a child’s head, with extra room in the diaper area. They’re also available with personalized embroidery to help little Molly feel like the future Dr. Molly Smith.

Aven started selling wholesale to hospital gift shops and got a good response; but her best outlet has been her Web site (www.miniscrubs. com), where she can get feedback directly from customers, “You can tell their excitement,” says Aven. >From moms who got the scrubs as baby shower gifts to children battling illnesses, Aven hears how her creation has brightened people’s lives.

Aven, who donated some of the profits from her sales of about 500 scrubs last year to organizations including the American Cancer Society and the Muscular Dystrophy Association, now plans to target doctors and dentists who want to outfit their children like morn and dad–and even has an eye on the veterinary market as well. Sounds like MiniScrubs is in very good health.

Ready for Takeoff

WHAT: A portable DVD-player rental service for airline passengers

WHO: Barney Freedman, Michael Freedman and Dave Kight of InMotion Pictures

WHERE: Jacksonville, Florida

WHEN: Started in 1998

MICHAEL FREEDMAN SPENT MUCH OF his time in airports and airplanes in the late ’90s, observing how bored people were in transit. Sure, there was in-flight entertainment–but it certainly didn’t interest everyone on board. It would be better, he thought, if passengers could choose their own movies and watch them on their own timetables.

At the time, DVD technology was still competing with the DivX format for consumer loyalty, but the trio of entrepreneurs put their money behind the DVD concept and designed their rental service offering. There are a few different rental options: Customers can rent the unit with a lilt DVD movie for the duration of the flight and then turn it in to a drop-off box at the destination airport. They can also keep the unit for the entire trip and return it ‘after the flight home. Or they can take a prepaid mailing envelope and mail the unit back from their destination.

The hard part was getting airport execs to warm to the concept. Freedman and his partners pitched all the airports they could and finally got Minneapolis-St. Paul International Airport and Portland International Airport to allow them to build storefronts in their concourses in 1999. Though Michael, 34, and partners Barney Freedman, 29, and Dave Kight, 38, lacked experience in the airport and film worlds, Kight had a retail background, which was helpful.

The business grew rapidly during the first two years, though the events of 9/11 slowed business dramatically. The company still hasn’t returned to its pre-9/11 rate of expansion, but its revenue growth is holding steady. Michael notes that today’s long security lines and even longer airport waits have made the InMotion product more useful than ever: People are actually watching movies at the gates well before takeoff. With 25 locations in 21 airports nationwide and sales well into the eight figures, these entrepreneurs are in for a very long ride.

All Dolled Up

WHAT: A manufacturer of authentic Russian nesting dolls with the likenesses of sports and entertainment figures, as well as traditional Russian nesting dolls

WHO: Alexander Krilov and Julia Butler of Newcrafters Nesting Dolls Co.

WHERE: Encino, California

WHEN: Started in 2000

ALEXANDER KRILOV WAS A MEDICAL doctor by trade, but when he emigrated from Ukraine 15 years ago, his thoughts turned to entrepreneurship. After running a variety of businesses, ranging from athletic shoes to international distribution for online florists, Krilov landed on the idea for sports-themed Russian nesting dolls while working as a business manager for Los Angeles Lakers star Stanislav “Slava” Medvedenko.

Krilov, 40, and his wife, Julia Butler, 45, noticed sports fans would buy anything featuring their favorite player’s likeness, so the pair decided to create a traditional-looking Russian nesting doll with the modern twist of a superstar’s face. Obtaining licenses from the NBA took perseverance, but in the end, Krilov and Butler were able to make dolls with the renderings of Kobe Bryant, Rick Fox and Shaquille O’Neal.

Manufacturing the dolls in high-quality plastic with almost portrait-quality artwork, Krilov and Butler have since secured licenses from the NHL and Major League Baseball, in addition to Elvis Presley and I Love Lucy properties. With these unique collectible alternatives to bobblehead dolls now being sold nationwide in arena stores, specialty stores and online, sales should hit $1 million in 2004.

ON A SHOESTRING

WHAT: A company that prints advertising on parking-garage tickets and other types of tickets in the transportation industry

WHO: Christopher Gilliam of AdverTickets

WHERE: Dallas

WHEN: Started in 1998

HOW MUCH: $5,000

With an eye for untapped marketing vehicles, Christopher Gilliam saw prime advertising space on the empty backs of parking-garage and valet tickets. People had to take the tickets, he reasoned, and keep them in their cars or hold onto them for the valet. Gilliam, 41, worked for an advertising company at the time and pitched the idea as an addition to the company’s offerings. When the agency didn’t want to take the chance, Gilliam decided to make a go of it on his own.

With a little less than $5,000 to start, he hit the ground running. He trekked to local parking garages and advertisers to gauge their interest in the concept. The interest was there, but learning the ins and outs of printing was a challenge for Gilliam, as was finding a printer he could trust. In fact, a mishap with a substandard printer cost him a substantial portion of his startup cash.

Despite his loss, Gilliam, a marketer at heart, spoke to anyone and everyone about his business. With luck on his side, he eventually met a property owner in Dallas who leased him an office for a very low rate–with no big deposit upfront. Located over a restaurant, the place had interesting (read: funky) food smells wafting in at 11 a.m. each day, but the space helped Gilliam grow the business fast and rebound from the printer glitch.

To further spread the word, Gilliam crashed the National Parking Association’s Parking, Transportation and Services Convention & Exposition trade show–”I didn’t have money to get a guest pass; [I was] sneaking around the monitors”–and started meeting people and showing them the product. His stealthy maneuver worked. Today, AdverTickets has clients like Delta Air Lines, DreamWorks; Jiffy Lube, Lexus and Sony, and can be found in parking garages all over North America and in Mexico and Puerto Rico. Sales are expected to exceed $10 million in 2004.

If the mission of the Association of American Medical Colleges is clear–”to change the face of medicine to reflect the face of America,” said Dr. Charles Terrell, the group’s vice president for diversity policy and programs, at the opening of AAMC’s recent conference on career development for minority faculty–then another fact is equally clear: The barriers are high.

Racial and ethnic minorities–especially African-Americans, Latinos of Mexican American and Puerto Rican descent and American Indians–are a small proportion of academic faculty at U.S. medical schools, a proportion that appears to be growing at only a glacial pace, Terrell said. American academic medicine, he continued, seems to be “afraid of the dark.”

Indeed, while Whites comprise 76.3 percent of the general population, they make up more than 79 percent of all medical faculty and nearly 89 percent of all full professors in academic medicine, said Dr. Denise Cora-Bramble, executive director of the Goldberg Center for Community Pediatric Health at Children’s National Medical Center in Washington, D.C.

Minorities, meanwhile, are more than 23 percent of the population, but only hold 4.9 percent of all medical faculty positions and 2.2 percent of full-time positions.

None of this, of course, was exactly news to the men and women gathered at the Georgetown University conference center for AAMC’s annual Minority Faculty Career Development Seminar.

The group–mostly composed of mid-career faculty but also including a sprinkling of senior faculty looking to improve the minority numbers at their academic organizations–nodded and sighed as conferees discussed the barriers facing people of color, including the low numbers in the pipeline, the desire to pay off school indebtedness and the lack of role models or mentors who could steer them to opportunities in academic medicine.

Even when minorities find their way into faculty ranks, “we’re not happy campers,” Cora-Bramble said. She ran off a quick list of reasons: lower rates of promotion experienced by under-represented minorities; “toxic” competitive environments where harassment and bias are the rule rather than the exception; the “Black tax” of committee assignments that eat up time that could be more profitably spent in research; and conflicting desires for career advancement and for a satisfying family life. The discussion of these issues and annoyances drew the strongest reactions from the audience at AAMC’s conference.

But unlike other conferences on ethnic and racial disparities, the bad news was simply the place where the discussion began, a way of “keeping it real,” said Cora-Bramble. For the two and a half days that followed, conference attendees received a crash course in navigating the tricky environment of academic medicine–both the rules of the game and the “hidden rules” that trip the unwary.

An essential first step was outlined by Dr. Valerie Williams, associate dean for faculty affairs at the University of Oklahoma College of Medicine and director of the Health Sciences Center Faculty Leadership Program: “You have to have a framework for your academic career,” she said. “You have to be able to state clearly what your interest is, and you have to consider how you might share that with other people.”

Indeed, she noted, many an academic career has gone off the rails for lack of a simple plan. “You don’t want to end up with a life that is, in the words of Sir Walter Scott, ‘unwept, unhonored and unsung,’” Williams said.

Career planning requires facing fundamental questions about one’s relationship to academia. The questions can be as simple as, “How do I reasonably fit in?” or as complex as “How do I maintain my integrity around issues that are important to me?”

But Williams’ concept of career planning begins with finding an individual’s passion–that spark that brought them to medicine and kept them motivated during the long years of training. “What you’ve got to do is leverage that passion into something that can be connected to an institution’s mission,” she told the attendees. “That lifts us all up, because if we can get our institutions to see how we fit and vice versa, we can make things happen in our careers.

“You are a unique individual–you bring something unique to the environment,” she continued. “But what you bring has to be recognizable in terms of what your peers find of value because peer review is the coin of the realm in our environment.”

Williams’ emphasis dovetailed into the presentation that followed by Dr. Laura Schweitzer, interim dean of the school of medicine at University of Louisville’s Health Sciences Center. She spoke on demystifying the tenure and promotions process.

“Here are a few words to the wise: Right or wrong, the promotion and tenure process is a political process. So you can’t underestimate the power of your personal relationships when it comes to navigating that process,” Schweitzer said. “It’s all up to you. You have to make the case for your promotion or tenure. You have to state the case in terms of whether you’ve met all the criteria. And you have to state that case in terms of what your institution values.”

Responding to a comment from an audience member who expressed distaste for the ways in which her colleagues vied with one another in tooting their own horns, Schweitzer made no bones about her views: “Promotion and tenure is not a time to be worried about bragging. You have to brag during promotion and tenure evaluations, because if you don’t do it, no one is going to do it for you.”

The inspiring thing about the AAMC conference was that one could see little fires of recognition light up all around the room. During the discussion of “toxic environments,” Dr. Mildred Olivier, an award-winning ophthalmologist from Chicago, brought up the case of a friend whose chair wasn’t supportive of her work. “And if your chair isn’t supportive, does it really matter that you have [National Institute of Health] grants?”

Allison Jackson of Children’s National Medical Center found herself struck by a point during Schweitzer’s presentation. Upon learning that most promotions proceeded from either a clinical services track or a research track, Jackson found herself wondering about the track she was on.

“I’m a clinical educator–that’s a track that’s recognized by my hospital but not by George Washington University,” the academic institution with which the hospital is affiliated.

But these are precisely the questions the AAMC’s annual career development programs are set up to answer.

“For those that journey there isn’t always a pathway,” Cora-Bramble said. “That doesn’t mean you’re doomed to fail. It just means you need a serious personal plan.”

Dr. Jordan J. Cohen, president of AAMC, told Diverse that their research has found that the cost of medical education and the length of time it takes to complete medical training may be deterrents for more African-Americans to apply to medical school.

“Although ample loan funds at attractive interest rates are available for medical students, we speculate that African-American families are, in general, less inclined than others to borrow substantial amounts of money,” Cohen says. “We hope to communicate more effectively with prospective African-American college students that an investment in a medical education is not only financially wise but can lead to a most fulfilling career in a field with endless opportunities.”

Who’s Producing the Most Minority Doctors?

* Howard University College of Medicine: African-Americans

* University of Oklahoma Health Sciences Center: American Indians

* University of Medicine and Dentistry of N.J.: Asian Americans

* University of Puerto Rico-Medical School Campus: Hispanics

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Applications to US medical colleges have fallen by a fifth in tour year’s, as the internet and other new industries bring new career opportunities to young and upwardly mobile people. According to the Association of American Medical Colleges, which represents the 125 accredited medical schools, at total of 37137 students competed for 16 303 places this year. This is a 3.6% decline in the number of applications last year and is 21% lower than the record 46 968 students who applied to US medical schools in 1996.

Applicants from underrepresented minority groups this year totalled 4267 (1.9% more than in 1999). Of these, 2571 were women, an increase of 0.5% over 1999. The Association of American Medical Colleges classifies underrepresented minorities as black, native American, Mexican American/Chicano, and mainland Puerto Rican.

“In spite of the ever expanding list of career options available to young people today, especially in the burgeoning internet economy, medical schools continue to attract large numbers of gifted individuals who are interested in becoming doctors,” said the association’s president, Dr Jordan Cohen.

The association thinks that several factors may be contributing to the decline in applicants–for example, the relatively strong economy and the increasing variety of exciting and intellectually challenging professional opportunities outside the traditional career choices.

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PHYSICIANS NEED TO BE ABLE TO PROVIDE effective care for diverse ethnic and racial populations. A new study shows that medical students can do this if they are part of a student body that is racially and ethnically diverse. The study, conducted by Harvard Medical School and the Harvard Graduate School of Education, was published in the May issue of Academic Medicine, the journal of the Association of American Medical Colleges.

Students at the medical schools of Harvard University and the University of California, San Francisco, were interviewed for the study. Asked if interaction with students of diverse backgrounds was a positive element in their educational experience at medical school, 94 percent of the students agreed; the responses did not differ significantly among races. Seventy-six percent indicated that a diverse student body improved their ability to care for patients of different races; only 4 percent said diversity was of little or no help.

Ninety percent of all students believed that affirmative action should be strengthened or maintained at medical schools, while only 3 percent thought it should be discontinued. In addition, 84 percent believed that diversity improved classroom debate, leading to more examples arid increased discussion of alternative viewpoints, though they did not think that diversity necessarily led to higher levels of intellectual conflict or challenge.

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It used to be that, because of religious discrimination, young U.S. Catholics who hoped to become physicians would enroll in Catholic medical schools. Now those days are past. Religion is no longer a factor in medical education. Nine Catholic universities once had their own schools of medicine, but only five do so today. Are there good reasons why Catholic universities should continue to sponsor medical schools? asks Daniel P. Sulmasy, OFM, MD, PhD, a writer and speaker who is well-known in our ministry. Yes, is Dr. Sulmasy’s answer. And in “Can Medical Schools Be Catholic?” (p. 10), he says what those reasons are.

Medical futility policies are the subject of two articles in this issue. In “Creating a Medical Futility Policy” (p. 14), S. Y. Tan, MD, JD; Bradley Chun, MD; and Edward Kim, MD, describe the process that they and their teammates went through in developing such a policy for St. Francis Medical Center, Honolulu. Meanwhile, Ronald P. Hamel, PhD, and Michael R. Panicola, PhD, argue, in “Are Futility Policies the Answer?” (p. 21) that better communication between caregivers and patients and their families could make such policies unnecessary.

Writers in the March-April issue of Health Progress discussed the nurse shortage in U.S. health care. In this issue, Joan Ellis Beglinger, RN, MSN, MBA, describes (in “Transforming Nursing,” p. 25) the success that a Catholic hospital in Madison, WI, has had in holding on to its nurses. Readers-especially the nursing directors among them-will find her article thought-provoking.

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For Two Reasons, Catholic Universities Should Continue Sponsoring Such Schools

Catholic hospitals and Catholic medical schools have much in common, but they are also very different. The mission and purpose of Catholic hospitals was clear and purposeful from the outset in a way that has not been historically true of Catholic medical schools. By and large, American Catholic hospitals were founded by orders of religious women who were spiritually inspired to respond to God’s call in their lives by caring for the sick. Sociologically, these were generally poor women who found in nursing opportunities for educational advancement and professionalism. They came to the United States largely to escape poverty such as that in Ireland or oppression like that of the Kulturkampf in Germany. They responded to the emerging needs of a growing American nation for nurses and hospitals during the Civil War and then afterwards in recurring epidemics of cholera, typhoid, and tuberculosis, in the Western expansion, and in Eastern urban poverty. These Catholic women essentially shaped the American nursing profession and hospital care, and they grew and adapted as medical science grew. While there were struggles along the way, there was also, until recent years, a synergy between what nursing sisters offered and what America needed and wanted. Their care for the sick was their prayer and their preaching, and for 150 years it was resoundingly American, Catholic, and professional.1

American Catholic medical schools, by contrast, grew up rather accidentally. American Catholics originally founded colleges to train seminarians, eventually expanding their purposes to teach advanced catechesis and apologetics and to provide social opportunities for Catholic immigrants. In time, they added professional schools, providing a quick way for the college to become a university while serving the needs of Catholic students

Nine U.S. Catholic colleges have had medical schools, four of which have been closed or sold.3 One of these (Niagara) lasted only two years (1888-1900). Another (Fordham) closed in 1921. Seton Hall’s medical school opened in 1956 and was purchased by the state of New Jersey in 1965. Marquette’s medical school became the Medical College of Wisconsin in 1967. Four Jesuit institutions (Saint Louis, Georgetown, Creighton, and Loyola Chicago) still operate medical schools. The newest, New York Medical College, became affiliated with the Archdiocese of New York in 1978, making it the lone non-Jesuit U.S. Catholic medical school still in existence.

The students and faculty of the first eight of these medical schools were, by and large, culturally Catholic. The students came from Catholic undergraduate institutions where the work of catechesis was assumed to have been completed. The mission of these schools was never really so much to train doctors to be Catholic as it was to train Catholics to be doctors. There never really were any clergy on the faculty of Catholic medical schools. Canon law at the time prohibited priests from performing surgery.4 A token Jesuit taught the requisite brief course on medical morals. But there has never been any such thing as a distinctively Catholic approach to histology. So these schools just taught histology and concentrated on producing competent physicians.

Over the last few decades, however, the students and faculty at all of the five extant U.S. Catholic medical schools have become increasingly diverse and the cultures of these schools have become increasingly secularized. All of these schools are struggling financially-three have been forced to sell their university hospitals; one, which never owned its teaching hospital, simply employs strong teaching affiliation agreements. None of these is ranked among the top 25 U.S. medical schools. And, when compared with Catholic hospitals and nursing schools, these medical schools have been a sideshow in the history of U.S. Catholic health care.

So the question why the church should sponsor medical schools is genuine. With increased opportunities for Catholics at secular medical schools, one of the major historical reasons for their existence has become obsolete. And the historical basis of the Catholicity of these schools has also become a thing of the past: Large minorities or even majorities of the student bodies and faculties at Catholic medical schools are no longer even nominally Catholic. Keeping any medical school open these days is hard work. Keeping a medical school open and Catholic is even harder.

Perhaps the best thing to do for the sake of the church would be to empower lay Catholic men and women to go to secular schools and to live the Gospel. At least it seems that the burden of proof has shifted to those who would keep Catholic medical schools going.

Mark Sargent, the dean of Villanova Law School, has stated that the purpose of a Catholic law school is to be a vehicle by which the church “confronts in creative dialogue the world’s different truth claims.”5 Whether such a mission is strong enough to carry the Catholic identity of a law school can certainly be debated. However, there is no debating the fact that such a statement would seem senseless to the faculty of a Catholic medical school. What purposes can there be for having Catholic medical schools?

PROFESSIONALISM AND CATHOLIC IDENTITY

By and large, the demands for technical and professional excellence have caused Catholic medical schools to lose sight of their Catholic missions and religious sensibilities more completely than either Catholic undergraduate institutions or Catholic hospitals. This leads one to wonder whether the demands of professionalism are in essential tension with the demands of Catholic education, or whether the present situation has simply been an accident of history.

There are many definitions of professionalism. However, the criteria set forth by Abraham Flexner, the great reformer of American medical education, seem especially relevant since the five extant U.S. Catholic medical schools survived his careful scrutiny and initially flourished because of his famous report.6 Flexner set forth six criteria that distinguish professions from other human enterprises. He suggested that professions:

* Are intellectual operations with large individual responsibility

* Depend upon science and learning

* Put their learning to a practical and definite end

* Possess an educationally communicable technique

* Engage in self-organization and self-regulation

* Tend to become increasingly altruistic in motivation7

The first four of these criteria do not, it seems, raise any immediate issues for Catholic professional education that are not true of Catholic higher education in general. Science and the church have certainly had their struggles, especially over physics. But the church docs not claim the competence to declare the function of the pituitary gland. Gaudium et Spes (nos. 36 and 59) explicitly reserves such pronouncements for the proper sciences. Ex Corde Ecclesiae (no. 29) states that, “The Church, accepting ‘the legitimate autonomy of human culture and especially of the sciences,’ recognizes the academic freedom of scholars in each discipline in accordance with its own principles and proper methods, and within the confines of the truth and the common good.” So, at least in medicine, the issue does not seem to be one of competing claims about empirical truth.

However, Flexner’s last two criteria are very interesting. I think that the fifth, the mandate of professions to engage in self-organization and self-regulation, docs pose significant tensions for Catholic professional schools, while the sixth, altruism, points to what Catholicism can best give to our desperately needy professions. Out of the tensions involving the church and these two defining characteristics of genuine professions, I will suggest, arise the best reasons one can hope to give for having Catholic professional schools in the 21st century.

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