Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7131 Volume 316 Editorial Saturday 21 February 1998 Not one academy but two The new one should focus on fixing academic medicine Everybody in Britain should be grateful if the Academy of Medical Sciences that was launched this week can preserve and promote academic medicine - for it approaches a parlous state. But we don't need yet another body of old men with chains around their necks that dines, processes, and professes and offers a further source of advice to government that it can take or leave to suit its own ends. The academy must target its efforts and aim to be effective not grand. A Martian - or even an American - might be surprised that after 50 years of unresolved debate about the need for an academy of medicine Britain suddenly has not one but two. The cognoscenti will understand well the difference between the Academy of Medical Royal Colleges and the Academy of Medical Sciences, but few ordinary doctors and almost no members of the public will. Medical students understandably go blank when asked to explain the purposes and structures of Britain's expanding constellation of medical institutions - comprising the BMA, General Medical Council, royal colleges and faculties, specialist societies, and myriad other bodies. British medicine's problem is not too few organisations, but too many. Given the unimaginable opportunity of starting from scratch, a new chief executive of British medicine would undoubtedly undertake a restructuring more dramatic than anything seen by British Telecom or other liberated monopolies. He or she would slash corporate headquarters, cut overheads, sell off the gowns, cancel the committees, and send people back to their hospitals, surgeries, and medical schools to "add value or go bust." Such dramatic changes are possible only when the country is flattened and the old guard killed off by war, explaining the seeming paradox that countries who lose wars do better economically in the long term than those who win them. If we are to have another medical institution, then we need either a high level strategic one that points existing bodies in the same direction or one that meets a genuine need. There is a danger that - without focus - the new academy may be neither. In 1994 Maurice Shock, a political scientist, famously told British medicine's first summit meeting in 30 years that doctors were not well organised, had failed to see major changes that were happening around them, and needed a top body concerned primarily with strategic and high political matters.(1) Otherwise, he said, "the profession will never be able to punch its weight." The new academy might have been such a body, but it surely now cannot be. Although the fifth aim of the new academy is "to give national and international leadership in the medical sciences," it cannot be a strategic body because it does not bring together the existing powerful and (in some cases) well resourced bodies. Rather, this strategic function might be fulfilled by the "group of nine," a largely invisible body that meets regularly and does include representatives from the major bodies. If the new academy is not to be strategic then it must be focused, and the right focus is academic medicine. Abundant evidence shows that service and funding pressures, diminished career prospects, problems of accreditation, and the research assessment exercise are eroding Britain's capability in academic medicine.(2-6) Here is real need. To promote academic medicine should be the academy's primary purpose, and it is to be applauded for bringing together clinicians and basic scientists. Structure, as every first year management student knows, must follow function, and we must worry that the academy's structure will not be best suited to this function. Academic medicine depends critically on bright young people. Without them, the endeavour is nothing. This is why the BMJhas argued for the creation of an organisation of "young Turks" to promote research. The new academy may, however, be in danger of excluding these very people. It is to begin with a founding fellowship of 350 nominated by the Royal Society and four other bodies. Aren't these likely to be the same old greybeards that run all the existing organisations? We must hope not. The new academy may have some spare time and energy to "enhance public understanding of the medical sciences" and "establish itself as an authoritative body to assess and advise on issues of medical science of public concern," but we advise it to concentrate on academic medicine. Fix that, and we will all benefit. Richard Smith Editor, BMJ References 1 Shock M. Medicine at the centre of the nation's affairs. BMJ 1994;309:1730-3. 2 House of Lords Committee on Science and Technology. Report. London: House of Lords, 1995. 3 Committee of Vice Chancellors and Principals. Clinical academic careers. Report of an independent task force. London: CVCP, 1997. 4 Rees M. Who wants a career in academic medicine? BMJ 1997;315:74. 5 Chaudry B, Winyard P, Cale C. Academia: the view from below. BMJ 1997;315:560-1. 6 Grahame-Smith D G. Clinical academic medicine: a Socratic dialogue. BMJ 1997;315:593-5. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline