Academic medicine is still hospital based

EDITOR—Stewart in his editorial on academic medicine displayed a total lack of recognition that academic medicine includes general practice and other disciplines not included in “teaching hospitals.”1 The largest group of consultants in the NHS work in general practice, not anaesthesia, and maybe Stewart wondered how many general practice trainees were contemplating an academic career.

As someone who started an academic career in 1976 and is about to re-enter the fray, let me offer a different reason why academic medicine is so unpopular. Academic medicine is still dominated by the aristocratic hospital minorities such as internal medicine and surgery, which play such a small part in the modern practice of medicine. Perhaps it is because they have so much time to spare that they can spend their time administering. To become a professor of medicine or surgery now you have to be young, impossibly specialised to the point of non-functionality in any clinical reality zone, and skilled either in the treatment of rats and cats or in plagiarising other people's research through meta-analysis. You then progress to deanship and the task of creating academics in your own image.

The hospital is now an obsolete concept, and most of the departments on which academic medicine is based are as outdated as orders of the garter, the bath, or the chamber(pot). What we need is for academic medicine to provide generic training in the education of students …