Shelling Out For Students

In an interview with The Crimson in October, soon after he had announced his plan to resign as Dean of Harvard Medical School (HMS) effective this July, Joseph B. Martin said, “I want to be remembered first as a dean of students.” With this weekend’s announcement of HMS’s plan to double its expenditure on compensation for hospital-based teachers, Martin may have found a roundabout way to solidify that image in the eyes of HMS doctors for years to come.

HMS currently budgets $8 million per year to pay its 7,000 Harvard-affiliated doctors. Unlike most medical schools across the country, Harvard does not run its own hospital; instead, HMS maintains relationships with teaching hospitals, which provide doctors-cum-instructors on a good will system. Although “7,000 Harvard-affiliated doctors” may seem unexpectedly large since HMS has 771 students in its MD program, each doctor is only expected to teach for 50 hours per semester, and those quotas are unmonitored and by all accounts rarely met.

This disparity stems from the small and variable pay that doctors can expect from an hour of teaching Harvard students. Currently, some doctors receive as little as $30 per hour as an instructor, which falls well short of the $100-per-hour rate of the average Boston primary care physician. The result is that course directors have a tough time finding teachers; one described hiring residents, fellows, and doctors at other universities to The Boston Globe.

Under HMS’s new plan, doctors will receive approximately $100 for each hour of their teaching. Although this increase still falls short of the average pay of most specialists and surgeons, it is an important step in creating financial incentives for teaching.

The success of this initiative is especially important for HMS because of its recently introduced—and much heralded—curricular reforms. Unlike nearly all other medical school programs, HMS students now spend their third year in a single hospital rather than rotating through several institutions. The reforms, designed to improve student relationships with patients and doctors, are simply untenable without expanded faculty involvement. Not surprisingly, the initial results of this increased student-faculty contact have been promising.

Theoretically, these incentives would not be unnecessary, and doctors—like professors on Harvard’s other faculties—would be as attracted to the classroom as they were to a new book or a $100,000 surgery. Realistically, however, doctors and professors have many conflicting incentives, and teaching usually falls last in its magnetic appeal. Although HMS is not directly analogous to the Faculty of Arts and Sciences (FAS), HMS’ experience shows just how important incentive schemes are.

In January, the Task Force on Teaching and Career Development at FAS released an extensive report which suggests tying pay raises to teaching in more extensive and explicit ways. Such changes are critical to improve pedagogy at Harvard, which can be wildly inconsistent. We hope that person who will actually institute these reforms—the next FAS dean—will follow HMS’s lead. Then, maybe, he or she will also be “a dean of the students.”