8. The medical school where Dr. Jones teaches is raising its expectations for clinical faculty to generate practice income. The medical school has multiple missions: educating future physician; researching advancements in medicine; treating patients and funding the first two missions with revenue from patients. Does the medical school have a conflict of interest if one mission, patient revenue, diminishes faculty’s ability to meet other missions?
#	Response Date	Comment
1.	Tue, 3/13/07 11:00 PM	I am not sure that I see this as a COI but not a fair practice as an institution with such a complex mission.
2.	Wed, 3/14/07 12:08 AM	These are different interests, but I don't believe they conflict. If the clinic closed due to financial difficulty no mission could be served. The way in which doctors create patient revenue needs to be monitored so that patients are not abused (in the most general sense); but financial solvency is not at odds with education or research.
3.	Wed, 3/14/07 12:09 AM	if the faculty will be evlauated by performance in each or the one mission of focus (OK to have speicalty teams/palyers)
4.	Wed, 3/14/07 12:25 AM	why does the med school care about the MD's clinic revenue??? does the school get a %age??
5.	Wed, 3/14/07 1:37 AM	I don't define this as a COI. It is a problem in terms of faculty expectations, but not a COI
6.	Wed, 3/14/07 1:55 AM	welcome to the realities of life. these are the ground rules that faculty must accept to be faculty.
7.	Wed, 3/14/07 2:44 AM	It doesn't so much depend, but we all must acknowledge the unfortunate truth of the matter that funding is needed to run and better medical care and education. If the faculty's ability is/or might be compromised, then a solution should be sought to allow them to refocus on their tasks of teaching, researching and treating while increasing revenue...ie hire another physicia or a PA/NP to increase volume and revenue while allowing physicians to monitor the other missions.
8.	Wed, 3/14/07 3:17 AM	Yes, if collectively one or more of the other missions suffer because adequate faculty time was not allocated
9.	Wed, 3/14/07 12:43 PM	in the sense that there are competing interests or goals and one suffers when the other takes precedence.
10.	Wed, 3/14/07 1:30 PM	note: "Patient revenue" was not explicitly described as a mission in the original statement. The necessity of generating revenue (patient revenue, other sources) to meet one's missions is a fact, and likely will generate some conflicts (likely small to moderate).
11.	Wed, 3/14/07 1:39 PM	This is the conundrum that modern medical education has created. It behooves the medical school to produce a metric that is fair to faculty and a mentoring sytem to help faculty meet scholarly expectations.
12.	Wed, 3/14/07 1:50 PM	Depends on the terms of employment which should be renegotiated if expectations change
13.	Wed, 3/14/07 2:04 PM	An internal conflict amongst the varying goals of the mission which in fairness should be addressed...I hadn't thought of this as an COI until this question was posed...I think that I tended to perceive COI in terms of conflicting financial interests.
14.	Wed, 3/14/07 3:56 PM	Educating students, performing research & treating patients are all very important tasks. Some physicians prefer teaching & research to generating patient revenue & they're very motivated and productive in those areas. Others physicians prefer patient interaction and excel in that arena. Personal interests and departmental performance expectations should be discussed and clearly outlined during the hiring process. Forcing a physician hired primarily as a researcher to generate patient revenue at the same levels as those who are not research oriented could be a serious COI. As would be suddenly requiring a person who's great at generating patient revenue to also perform research.
15.	Wed, 3/14/07 4:32 PM	This is a delicate balancing game. Certainly no one person can be expected to fulfill all of these missions by themselves. A medical school is a team effort. If there are minimum requirements for everybody that altogether take up too much time, then one or another will suffer, which leads to suffering of the whole program and the students. People who work in medicine are normally very driven, but it is possible to ask too much of them. They need time to rest too.
16.	Wed, 3/14/07 10:00 PM	If each individual faculty member must contribute to all missions then this is a problem..If the college as a whole has multiple missions, they can be accomplished as a whole, each contributingin different ways.
17.	Thu, 3/15/07 2:33 PM	THis is true in all medical schools in this country. IT is an issue of being explicit about priorities, and matching faculty assignments to skills and time available. SO specificity of job description of faculty, with evlauations being made based on the assignment, is the issue here.
18.	Sat, 3/17/07 1:27 PM	Sounds like CHM! I'm not sure that I'd call this a conflict of interest as much as a challenge of multiple missions that at times are not easy to perform. It makes faculty retention challenging and forces the school to get smarter about how it gets its work done.
19.	Sun, 3/18/07 6:29 PM	It depends on whether the patient revenue is the sole or major source of funding for the other missions, and how the school intends to increase revenue from patients.
20.	Mon, 3/19/07 12:03 AM	It is amoderate conflict of interest but it happens all the time
21.	Mon, 3/19/07 4:08 PM	Depends on the balance of work expectations... quality clinical care is a part of role modeling in teaching--example Mayo Medical Center.
22.	Mon, 3/19/07 4:32 PM	This constitutes a small COI, but is unavoidable considering the funding structure of medical schools and teaching hospitals. This is fairly easy to manage by ensuring that the revenue generating opreations of the medical school are administered separately from its other missions (teaching and research) as is usually the case.
23.	Mon, 3/19/07 5:23 PM	COI doesn't bother me. What we have here is a corruption of the med school.
24.	Mon, 3/26/07 3:06 PM	Yes, since the missions are in conflict; however, the extent of the problem would depend on several factors. For example, if there were sufficient faculty so that some were more engaged in one mission and overall the missions were met. In this case, it is concerning that the expectations are raised without clear indication of how the other missions will be protected
25.	Mon, 4/23/07 1:21 PM	This is a COI that must be recognized and addressed but is also somewhat necessary.
26.	Mon, 4/23/07 3:41 PM	I depends on which is the PRIMARY mission
27.	Mon, 4/23/07 10:28 PM	If the school would not be able to exist without the revenues, then it is acceptable have limits on the extent of missions. Ie no margin - no mission at all of any kind.
28.	Tue, 4/24/07 1:45 PM	Yes but without revune, the faculty (and med school) would be unable to carry out any mission. Lesser of two evils?
29.	Tue, 4/24/07 9:32 PM	Not if the faculty member can adequately balance out the demands of time and effort across the three expectations.
30.	Wed, 4/25/07 12:43 AM	Describes MSU.
31.	Wed, 4/25/07 12:47 AM	a problem nonetheless
32.	Thu, 4/26/07 12:22 PM	If faculty have performance based contracts then, I think it is a serious problem.
33.	Tue, 5/1/07 1:39 PM	Balancing multiple missions is a reality of life. How that is carried out determines the extent of COI