Editorial: Legal eagles insure us against the dangers of teaching medical students

Volunteer faculty instructors can add to the experience of ophthalmology residents, sharing the skills and perspectives gained over decades in their busy practices. In public universities and Veteran's Administration hospitals, self-insurance with the deep pockets of a state or federal government can make liability insurance for teachers a non-issue. But for private institutions the costs of taking out policies on an entire volunteer faculty would immediately bankrupt most medical schools.

"The first thing we do, let's kill all the lawyers."

Act IV, Scene II, Henry VI Part 2 (William Shakespeare)

Alawyer calls his client to tell him about his fee schedule.

"What! That sounds like a car payment schedule," retorted the client.

"You're right. It's mine." ( http://www.ahajokes.com/law017.html)

Today I received an e-mail from one of my part-time (volunteer) faculty members telling me he will need to resign from his position. This faculty member (name withheld to protect the innocent) wrote: "I never imagined myself having to say this, but I cannot teach the residents or students at Hopkins anymore." He was a particularly motivated and enthusiastic teacher, and had recently been presented with a teaching award by the medical students.

A part-time volunteer faculty instructor definitely can add to the experience of ophthalmology residents. In both my current and two previous departments, volunteer faculty taught in the resident teaching clinic and operating rooms, and did so with alacrity. The residents benefited enormously, as the skills and perspectives-gained over decades in the volunteers' busy practices-were shared with the residents.

Although great clinicians and surgeons who are full-time academicians exist, of course, most academicians also are taking time out to do research, write papers, deliver lectures, participate in university committee meetings, etc. Our brothers and sisters in private practice, however, typically have less non-practice-related activities, and generally have relatively greater clinical volumes and experience. Often, this gives them a wealth of experience and "real world" clinical wisdom to impart.

Needless to say, the medical students and residents also benefit from the perspective of ophthalmologists who manage successful private practices. The leadership and managerial experience possessed by these private practitioners can complement the scientific and academic prowess of the full-time academic faculty.

A recent survey of young ophthalmologists found that they crave knowledge regarding the skills and competencies required to provide high-quality care in an efficient practice after graduation, and volunteer faculty particularly are able to convey that information.1

Two-way street

So, most wise department chairmen I know value the contributions of their dedicated and conscientious volunteer faculty. This is a two-way street. Throughout the years I have probably heard a thousand times from the volunteers how enjoyable and stimulating it is to be in clinic with young residents, how much the faculty member learns about himself or herself from the experience, and basically how rewarding it is to work with some of the brightest young minds in medicine (ophthalmology residencies remain quite competitive).

Knowing how much this particular faculty member enjoyed teaching, I knew there must be an important reason for him to discontinue in this role. Was it illness, retirement, or a personal or family crisis? No, it was the malpractice carrier: "My professional liability insurer has just informed me that if I continue doing any kind of teaching at Hopkins, it will cost me several thousands of dollars a year in additional premium payments. It does not matter to them that in 34 years I have never been sued, it does not matter that I never write in the chart...and it does not matter that I do my teaching as a volunteer." This is the second faculty member to resign for this reason.

In public university and Veteran's Administration hospitals, self-insurance with the deep pockets of a state or federal government can make liability insurance for teachers a non-issue. But my institution is private, and the costs of taking out policies on our entire volunteer faculty would immediately bankrupt this medical school.

My guess is that this type of response from malpractice carriers to the liability crisis in the United States will only get worse, and it appears that teaching will become another victim of our tort system.

By Peter J. McDonnell, MD director of the Wilmer Eye Institute, the Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu


1. McDonnell, Peter J. Brush up your business skills. Ophthalmology Times. 2008;15:4.