Abstract
The rapid pace of breakthroughs in discoveries and technology during the last half-century disrupted traditional medical-education systems. As of 1995 at AUBFM, a full strategic assessment defined clear goals and targets aligned to the missions of education, research and patient care focusing on human needs of all stakeholders with the objective of undertaking a major transformational restructuring that made each grow in a financially sustainable manner with a defined timeline. Recruiting the number of faculty members required for the changes implemented after 1991 would have necessitated an unsustainable increase of tuition fees by 1999. Tuition fees increased at the AUBFM from $700 per year in 1960, by 2.24-fold in 30 years, by 12-fold in the next 10 years (1990–2000), while as a result of intervention, by 1.30-fold in the following 10 years and 1.64-fold by 2019. A 55-fold increase in tuition occurred from 1960–2019 while the Lebanon GDP purchase power parity (GDP-PPP) increased by about twofold in the same period. This diminished greatly socioeconomic diversity, reduced significantly the potential pool of applicants to medicine, weeding off potential skill and talent, and changed the character of the profession.
A Medical Practice Plan (MPP) was adopted in 2002 as the centerpiece of Medicine’s recovery plan to be the locomotive that drives growth and sets the foundations for growth and financial sustainability. The plan resulted in recruitment of professional change agents and physicians that increased patient workloads and revenues significantly per year as of 2002 and beyond, improving efficiency of the medical institutions.
This chapter focuses on the major transformational changes, 1999–2009, that built the foundations, made a quantum leap forward, set the stage and developed a trend that continues to date. The experience may be helpful to the plethora of emerging universities in the Arab world.
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Notes
- 1.
Cornelius and William Van Dyck, George Post, John Wortabet, Edwin Lewis and Richard Brigstocke.
- 2.
A Prussian Hospital built by the Knights of the Order of St. John in Ras Beirut.
- 3.
From the Adhm (Azm) family.
- 4.
Taken from a commencement speech on the hundredth anniversary of the hospital (now AUBMC) given by the author.
- 5.
The vaccine was prepared at the Department of Microbiology and Parasitology of American University of Beirut.
- 6.
From a written statement by Raif Nassif, former Director of Laboratory Medicine and the Hospital (AUBMC), on the 100th Anniversary of the AUB Hospital, taken from the Annual reports.
- 7.
By James O. Pinkston, Dean of the Medical Faculty at AUB, 1944–1950, taken from History Makers in the Health Sciences from the American University of Beirut, compiled and edited by Nabil Kronful, American University Press May 2017.
- 8.
Such as the Sidon Government Hospital, and among the not-for-profit institutions: the Lebanon Hospital for the Mentally Diseased at Asfourieh, the Hamlin Sanatorium at Shebanieh, the Kennedy Memorial Hospital in Tripoli, the Karaguezian Maternity and Prenatal Clinic in Bourj Hammoud and the Mother and Child Social Center in Ras Beirut. Midwives and students were trained and went for home deliveries. Championed by John Wilson.
- 9.
By Raif Nassif MD, Chair of Clinical Pathology then and later Director of Faculty of Medicine and Hospital.
- 10.
Built by the United States Agency for International Development (USAID) funds.
- 11.
Exchange programs partially funded by the US based Rockefeller Foundation and the Commonwealth Fund.
- 12.
US Middle States Association for the Faculty of Medicine as part of the University, Joint Commission International (JCI) for the Hospital, Magnet for the Nursing Service, The College of American Pathologist (CAP) Accreditation and when available to foreign Medical schools, The Liaison Committee on Medical Education (LCME) accreditation or equivalent for the Faculty of Medicine and the American Council for Graduate Medical Education (ACGME), currently available as ACGME-i for international Faculties of medicine.
- 13.
Funded by the Ford Foundation.
- 14.
The Joint Commission Worldwide (JCW) and Health Care Consultants, USA, were invited by AUB President John Waterbury in 1997 to review the AUBMC, and concluded their work in 1998 by an extensive report entitled “AUBMC, Strategic and Operational Assessment.”
- 15.
The Academic Review Team included. Paul Griner, M.D., Chair, J. Robert Buchanan, M.D. Ramsey Cotran, M.D. Linda Lewis, M.D. George Thibault, M.D. Torsten Wiesel, M.D. Their Report was submitted to AUB in 1999.
- 16.
Sasaki, Machado and Silvetti Associates Inc. an Architecture and Engineering firm, registered in Boston MA assisted by MGT of America Inc., a US consulting firm for documenting program requirements with future projections were invited by President John Waterbury to establish a comprehensive facility master plan for the whole university. The campus plan is published at www.sasaki.com/project/163/amercan-university-of-beirut-campus-master-plan/
- 17.
For decades before, the rate was quasi stable at about 3 Lebanese Lira (LL) to a US dollar.
- 18.
Banque du Liban (BDL) history of the Lebanese Lira (pound) exchange rate with the US dollar, published on the web.
- 19.
All physicians that are appointed as full time by the Faculty of Medicine have an academic title and given practice privileges at AUBMC.
- 20.
End of service indemnity is 12.5% of physicians take home from the plan and is given, with its appreciation, as a lumpsum upon retirement as per policy.
- 21.
Trips to conferences for faculty members $ 500,000 in 1999–2000 and Education allowances to children of faculty amounting to $ 530,000 in 1999–2000.
- 22.
Registration fees in the Order of Physicians as an example.
- 23.
Pathology and Laboratory Medicine, Radiology, Radiotherapy and Anesthesiology.
- 24.
About 90% of full time clinical faculty members signed the documents in the trial mock year and the rest by the second year. The trial year in effectively became the initiation year.
- 25.
The scenario that shifted the authority and liability of professional fee revenue from FM/AUBMC to the MPP participants.
- 26.
Each physician had to commit usage for a year e.g. 3 half days per week for a year but may change the commitment for each coming year as a function of anticipated loads.
- 27.
Full teaching load per academic year is considered as 12 credits. The number of credits a faculty member teaches will determine the % teaching effort and the hours spent on administrative academic committees will determine the % effort in academic administration.
- 28.
As defined in the Statement of Policies on Benefits and Allowances for Academic Personnel.
- 29.
For example, the Chief Medical Officer, also referred to at AUB as the Associate Dean for Clinical Affairs.
- 30.
Lecture rooms, discussion spaces, laboratories and lounge spaces.
- 31.
The Diana Tamari Sabbagh Building.
- 32.
It is hoped that as tensions ease in Lebanon and qualified students from the region or outside will be attracted to apply to AUBFM, expanding the pool of applicants.
- 33.
The Basile adult cancer program floor of around 44 beds. I am greatful to Drs. Ali Bazarbachi and Marwan Sabban for developing the proposal for stablishig a multidisciplinary cancer center with the author for Naef K. Basile.
- 34.
That was occupied by a makeshift nursery and neonatal unit while the new one was being built.
- 35.
Within the Mounir Abuhaydar multidisciplinary neuroscience program.
- 36.
Three were completed in 1983, built through a USAID donation the last finished in 2010, built in the name of Mr. Jirji Bachir, funded by him and a group of his friends. Dr. Ali Bazarbachi became pivotal in the growth of a successful and growing Bone marrow Transpalnt Service at AUBMC.
- 37.
Prior to that each clinical department took care of their patients.
- 38.
Sent initially to Ms. Mamdouha Bobst in 1999 who connected AUBMC with the American Cancer Society and the Memorial Sloan Kettering Cancer Center who made very valuable comments. She supported a breast cancer program for poor patients and funded the establishment of the Breast Cancer unit. She funded the purchase of two linear accelerators in 2009 and pledged for a large donation in her will for cancer at AUBMC and a satellite in Tripoli. The establishment of the Adult cancer center, through the same proposal was funded by Naef K Basile that included significant upgrade of the outpatient facility in 2002 and renovating a complete inpatient floor for adult cancer patients that was opened by the end of 2009.
- 39.
In Memphis Tennessee, USA.
- 40.
Funded through a donation by Mounir Abuhaydar.
- 41.
Dr. Amine Kazzi was the founding Chair.
- 42.
The number of clinic visits was taken from a special report of the Dean to the BOT and through courtesy of Deputy VP Ziyad Ghazzal.
- 43.
Such as renovation and construction during that year and the political environment.
- 44.
In 2002, by Sasaki Machado and Silvetti Associates Inc. an Architecture and Engineering firm, registered in Boston MA. Viewed on the web at www.sasaki.com/project/163/american-university-of-beirut-campus-master-plan/
- 45.
Built in 1954 as a building with 4 ORs for surgical patients.
- 46.
Funded by Pierre (Fahd) Abou Khater, 45 clinics were ready in 2006 and the rest deferred till 2014.
- 47.
Around 40 existed in 2009.
- 48.
Orthopedics planned close to the physiotherapy department.
- 49.
In the Children Cancer Center of Lebanon (CCCL), Family Medicine, Adult Cancer and Psychiatry.
- 50.
Not in the original plans.
- 51.
Funded by Wassef and Souad Sawwaf, philanthropists.
- 52.
With the help of KPMG, one of the big four international auditing firms.
- 53.
Ramzi Sabra who was supported to receive an Master’s degree in medical education from the University of Illinois.
- 54.
A simulation training program was initiated for training staff nurses and to be expanded to include all aspects of education and training.
- 55.
Obtained from reports to the BOT, 2001–2009 and from 2009–2018 from the website of the Office of Institutional Research and Assessment (OIRA) through guidance of Dr. Karma El Hasan, its Director.
- 56.
Assassination of Prime Minister Rafic Hariri in 2005 and the Israeli invasion of Lebanon through July 2006.
- 57.
The new construction and renovation plan will result in a 30% increase in bed capacity in 2010 as compared to 2008–2009.
- 58.
Quotation from Restoring Excellence: AUB 1998–2008 by John Waterbury in Lead Innovate Serve: A Visual History of the American University of Beirut’s First One Hundred and Fifty Years; First edition 2016, Section 5, A New Millennium 1997–2016 pp. 219–224; published by American University of Beirut Press; Page 222.
- 59.
By Deans Joseph McDonald (1953–67) and John Wilson, (Chair of Surgery 1953–1966 and Dean 1966–1968) who made most use of this system to build the department of surgery. Other departments followed suite.
- 60.
600 h per year when on salary and 300 h per year when off salary.
- 61.
As a continuation of the legacy that started with the Prussian Hospital.
- 62.
Had effectively low basic salaries with benefits for teaching but took about 90–95% of their patient care earnings.
- 63.
In line with historical compensation at FM AUBMC and to facilitate implementation.
- 64.
Ratios for rank differentials are taken from the annual AAMC compensation surveys across the USA.
- 65.
As determined by the strategic plan timeline.
- 66.
Carried through from the old academic part time, clinically full time faculty with clinics outside AUBMC.
- 67.
The author is grateful to Provost Mohammad Harajli for authorizing HR to provide him the faculty number data and to Deputy VP Ziyad Ghazzal for authorizing Nabil Mansour (HR/FM) to provide me with required data for FM and AUBMC.
- 68.
See Fig. 9.
- 69.
AHNI stands for the Abuhaydar Neuroscience Institute.
- 70.
USAID is the United States Agency for International Development.
- 71.
All accreditations were successfully renewed on time since.
- 72.
Mainly for the annual Middle East Medical Assembly (MEMA).
- 73.
SoN is School of Nursing.
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Acknowledgement
The author acknowledges Mr. John Rhoder, Drs. Marina Hajj, Fuad Ziadeh, Salim Kiblawi, Ms. Gladys Mouro for being in the team that did the work and Dr. Ghassan Hamady for reading the manuscript and giving valuable comments.
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Cortas, N. (2020). Innovations in Creating Incentives for Academic Achievement and Growth: Developing a Compensation Model at the Faculty of Medicine of the American University of Beirut (AUBFM) 1999–2009. In: Badran, A., Baydoun, E., Hillman, J. (eds) Higher Education in the Arab World. Springer, Cham. https://doi.org/10.1007/978-3-030-37834-9_13
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