Avert Rheum’s Coming Crisis

Gaudi’s Sagrada Família has been under construction for more than 100 years.

Fund Education Directly

To support training programs, we have to develop a different funding model that separates research from the education and training missions. The need is especially pressing given the location of training programs in large medical centers. With the movement of rheumatology care into the outpatient arena in these centers, our specialty will be ineluctably threatened in an environment where the big inpatient specialties dominate and the proceduralists generate the largest flow of money.

The more our group of lounge lizards chewed on the idea of the endowments, the better it seemed. Indeed, we became downright giddy as we conjured this appealing path to financial stability for our mission.

Inevitably, reality had to set in. “How much do you think it would cost?” one of the more sober members of our group asked.

Quickly, we did some calculations on the back of a napkin. To make the enterprise succeed, each academic unit would need an endowment of about $4 million: $1 million for an endowment for a fellow each year and $3 million for an endowed rheumatology chair. Let us project the need for 200 endowments to fund existing adult and pediatrics program as well as a healthy boost in the number of pediatrics programs. That way we are well stocked to take care of babies and baby boomers alike. The price tag for that plan would be about $800 million, but we can round off to an even $1 billion.

Depending on your point of view, that is or is not a big sum of money. I will not get into making comparisons between expenditures on healthcare and other societal outlays (like bombers, bridges, or space flights), but – for the whole endowment enchilada – we are in the range of salary for the New York Yankees for a few years. As everybody knows, they are now big losers, despite the millions of dollars thrust upon A-Rod and Roger Clemens.

Nevertheless, $1 billion is a lot of money and would take about 10 million bake sales to raise. As the magnitude of the task sunk in, it seemed that the thinking of our group had run amok outside the protective walls of our usual boxes. Maybe we were jet-lagged or had let our heads bake in the sun or had imbibed too many free drinks. The executive lounge, you see, had an open bar that provided libations gratis to the lucky inhabitants of the executive floor. Imbued with the warmth and ease of Southern Europe, perhaps some of us had overindulged and lost our bearings.