“We are having cuts in salary while requiring higher performance standards in terms of additional patient services,” she says. “So you are being told to do more while you are being paid less. Why wouldn’t someone go where things are not so dire?”
Although retention is a concern, Dr. Hahn feels that recruitment is where California’s state-supported medical schools may suffer the most in the longer term.
“Academically, we can’t even look at a young person who is not bringing enough grant money with them to completely support themselves for at least three years,” she says. “That is a very rare and highly sought-after person.”
Budget constraints also have an effect on the ability of many programs to properly support junior faculty members without their own sources of funding. The schools used to be able to supply support staff to the younger faculty members until they could get published and begin to generate their own grant money. This is no longer a given in the current fiscal climate.
The budget concerns are only adding to the problems that were already faced by California schools in general. “Living in California, and especially in San Francisco, is so expensive,” notes Dr. Weiss. “Our junior faculty cannot easily afford housing and will eventually make choices on where they are going to live based on the economic realities. If it is hard to raise your salary here because of constraints on research dollars or pressures in the clinic, eventually people will go elsewhere.”
Fellows and Residents Spared
Graduate medical education was spared from cuts to the fellows and residents in the rheumatology programs. Nonstate funding sources such as Veterans Administration money and NIH training grants meant no cuts in pay; in fact, some actually saw an increase in salary.
“The problem we are seeing among these people is getting jobs when they graduate,” says Dr. Hahn. “Many practices in the community are not recruiting because they have financial concerns of their own. If you want to practice in the community, how are you going to get a loan to start a practice under current conditions?”
Tuition Increases
Although the cuts in California funding have gotten much of the attention, all three leaders interviewed for this article agree that the biggest future impact on rheumatology in the state will not be related to staff. Instead, the 30% increase in tuition for medical students may lead to fewer people deciding to choose rheumatology as their postgraduate specialty.
