A Canadian urologist who is one of the most
prominent academics in the field has often been quoted as stating that the two
cities in the world that really punch below their weight in terms of urological
publishing and international academic recognition are Sydney and Rome. Sadly, I must agree with him. I can’t really
speak for Rome but I can speak for Sydney.
I recently had a letter published in the Australian
and New Zealand Journal of Surgery that quantifies the academic publishing
output of Level D and E ‘titled’ academics in Melbourne and Sydney. This refers to those who hold a position of
Associate Professor or Professor respectively.
For some, the position may be honorary and given in return for doing a
bit of unpaid teaching to medical students – these honorary titles are usually
prefixed by the term Adjunct, Conjoint or Clinical. Academics who are employed by the
universities usually have their title followed by a descriptor such as ‘of
surgery’ or ‘of urology.’ The
requirements for a paid position are usually significantly greater than for
honorary titles but some holders of honorary titles should not be underestimated
for their academic contributions which at times may well exceed those in paid
positions.
So back to my letter. What I did was to search and manually
identify any academic writings indexed on Pubmed/Medline that could be
attributed to authors who carried a Level D or E title and made comparisons
between Melbourne and Sydney. The
results were not surprising but also disturbing. There were a similar number of those with
level D or E academic titles in both cities but the overall publication output
from Melbourne was more than double that of Sydney overall and per annum. In Sydney, there was only one urologist who
was publishing on average in excess of 5 pieces of academic writing per annum
over the past 5 years compared to Melbourne where there were at least 3 with
this level of output.
How do we explain this? Both cities have public hospitals funded by
similar models and both have excellent universities with well regarded medical
courses. Both cities have urology
departments that are equally poorly funded and poorly supported by the public
hospital system and universities.
I do have some thoughts as to why this is
the case and of course many will beg to differ. Some may unkindly suggest that Sydney
urologists are so consumed by private practice and making money and to the
extent that any academic pursuit is well down the list for matters of importance. Whilst there might be some
truth in this, it is clearly not as simple as this.
Whilst the funding models for public
hospitals in Sydney and Melbourne are globally similar, there are some
differences in how things have become structured over the years. As a result of funding cuts to support public
outpatient departments in NSW hospitals, the vast majority of patients seeking
urological care must see a urologist in their private rooms before being
referred to a public hospital for treatment.
This drives work to the private rooms and the high cost of operating a
private practice creates this imperative to work hard in the rooms to cover
costs. There is poor separation of
private and public consultative practice compared to Melbourne. In other words, urologists are spending time
in their rooms trying to cover their costs are probably too busy to think about
academic pursuits.
What of university funded positions? Some
surgical specialties such as vascular surgery, colorectal surgery,
breast/endocrine surgery and upper gastrointestinal tract surgery will have
paid academics in almost all of the teaching hospitals at the expense of
subspecialties. But the situation is no
different between Sydney and Melbourne.
Is anything else different? The most striking difference is the manner by which public hospital urology units have been established. There is a common thread amongst all of the
key academic centres in Melbourne. In
each of these, the Heads of the Urology Departments were all appointed when
relatively young in their careers and these positions tied in with academic
appointments. These urologists were able
to carve out academically strong departments in their own style. To name a few, we have Professors Damien
Bolton, Mark Frydenberg and Anthony Costello.
They all built departments from an almost embarrassing levels of
infrastructure and nothing more or less than what any department in Sydney would
have had when they began their academic tenure.
They have now mentored a fossil layer to whom they can hand over the baton and
those mentored, already hold major positions within international organisations
and urological journals and are already well established international key
opinion leaders. Can we say the same
about Sydney? Sadly not and hence the
comments from our Canadian friend. Within an established academic environment
as has been created in Melbourne, it is substantially easier to maintain the
academic throughput but if there is none to begin with, as is the case in just
about every urological unit in Sydney, what hope is there.
To effect change in Sydney, future academic
leaders need to be identified and offered positions of department leadership
with associated university positions while they are young energetic and full of
bright ideas. They will make mistakes
and will grow as a result of them. What
they do create will outweigh any risk associated with placing a relatively
inexperienced leader into the helm. These leaders need to be supported to grow
their departments in their own style and with a long term vision in mind. To move forward, either current department
heads should make way for new leaders or as they retire, appropriate succession
planning for a strong academic head should be in place. Over the years I have seen numerous Sydney
trained urologists who could have been great leaders that could have steered
Sydney public hospital units to the same level of international recognition as
those in Melbourne but have been lost to battlefields of private practice. Following
their post fellowship training, they return to public hospital units with no existing academic infrastructure or capacity to develop such infrastructure.
As far as academic urology in Sydney is
concerned, we punch way below our weight.
The Melbourne situation demonstrates precisely where we should be and
precisely what is possible if there is a will to effect change.
(Footnote - some grammatical corrections have been made since first published. I really should proof read a little better)
(Footnote - some grammatical corrections have been made since first published. I really should proof read a little better)
