The Rise and Decline of a Professor—a Fable

THE RISE AND DECLINE OF A PROFESSOR—A FABLE ALVAN G. FORAKER, M.D* Once upon a time there was a boy named BiU Button who wanted to become a doctor. BiU's father was a general practitioner in Podunk, an industrial town of 40,000 inhabitants. Podunk was seventy-five miles southeast of Vapid City, the metropoUs of the area. BiU's father, Dr. Button, had taken short courses in omphalology and did most of the omphalology in addition to general practice in Podunk. BiU and his father planned for him to return to Podunk forjoint practice. They hoped BiU could become the first qualified omphalologist in Podunk. BiU took his premedicai work at the University ofVapid City, which had been his father's coUege and medical school. BiU's grades were good. He would have preferred to go to some big Eastern university to medical school, buthis father pressed for the University ofVapid City for financial and sentimental reasons. The University ofVapid City was a typical urban university in a typical metropoUs. In bygone years it had few claims to fame, beyond a good footbaU team. When BiU's father attended medical school in Vapid City some thirty years previously, the school had no inteUectual pretensions. There were a few low-salaried basic science professors. The clinical faculty was entirely volunteer and part time. They were the speciahsts ofVapid City, who performed a pubUc duty while enhancing their prestiges and augmenting their practices through their medical school affiliations. No research occurred in the medical school. The students received a practical, mediocre training in medicine. The school aimed to train young men to practice in Vapid City and its hinterlands, with no nonsense about research . The medical school was successful in this purpose. Most of its graduates took only one year of internship, frequently in a community hospital, then went into general practice. Some tried to specialize by vari- * Pathologist, Baptist Memorial Hospital, Jacksonville, Florida 32207. Cartoons are by Frances Houston, MT (ASCP), section head, clinical chemistry. This paper was presented as one in a series on the "History and Philosophy ofMedicine," University of Florida, Gainesville, March 10, 1967. 71 ous means. Some, like Button, took two-week postgraduate courses occasionaUy and tried to develop some special practice, while continuing to treat everyone. Some became preceptees of older established specialists, while supporting themselves by part-time general practice. Some took briefresidencies, usuaUy at the University ofVapid City-related hospitals. OccasionaUy, someone went away for a residency. Most ofthe physicians hadneverleftVapid City or its area ofinfluence inteUectuaUy. Thisled to a stable, pedestrian existence. The university and its medical alumni were essentialto the area but created no inteUectualwaves in moredistantplaces. About six years prior to BiU's entrance into medical school, there was a "renaissance" at the university. Men in power became dissatisfied with the mediocrity ofthe university and its products. A new order was sought. A large institutional grant for this development was obtained from the Geltmore Foundation. Alumni and others were soUcited for funds. New hospital facilities were added. Research faculties were created where none had existed before. The senescent, overworked, underpaid, and nonresearching teachers ofanatomy and other basic sciences were retired on meager pensions. Bright, promising, young scientists were recruited from distantmedical centers. GraduaUy, thevoluntarypart-timeclinicalteachers were replaced by young active physicians chosen primarily for research promise. Large government grants flowed in. Some ofthese funds were used indirectly to support the new fuU-time clinical teachers as weU as for research. A new day dawned for the university. BiU Button entered medical school in the morning Ught ofthe new era. He and his classmates were fascinated by the aura of research and intellectuaUty . They were infected with the feeling ofparticipation in research which would lead to great discoveries. There was very Uttle ofthe plugging memorization of gross anatomy, of droning lectures cribbed from standard textbooks, of foot-dragging ward rounds, or retractor holding with aching backs, which had characterized Dr. Button, Sr.'s education, and which had prepared him adequately for general practice in Podunk. BiU and his classmates had little contact with the practicing physicians of Vapid City. Most ofthe cUnicaUy successful speciaUsts had been squeezed offtheuniversity...