Academic medicine and the search for meaning and purpose.

The transformation of the health care industry into a marketplace governed by commercialism and free competition challenges the doctrine of medicine as a profession valuing service to the patient above financial reward. Many physicians have become disenchanted with their ability to serve as advocates for and provide care to their patients. Financial success, the measure of the marketplace, has become the dominant standard of measurement or "value" for most academic medical centers (AMCs). Many doctors report their work is less fulfilling. As a result, all three social missions-patient care, teaching, and research-are in jeopardy. The growth of modernism, preeminence of biomedical research, and dominance of a market-driven clinical enterprise will continue to pose challenges to the health care system in the United States. However, AMCs can provide the leadership and serve as the ambassadors through which the health care system can be renewed with a sense of direction and purpose. Renewal must begin with more open discourse about what we value in health care and what kind of medical profession we want to have, to include addressing questions such as: What does it mean to be an academic physician? What gives my work meaning and purpose? This kind of dialogue could easily be built into the medical students' curricula and residency training programs, with the faculty taking the lead.