Realizing our quest for meaning.

The author asks whether the quest for growth in academic medicine has begun to obscure the quest for meaning-the deep-seated aspiration of those in academic medicine to contribute in meaningful ways to the improvement of the human condition. He describes the unprecedented growth in medical schools and teaching hospitals over the last few decades, and then offers suggestions for how these institutions, through each of their missions (education, research, and improving health), can make meaningful contributions without spending so much energy trying to get even bigger. Throughout these suggestions runs the common thread of collaboration: the need for academic medicine's institutions to coordinate their efforts, give up just a little of their independence, and join forces to achieve goals beyond their individual reach. With collaboration, like-minded institutions might be able to (1) form a nationwide clinical research collaborative to translate basic knowledge into better health; (2) transform this country's ineffective continuing medical education enterprise; and (3) partner with public and private payers of health care services to rationalize our irrational system of health care. He acknowledges that such goals would be difficult to accomplish, but that academic medicine's quest for meaning can be best realized only when its institutions shift from a paradigm of individualism to one of collaboration, all seeking to maximize the societal benefits for which they are responsible.