When we chose to come to the University of California for medical school, we thought, perhaps naively, that we were going to a public institution whose purpose was to teach, to do research and to provide public service. This understanding was based on the university’s mission statement. Alas, the university’s actions often show that this is, in fact, not the case.
As medical students, we spend hours each day poring over lecture notes, textbooks and primary medical research data trying to understand how the body works (physiology), how things can go wrong (pathophysiology) and what we can do to fix it. This is the overt medical school curriculum, and the University of California does a terrific job of teaching us these principles.
Yet buried within the standard medical school curriculum exists a hidden, or modeled, curriculum whereby we learn by watching what our mentors do. Every action that our teachers take, in the hospital or in the clinic, we watch and take note. We think, “This is what being a doctor is like.” We also watch and take note of what our executives, deans, provosts and chancellors do, observing how they work as part of a team, how they motivate others to do good work and how they set the priorities of a “world-class” institution of higher learning. Shouldn’t it be that the priorities that guide the institution mirror those that have driven us to become doctors?
• To not allow our actions to cause harm.
• To prevent and, if possible, treat disease.
• To remember that we are members of society with special obligations to our fellow human beings.
We are fortunate to have many faculty members and administrators who truly believe in this covenant and who actively practice these ideals in their work. However, time and again, the University of California teaches us, in the hidden curriculum, that these are not the institution’s priorities.
Over the past year, the University of California office of the president and the Davis campus have increased student fees by 32 percent. They have decided to close the CAARE Program, the only clinical program in Northern California that is capable of doing forensic examinations on physically and sexually abused children. And UC Davis Medical Center has refused to accept low-income patients who are enrolled in the County Medically Indigent Services Program because of the reduced funding they carry.
All of this is happening while the regents approve $3.1 million in bonuses to hospital executives and while the University of California spends $500 million on a new emergency room and surgery suites and $35 million on a new telehealth education center, both being built in Sacramento.
These decisions are part of the hidden, modeled curriculum, and it is not one that any of us expected. What is it teaching the future doctors of California?
We are tired of seeing those who cannot care for themselves and those who cannot afford health care left on their own. We are tired of seeing our fees rise, forcing us into more debt, encouraging more of us to go into high-paying sub-specialties while the institution continues to grow and spend money.
How can this be happening in an institution, paid for by taxpayers, whose very purpose lies not in revenues, market share and performance bonuses, but rather in education and public service? Perhaps it is because the University of California is the new AIG, most interested in cutting nonprofitable programs, raising capital by hiking fees and retaining executives who are rewarded for profits rather than compassion and service.
We are learning to take the money when you can, to abandon patients if it makes financial sense, and if others have to suffer because of it, so be it. If this is not the case, someone show us, because that’s exactly what the hidden curriculum has taught us over the past year.