From Joel Levine: RE: From Bill Mohler: Don't base big decisions on iffy statistics.

Dear Fellow Faculty

These discussions have been helpful and Dr. Decker's letter a strong one reflecting his opinion. I would like to make my contribution in a somewhat different way and pose questions that avoid any of the historic issues about unionization or some of the topics under current discussion ( salary, union purview, etc ). I would like to have my discussion seen in a larger light as , I believe, it is what is coming , rather that what is past, that will be most germane.

1. The pressure on academic health centers will increase testing their inherent viability to perform manifold missions. This will be especially true for public funded Medical Centers. The federal Health Reform proposals are predicated, one way or another, on spending less money , over time , for health care. Currently, as example, there is still a 250 billion dollar decade long reduction in reimbursements to Medicare physicians and it is likely that private carriers will not fill the gap.It is clear that the effort to partner with Hartford Hospital speaks to the difficulty of maintaining a full time clinical faculty. Hartford Hospital will see, as would any other community hospital, UCHC clinical faculty as they see their own full time staff. If, in the future, the financial return from a physicians effort is less, whether at UCHC , HH or St Francis, the choices will be more work, less pay, less physicians or less services. The question is evident: Will Faculty unionization be a boon or burden in this coming world of constrained clinical dollars?

2. Dr. Deckers and I had submitted, while he was Dean, a number of proposals regarding options for a Farmington based University Hospital. Prior to the initiation , by the legislature, of the CASE process, there was an inherent logic in having a larger University Hospital to add to the strengths within the community. It was assumed that a strong University Hospital would serve in critical ways: retain clinical and translational research as primary, not secondary, interests, be an educational resource, to the region, for the transfer of burgeoning molecular and genetic practice relevant information, and model new systems of care including integrated physician education and quality improvement. There is no doubt that the community hospitals ( I think Hartford has been explicit on this issue ) have a strongly adverse opinion about faculty unionization. They would walk away ( even those working with the new UCONN Board Chair)and pursue their own competitive interests ( as in the past ). We would thus need a real alternative plan. It is possible but speculative that a Faculty Union at UCHC will increase political favor for a new hospital by a legislature that generally supports worker collective bargaining. There are two essential questions:In the long view, is a Farmington based University Hospital, in 2020,l the best option, funding aside, for the area's interlocking clinical, research, and educational needs and Will Unionization, likely to deter current community hospital partnerships , help or hinder our overall academic mission and/or eventual prospects for a new Farmington University Hospital?

3. This is a time to revisit an old question. How does the Health Center relate to the Main Campus and to what degree is the Health Center faculty a part of the University? Historically, for good or ill, the Health Center was an island apart. Since President Hogan's Tenure, he has sought to bring more administrative integration especially as regards research and administrative functions. In the good old days, clinical faculty were largely on the Tenure track so the requirements and benefits ( and risks ) in seeking promotion were evident. Many clinicians came with past research training and sought to make enough clinical revenue to justify their existence while working to be promotable. It was easier to see how Medical School faculty were similar to other University Faculty. Much of that has changed and many clinical faculty are more narrowly defined. This impacts how and why they are rewarded or criticized. I see two critical questions: To what degree do the current clinical faculty see themselves as different from colleagues in private practice? and Is a Faculty Union a necessary part of a closer relationship with Storrs and is this desirable?

4. Finally, in some ways the most important question: What is best for the Medical School? The Medical School is at the center of our reason for being and, as Peter emphasizes, whatever we do must be both strengthening and protective. In some ways, it would be very helpful if the faculty most involved with the quality and character of the School were to guide us as to consequences of a faculty union on securing the best teachers teaching the best content.