Evolution

While we are seeing the fragmentation of general medicine into various specialties, division of labour in a different domain is secretly taking place.

Let me give you a slightly convoluted account:

Fifty years ago, the department of medicine of a typical medical school had one professor and around a dozen of lecturers. They saw patients and taught medical students, the latter largely by setting examples via their own clinical practice. For the small amount of spare time they had, they did research, be it clinical or laboratory based.

In the following decades, things gradually changed. Our life expectancy lengthened, and the whole health care system expanded. We needed more doctors and therefore had more medical students. The number of academic staff rose.

The inevitable result of having a whole lot of lecturers is they all need a prospect of their career, which, when summarized in one word, is promotion. But, which lecturer should be promoted?

Our extra-terrestrial friends taught us that much: To be fair, we needed to think of an objective yardstick.

That opened a Pandora box.