May 8, 1987

The Town-Gown Syndrome

Author Affiliations

Association of American Medical Colleges Washington, DC

Association of American Medical Colleges Washington, DC

JAMA. 1987;257(18):2478-2479. doi:10.1001/jama.1987.03390180096031

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By the "town-gown syndrome" I mean the frictional interface between practicing physicians in private practice in a community and the full-time faculty of the medical school. Usually the syndrome involves faculty in clinical departments, although medical school administrators, hospital directors and staff, and sometimes even university administrators are involved. Basic science faculties are usually spared.

The basis for the town-gown syndrome is fundamentally economic. Practicing physicians resent that full-time faculty, who derive at least part of their income from the university, compete with them for patients. Practitioners also object to the fact that academic practices are subsidized because they are carried out in university facilities. The practicing community views the academic practitioner as "unfair competition" with which they as taxpayers (in the case of state-supported medical schools) or contributing alumni (in private medical schools) should not have to contend.

In fact, the economic competition between academic clinicians and private practitioners