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August 10, 1984

Tenure in Medical Schools

JAMA. 1984;252(6):767-768. doi:10.1001/jama.1984.03350060018014

To the Editor.—  Petersdorf's sweeping attack on tenure is both misguided and dangerous. Tenure, when shorn of elitist and grandiose overtones, simply entitles faculty members to review by a disinterested tribunal before adverse job decisions are rendered final—a protection routinely afforded physicians before dismissal from hospital practice privileges. Even then, administrative hearings are nonbinding on the president or board, who may and often do overrule "in-house" recommendations. No matter how polemics may cloud the issue, elimination of the fair-play doctrine of tenure permits unfettered administrative power to hire and fire and, with it, a chilling effect on free expression.Not only does Petersdorf underplay the need to protect medical faculty from external influences (politics), but he also fails to address the more pernicious issue of intimidation from within. Authoritarianism traditionally permeates medical thinking and practice, and the huge sums of money concentrated in modern academic health centers makes the pressure

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