Tripartite missions of medical schools are to educate, advance research, and provide clinical service. Clinical care is needed to achieve educational and research goals, and cutting-edge tertiary clinical care arises from educational and research missions. Thus, the 3 are inseparable and must be balanced. Medical schools are integrated into academic medical centers (AMCs), but if education and research missions are diminished, the tripartite missions are impaired.
Medical school funding from clinical service activities has increased markedly; now, clinical service activities are the main source of funding. Time for research and teaching has decreased, so academic neurologists spend only 10% median time on each. Many academic neurologists, especially younger faculty, are not fully aware of this history as transparent discussions of these problems and possible solutions are not common.