The Four Horsemen of the Apocalypse

doi:10.1001/jama.1982.03320330049025

The Four Horsemen of the Apocalypse

Study of Academic Medical Center Governance

Robert G. Petersdorf, MD;
Marjorie P. Wilson, MD

From the Department of Medicine, Harvard Medical School, Boston (Dr Petersdorf), and the Department of Institutional Development, Association of American Medical Colleges, Washington, DC (Dr Wilson).

Abstract

Governance of academic medical centers is in a process of change. This essay reviews some of the historical factors that have affected the present status of academic medical center governance and describes the functions of the four individuals who are most involved in the operation of academic medical centers: vice-presidents for health affairs, deans of schools of medicine, department chairmen, and hospital directors. The relationships between these four individuals are analyzed, and points of conflict are identified. Some suggestions about how these individuals can work together more effectively are made.

(JAMA 1982;247:1153-1161)

Footnotes

Adapted from the first Robert H. Williams Lecture presented at the annual meeting of the Association of Professors of Medicine, San Francisco, April 24, 1981.
Reprint requests to Vice Chancellor for Health Sciences, Dean, School of Medicine, University of California, San Diego M-002, La Jolla, CA 92093 (Dr Petersdorf).