In the past two months, the dean of the University of Maryland School of Medicine has ousted the chairmen of the school's two largest departments and the director of its cancer center in a flurry of moves that has set many faculty members on edge.
It was not clear yesterday why Dr. Donald E. Wilson, Maryland's dean of medicine, made the changes.
But medical faculty members interviewed suggested two possible factors: a clash of egos between the dean and the two strong-willed department chairmen, and the dean's concern that the school was not sufficiently addressing financial pressures facing it.
The departments of medicine and surgery include the majority of medical faculty members, and their leaders tend to exercise great influence within the institution.
Wilson did not return several messages seeking comment.
In early February, Dr. Anthony L. Imbembo, chairman of surgery at the medical school, was transferred from his job as chairman of the department. He has been given a new post as the associate dean for administration and the title of distinguished professor of surgery.
The dismissal of Dr. John A. Kastor, chairman of the department of medicine for a dozen years, occurred last week. Both moves were effective immediately, as was the forced departure of Dr. Ernest C. Borden, the cancer center director, earlier this spring.
Borden also did not return a call seeking comment. Kastor said that, on advice of his attorney, he would not comment. Through an associate, Imbembo said late last night that his move was voluntary and noted that he continues to practice surgery at the university.
Dr. David J. Ramsay, Wilson's boss as president of the University of Maryland at Baltimore, was traveling in Japan yesterday and could not be reached.
According to medical faculty members, Wilson held meetings with each department involved to inform them of the moves.
In each case, Wilson gave the doctors no reason for the change and refused to take questions about it, several doctors present said. At the Monday meeting on Kastor, the dean had no words of praise for the former medicine department chairman, several people said.
"We all have to deal with this without any adaptation," said Dr. Lewis J. Rubin, chief of pulmonary and critical care, and a member of the department of medicine. "One day John Kastor is my boss and the next day he's not. That makes it difficult to simply continue business as usual."
"Firing people of this caliber was just astounding," said a Maryland surgery professor who declined to be named.
The new financial pressures on academic medical centers -- caused largely by a drop in health care payments from insurers and government programs -- have caused wrenching changes and internal tensions across the country and across town.
For much of this decade, officials at the Johns Hopkins University's East Baltimore medical complex have warred over how to meet those challenges. For several years, the tradition-minded dean of the Hopkins medical school was pitted against the more reform-minded president of Johns Hopkins Hospital. Both men are now elsewhere.
While the hospital affiliated with the University of Maryland Medical School has been spun off into a separate, state-chartered not-for-profit corporation, the medical faculty members generally serve as physicians at the hospital. A substantial amount of the medical school's income each year is derived from the fees charged for the faculty's medical services.
Borden was brought to Baltimore a few years ago to help the cancer center confront the financial pressures of managed care; several physicians said yesterday that the center's budgets are still shaky.
Perhaps his most public coup was helping to secure a $10 million gift in June, largest in the university's history, most of which will go to the cancer center.
The Maryland Medical School, the nation's fifth oldest, has a strong tradition as a teaching institution. Yet in recent years it has started to win national recognition for some of its clinical initiatives, such as its transplant program, and last year, for the first time, its faculty members won more than $100 million for research grants and contracts.
As the Maryland Medical School has started to emerge from the shadows of Hopkins, which receives more federal medical research money than any other medical school in the country, some faculty members have become frustrated to see cost-cutting measures pose a threat to that progress.
Wilson has offered no clear path for the school to follow, other than saying he wants the departments to be in the top five or 10 in the country, several physicians said.
"I think there's a problem between the dean and the faculty in communications," said a senior physician who spoke on condition of anonymity. "There's also a question of egos involved.
"At the same time, I think, as a general rule, the dean has the job to establish the direction that the school should take. I think the dean thinks he should establish this direction. But, really, this direction has not been defined."
Pub Date: 4/25/97