If Prof. W.C. Roentgen were alive today, he would recognize the need for university hospital medical managers who can eliminate bureaucratic burdens, appreciate the heterogeneity of research, and preserve the freedom that creativity requires. He would heartily approve of managers who are committed to training physicians and scientists, focusing on improving patient care, and investing in the infrastructure of medical centers.

This was the central theme of Saturday's honorary lecture by Prof. Dr. Jörg Debatin, medical director and chief executive officer of the University Medical Center in Hamburg-Eppendorf, Germany. Debatin is convinced that efficient healthcare managers are necessary to promote innovation and avert the impending crisis in academic centers.

"For academic medicine to thrive, we need to preserve the unity of research, teaching, and patient care. This unity can no longer be achieved by individuals. Rather, it must be organized on an institutional level," he said.

Pressures on academic medicine are mounting as a result of skill shortages, low salaries, cost pressures, aging population, poor infrastructure, and failure of training programs to motivate students. The "brain drain" is further exacerbating the situation, according to Debatin. About 400,000 Europeans with science, medicine, and technology degrees live in the U.S., and another 30,000 leave for the U.S. every year. Only 13% of these graduates say they intend to return home in the future.

Many Europeans feel stifled by bureaucracy, over-regulation, and a rigid hierarchy in which age is considered more important than accomplishment, he said. Pay scales in Europe are subpar because of lower expenditures on research and development. The training system, with its strict limits on medical school enrollment, caps on salaries, and system downsizing, must share part of the blame.

"Unmotivated medical school teachers are destroying student interest," Debatin said.

Potential solutions to the brain drain include greater institutional commitment to research, teaching, and patient care, more transparency in competitive funding, a legal framework for third-party support, higher salaries for researchers, and organizational freedom for some forms of research, he said.