The failings of modern day academic medicine

Taking a tangent from previous postings, I wanted to turn my attention on the topic of our broken healthcare system in the United States.
As a physician myself, I have seen firsthand the failings as well as the moments of glory and success that can happen in the care of patients.
One issue that particularly troubles me is the condition of academic medicine today. Ask the common man or woman in this country what their opinion of the quality of healthcare that is delivered in an academic medical institution versus a private practice setting, and I would bet that most people would hold acadmic medical institutions in higher esteem. Most physicians, too, look up to academia. The ideal of a physician who takes care of patients, teaches students and residents, and engages in original research certainly seems more distinguished than a physician who takes care of patients all day in a private practice.
The reality I discovered firsthand during my medical training is that things don't always add up for most academic physicians.
The modern day academic medical institute has become focused on a few things: 1) money - in the form of wooing wealthy donors and grants from government or private sources, and 2) research, measured by the metrics of publications and NIH grant dollars secured. The other two items that are assumed in the responsibilities of an academic medical center - teaching and patient care, are becoming the neglected step-children of modern day medicine.
With respect to teaching, I found an abysmal inconsistency among the attending physicians I worked with in a large, urban academic center. Some attendings were quite good at teaching, others had no idea how to teach. There was no support on the part of the academic center to develop teaching skills on the part of the faculty. An academic physician was assumed to have the ability to teach, after obtaining the requisite degree and clinical or research training. The reality couldn't be farther from the truth. Simply knowing something in no way confers the ability to teach it to others. Furthermore, there is little supervision of faculty with respect to observing their teaching skills. If a particular faculty member is a horrible teacher, or worse, is teaching wrong things to medical students and residents - who would know? As a student and resident, I on occaison would submit critical evaluations of faculty who had no business involved in medical education, yet these faculty were never removed from their teaching rotations. It is astounding to me that the people who are teaching the future doctors of America often have less formal instruction in teaching than an elementary school teacher.
The other issue I would bring to light is that of patient care. The explosion of knowledge, therapeutic agents, and research in various specialities of medicine is enough to overwhelm most practicing doctors. The academician, especially the classic "triple threat" physician who teaches, takes care of patients, and runs a research lab, is left having to triage his or her focus on the things that keep the job going - namely research output. Clinical care often becomes quite rusty along the way. In the academic center where I trained, research tract faculty were required to attend on the inpatient wards for one month out of the year. These researchers spent most of their time in a lab, generating data and writing papers and grants, were briefly thrown into a position of supervising the care of some of the sickest, most critically ill patients around for only one month out of a year. It is no wonder the amount of mistakes I witnessed and lack of attending oversight that occured at my institution. I recall going on rounds with the chairman of rheumatology, witnessing how many times he could not figure out the diagnosis in a patient, when I was able to. This chairman spent only one month out of the entire year seeing inpatient consults, seeing maybe 5 or 6 consults a week. The remainder of the time, he focused on his bench research. It is no wonder that such low clinical volume results in a deficiency of clinical skill, even from a department chairman!
The data from many studies, especially in the area of surgery, clearly show that the volume of patients a physician sees can correlate to quality of care and outcomes. Would you rather go to a doctor who treats a dozen patients with your condition or 1,000? The problem with academic medicine today is that many academicians, especially those who engage in research, do not see enough patients to gain any degree of clinical excellence. Though I would not generalize my comments here to all academic physicians, I would urge academic medical centers, and their patients, to closely scrutinize the issue of the quality of care, and the clinical and teaching abilities of academic physicians, lest we be lulled into a false sense of security within the ivy towers.