Clinicians and patients' welfare: where does academic freedom fit in?

Introduction

Suppose you are a surgeon who wants to do a randomised clinical trial comparing open with thoracoscopic spinal instrumentation and fusion. You prepare the trial and receive funding from a national funding agency—but the chief of surgery at your hospital deems that you fail to meet acceptable standards of competence and withdraws your privileges, effectively ending your research. Privileges in hospital can be limited or revoked for many reasons in addition to clinical proficiency: unacceptable standards of behaviour towards patients, failure to maintain adequate medical records, and substance abuse, for example. Inability to proceed with your trial means your academic freedom has been limited. Academic freedom for clinicians is contentious because the missions of universities and their faculty differ fundamentally from those of hospitals and their clinicians.1–4 This article addresses a practical issue; are clinical faculty different from faculty in the rest of the university, and if so, what is the forum (hospital or university) for resolution of disputes about academic freedom? A clear policy (in addition to existing policies5—such as they are6) is …