Anemia In Academia: Part 5 - Metrics culture (#541)

Force #5: Counting what’s easy instead of what matters.

A few years ago, after giving what I thought was a particularly good lecture - the kind where the room leans forward, where the questions keep coming, where you can almost feel understanding settle into place - I walked back to my office feeling quietly satisfied.

Not proud. Just content.

It had felt like teaching. Real teaching.

Later that week, my annual review arrived.

Pages of numbers.

Clinical productivity.

Relative value units.

Grant dollars.Publications.

Citations.

Teaching scores averaged to the second decimal place.

The lecture - the one that had felt alive - appeared nowhere.

There was no column for it.

No metric.

No place to record the light in a student’s eyes when something finally made sense.

I remember thinking:

If it can’t be counted, does it count at all?

Universities love numbers.

Numbers feel objective.

Clean.

Defensible.

They fit nicely into reports and dashboards and strategic plans.

They make comparisons easy.

Measurement promises fairness.

But measurement also changes behavior.

Because what we measure becomes what we value.

And what we don’t measure quietly disappears.

Some metrics are necessary, of course.

We should track outcomes.

We should evaluate performance.

We are stewards of public and donor funds.

Accountability matters.

But somewhere along the way, we crossed an invisible line.

We moved from measurement informing meaning to measurement replacing meaning.

And that shift has consequences.

I see it most clearly in young faculty.

They don’t ask, “How can I become a better teacher?”

They ask, “What counts for promotion?”

They don’t ask, “What clinical problem is most worth solving?”

They ask, “What kind of paper will publish fastest?”

They don’t ask, “How can I mentor this student well?”

They ask, “Does mentorship count toward my effort allocation?”

It’s not cynicism. It’s survival.

When your career depends on metrics, you learn to chase metrics.

Even when your heart is somewhere else.

The danger is subtle.

No one sets out to value numbers over people.

It just happens.

A grant is easy to quantify.

A conversation is not.

A publication can be counted.

A moment of mentorship cannot.

A citation has a score.

A quiet act of kindness in the clinic does not.

So, the system drifts toward what is easy to measure.

And slowly, the soul of the work, the part that drew many of us here in the first place, slips into the background.

Think about the best teachers you ever had.

Not the most published.

Not the most funded.

The ones who changed you.

The ones who stayed after class.

The ones who noticed when you were struggling.

The ones who taught you not just facts, but judgment.

Craft.

Character.

None of that shows up neatly on a dashboard.

Yet those are the people we remember decades later.

Those are the people who shaped us.

If they were starting today, I sometimes wonder:

Would they survive our current promotion criteria?

Or would we quietly lose them because their gifts don’t fit into spreadsheets?

Clinical medicine suffers the same fate.

We count cases.

We count revenue.

We count throughput.

But we rarely count time spent sitting with a worried client.

Or the extra minutes teaching a student how to hold a needle properly.

Or the long conversation that prevents a mistake.

Those things slow productivity.

Yet they are the very things that define good medicine.

In a metrics-driven system, efficiency quietly outranks excellence.

And that is a dangerous substitution.

Research, too, becomes distorted.

Instead of asking, “What question truly matters?” we ask, “What can I publish quickly?”

Instead of deep, risky, meaningful work, we gravitate toward safer, incremental studies.

Because numbers reward volume.

Not depth.

Five small papers often “count” more than one careful, transformative one.

So, we slice the salami thinner and thinner.

More papers.

Less nourishment.

There’s a phrase I’ve started using quietly to myself:

We measure citations, but not conversations.

Yet most of what shaped my career came from conversations.

A mentor leaning back in his chair, asking a hard question.

A late-night case discussion.

A walk down the hallway with a resident puzzling through a diagnosis.

None of those moments would ever appear in an annual report.

Yet they mattered more than almost anything else.

They built a life.

The irony is that the harder we chase metrics, the more hollow the work can feel.

Because numbers are abstract.

People are not.

You cannot love an h-index.

You cannot feel pride in a bar graph.

But you can feel pride when a former student writes years later to say, “You changed the way I practice.”

That’s meaning.

And meaning is what sustains us through long days and modest salaries.

Without it, burnout accelerates.

Departure feels inevitable.

Money may pull.

Bureaucracy may frustrate.

Burnout may exhaust.

Loss of autonomy may erode identity.

But metrics do something quieter still.

They slowly redefine success.

Until we forget why we came here at all.

Until we begin optimizing for numbers rather than nurturing people.

Until the work becomes efficient, but joyless.

I don’t believe we should abandon measurement.

But we must remember its place.

Measurement should serve the mission.

Not replace it.

Some things will always resist counting.

Mentorship

Wisdom.

Presence.

Human connection.

Perhaps that is precisely why they matter most.

If we want to restore vitality to academic medicine, we must protect those unmeasurable spaces.

Time to teach without rushing.

Time to think deeply.

Time to care.

Time for conversations that will never appear on a spreadsheet but will echo for decades in the lives of our students.

Because not everything that counts can be counted.

And if we forget that, the halls may still look busy, but they will feel strangely empty.

In Part 6, I want to write about something deeply connected to this loss of meaning.

The quiet disappearance of mentorship and apprenticeship.

The slow fading of the hand-to-hand passing of craft that once defined our profession.

#bunyipsbooksbeyond