Anemia In Academia: Part 4 - Loss of autonomy (#540)

Force #4: Decisions made far from the clinic floor.

There was a time in academic medicine when most decisions were made within earshot.

You walked down the hall.

You knocked on the department chair’s door, or the hospital administrator’s door if it was a clinical issue.

You talked it through.

A new piece of equipment. A schedule change. A clinical protocol. A hire.

It wasn’t perfect, but it was human.

Decisions were made by the people closest to the work.

The people who understood the research needs, teaching loads, students, the patients, the rhythm of the clinic.

If something needed fixing, you fixed it.

If something made sense, you did it.

There was trust.

Lately, when I watch how decisions are made, I notice something different.

The decisions haven’t disappeared.

They’ve just moved.

Upward.

Outward.

Away.

A curriculum change requires approval from three offices that have never set foot in the teaching hospital.

A hire is frozen because of a budget model built on a spreadsheet far from the clinic floor.

A donor’s priorities quietly shape program direction.

A corporate partnership arrives with unwritten expectations.

A new initiative is announced with polished language - branding, optimization, alignment - but no one asks the faculty actually doing the work what they need.

You begin to feel as though the levers of your own profession are being pulled from somewhere else.

From somewhere you can’t see.

From somewhere you can’t reach.

Autonomy is one of those words we don’t talk about much.

But it is oxygen for professionals.

It is the quiet understanding that says:

You are trained.

You are trusted.

Use your judgment.

Doctors, veterinarians, teachers don’t enter their respective fields to be managed minute by minute.

We enter them because we value responsibility.

Craft.

Discretion.

The freedom to solve problems in real time.

Take that away, and something essential disappears.

I notice it most in small moments.

A faculty member who once redesigned her course creatively now says, “I’ll have to check if we’re allowed.”

A clinician who once adjusted protocols easily now hesitates because “risk management might object.”

A department that once moved quickly now waits for permission from the dean’s office.

Not because people are incapable.

But because they’ve learned that initiative is often punished.

Or at least slowed to a crawl.

So, they stop trying.

Compliance replaces curiosity.

That’s a dangerous trade.

In private practice, autonomy often looks very simple.

See the patient.

Make the decision.

Act.

You are accountable for the outcome.

There is clarity in that.

In academia, responsibility has become strangely divorced from authority.

Faculty are still accountable for teaching quality, patient care, and research output, but they often lack the authority to shape the very systems that determine those outcomes.

It’s like being asked to captain a ship while someone else holds the wheel.

Eventually, you stop feeling like the captain at all.

There is also a subtler form of lost autonomy that arrives wearing a respectable suit.

Money.

Donors.

Corporate partners.

Boards.

None of these are inherently bad.

Universities need resources.

But when funding begins to shape direction, when naming rights influence priorities,and when partnerships quietly dictate policy, something shifts.

Decisions begin to serve optics and relationships rather than mission.

Faculty feel it.

Even if no one says it aloud.

The question creeps in:

Whose veterinary school is this, really?

Ours?

Or someone else’s?

I have watched young faculty grow cautious in ways that surprise me.

Careful about what they say.

Careful about what they criticize.

Careful about what they propose.

Not because they lack ideas.

But because they sense that decisions are already made somewhere higher up the chain.

Why spend energy pushing against a locked door?

So, they conserve their strength.

They keep their heads down.

They teach their classes.

They go home.

And the institution loses something immeasurable:

Engagement.

Ownership.

Pride.

The tragedy is that autonomy costs nothing.

Autonomy is free!

It doesn’t require a new building.

It doesn’t require a $120 million gift.

It simply requires trust.

Trust that trained professionals can make thoughtful decisions.

Trust that the people closest to the work usually understand it best.

Trust that not everything needs to be centralized, standardized, optimized.

Sometimes local judgment is wiser than distant policy.

But trust is uncomfortable for large institutions.

Control feels safer.

Even when it slowly suffocates the very people you depend on.

When faculty leave academia, they rarely say, “I wanted more control.”

But listen closely and you’ll hear it between the lines.

“I just wanted to practice medicine.”

“I wanted to teach without jumping through hoops.”

“I was tired of asking permission to do my job.”

What they’re describing is autonomy.

Or rather, the lack of it.

Money may tempt.

Bureaucracy may exhaust.

Burnout may deplete.

But loss of autonomy does something different.

It erodes identity.

Because if you cannot exercise judgment, if you cannot shape your environment, and if you cannot influence the direction of your own profession, then what, exactly, are you?

Not a scholar.

Not a craftsman.

Not quite a professional.

Just an employee.

And that is not why most of us came here.

Academic veterinary medicine, at its best, is built on trust.

Trust the clinician.

Trust the teacher.

Trust the scientist.

When that trust disappears, the halls don’t just feel empty.

They feel muted. Cautious. Less alive.

In Part 5, I want to explore another quiet force that grows naturally in this environment.

The steady replacement of meaning with measurement.

When numbers begin to matter more than mentorship.

When metrics begin to matter more than mastery:

The rise of the metrics culture.

#bunyipsbooksbeyond