Light at the End of the Tunnel?

After more than a year of political wrangling, the future at last seems a little more certain for Berlin's clinical scientists this week. Since elections in October 2001, the fate of researchers at the city-state's two university hospitals, the Free University's (FU's) Benjamin Franklin School of Medicine (UKBF) and the Humboldt University's (HU's) Charité, has been in the hands of the politicians.

The reason? Berlin's immense budgetary problems. The so-called red-red coalition senate, comprising the Social Democrats (SPD) and the postcommunist PDS, needs to cut the city's overall budget by an estimated ?2 billion annually. Despite preelection statements by all parties emphasising the importance of science and research for Berlin, the new senate's consolidation plans were not sparing of its universities, especially the highly expensive system of supporting two university hospitals. The senate's first proposal called for a complete closure of research and training facilities at UKBF, leaving it simply as a local hospital, resulting in projected savings of ?98 million annually.

But an unexpected public uproar--more than 300,000 letters and e-mail comments calling for UKBF to keep its research hospital status were received by the Berliner Morgenpost newspaper alone--led to a change in strategy. Critics called into doubt the projected savings calculation because the city would have had to refund to the federal government an estimated ?170 million to ?190 million in investments in UKBF. Moreover a comparison of the two institutions on the basis of scientific excellence showed Charité and UKBF--both highly regarded nationally and internationally--to be equals, despite Charité being almost twice the size of UKBF. A convincing rationale for degrading UKBF was hard to find.

The discussion did, however, pave the way for reform of the university hospitals. The senate appointed an expert panel on university medicine and charged it with the task of developing scenarios for the hospitals' future. At the same time, Germany's Science Council, the Wissenschaftsrat, too had a commission on medicine examining potential solutions. Whereas, in October last year, the expert panel recommended a merger of the universities' medical faculties, the Wissenschaftsrat's commission proposed the founding of an independent medical school for Berlin. Now the Wissenschaftsrat has carefully evaluated both proposals, considering ideas from both bodies.

The commission's idea of founding an independent medical school has been dropped, mainly because of the nightmare involved in disentangling the new school from both universities. However, the Wissenschaftsrat's new recommendations go further than those of the expert panel, proposing a very lean administration for a future interuniversity medical faculty under the auspices of both universities, and an operational separation of research and training on the one hand and public medical care on the other.

Meanwhile the potential for an agreement at last is a relief for all involved. Both university presidents welcomed the likely end of insecurity for clinical research in Berlin. However, HU president Professor Jürgen Mlynek and FU president Professor Peter Gaehtgens demanded that the senate make its decision quickly and then guarantee a "long-term organizational silence," in order to let the new structure settle down. If the merger procedure goes according to plan, the new faculty will be inaugurated on 1 April 2004.

One problem has already been solved by mutual agreement: Because of the tradition dating back to 1710, the faculty will carry on under the name "Charité." Among the issues still under consideration is how to handle fields of research currently undertaken by both hospitals. It is likely that such fields will undergo their own minimergers to be concentrated at just one hospital each, most likely leading to a cutback in the number of scientific positions. And the expert panel has called for a reduction in the number of beds, from 3500 currently to about 2200.

Meanwhile, the future of HU's other research hospital, the Charité-affiliated Rudolf-Virchow-Clinic, remains unsure. The small, but highly regarded facility may in the end become the necessary sacrifice for the conservation of UKBF and Charité.

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