Entrepreneurship in the Medical Academy

An entrepreneur in the broadest economic and social sense is a self-employed individual who has autonomy, controls his affairs, and is willing to take risks. Based on this definition, sociologists such as C. Wright Mills have argued that medicine is the apotheosis of an entrepreneurial profession in the United States.1 Both ideologically and economically, self-sufficiency remains a hallmark of the medical profession, notwithstanding an ever-increasing reliance on technology and the ever-expanding influence of regulation on medical practice. Charismatic authority, according to Weber,2 is another essential attribute of the professional persona: possession of a complex body of knowledge that can directly affect the health and survival of an individual accounts for the physician’s historically unquestioned leadership, especially under conditions of physical and emotional stress. The legitimacy of the profession grants this charismatic authority; yet this authority can be compromised if it is not frequently validated by physician behavior.Risk-taking self-interest can present a major challenge for charismatic (as well as traditional legal) authority, and requires careful oversight by every profession, but especially by the medical profession. A unique aspect of medicine is that it optimally balances the dynamic between charisma and entrepreneurship.3 In contrast to the clergy, who are much more charismatic than entrepreneurial, and attorneys, who, in the extreme, are more entrepreneurial than charismatic, physicians have historically struck a balance between these two important characteristics that has given us a unique position in society: we, in general, achieve financial independence and stability throughout our professional lives, while at the same time we engender the trust of our patients and guard the public health.1,3 These are noble sentiments, to be sure, but I believe they are highly relevant to this discussion.Over the past 20 years, there can be no doubt that entrepreneurship has expanded from a …