The inevitable rise of mediocrity in academic medicine

The present analysis addresses the question of how it has been possible for academic medicine to grow and lose its creative productivity at the same time. A mathematical model is developed to simulate the mechanisms that govern growth of medical systems over time. Time-dependent growth of system size increases the occurrence of statistical deviations of all system parameters. Deviations are correlated with costs and creative output. As deviation-induced costs start to strain the system's tolerance, means become implemented to restrict deviation, which ultimately also reduces its creative output. To maintain growth combined with high levels of creative output, an academic medical system would need to continuously branch off and nurture smaller subsystems, which pursue their own set of goals relatively independently of the overall academic structure.