WisconsinWildcard
The plural of anecdote is not data
Why do it that way?
I mean, I assume it's a scam, but I can't figure out the scam in this instance.
Is it a way for the institution to run on private donations but still rake in public funding? Or a way to hide their profits so they can duck taxes and qualify for other state and federal goodies?
The short answer is I am not sure how it all started that way. It likely has origins in many of these institutions being separate entities, eventfully merging into large health care systems.
It also gives flexibility in having clinically vs research oriented staff. The fact remains you need to see patients and do things to make money in our health care system. Those who are research oriented may only do 1-2 days of clinic a week, they are a "loss" for revenue for a large health system, but great for a large university. Those staff get a larger proportion of salary from the university and much less from the health system. These physicians are also in a traditional tenure track.
There are also clinical physicians who get much more salary from the health system and much less from the university. They are on a different "tenure track" that does not have similar requirements of publish or perish, and often they can stay as assistant professor for as long as they want. Promotion happens but it is based more on clinical production/teaching/etc.
You will lose so many recruiting battles for top physicians if you were to pay just from a large university pool. A neurosurgeon makes like 400k-1M/year. Offer them a 150K/year professorship and very few will jump at that. But if you offer them a 100K/year university salary and then 200-400K additional based on clinical productivity you can then recruit much better.