The emergence of the Medical University of Vienna 20 years ago.

At the beginning of the 2000s the Austrian public universities were characterized by staffing rigidities, little competitive research, outdated study curricula and free access to all fields of study, the latter combined with high dropout rates and long study durations. As a countermeasure the universities were granted full legal capacity. For new employees the status of civil servants was herewith cancelled and, being now subject to the Employment Act, tenured employments for anyone who wanted to stay at the university were no longer possible. Medical faculties always had special provisions which would be difficult to reconcile with the full legal capacity of the universities: (i) the requirements of the hospitals affiliated to universities for research and teaching in addition to patient care had to be reimbursed to the Austrian federal states maintaining the hospitals, (ii) the physicians of university-affiliated hospitals were largely employed by the respective university and (iii) to ensure financing of clinical research and teaching at the hospital, the medical faculties received a budget separated from the rest of the university. As it was neither politically possible nor foreseeable that universities would be able to form a subcorporation with the affiliated hospital (integration model) or at least a close cooperation with the hospital if that has legal capacity per se (cooperation model), the necessary budgetary sovereignty of the medical faculties could only be guaranteed by their transition to medical universities. Nonetheless, reservations about this spin-off of medicine were enormous, but quickly fell silent, as the newly established medical universities maintained close cooperations with their parent as well as other universities and achieved, for Austrian standards, favorable positions in international rankings.