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Hottest Job in Corporate America? The Executive in Charge of A.I.

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Many feared that artificial intelligence would kill jobs. But hospitals, insurance companies and others are creating roles to navigate and harness the disruptive technology.In September, the Mayo Clinic in Arizona created a first-of-its-kind job at the hospital system: chief artificial intelligence officer.Doctors at the Arizona site, which has facilities in Phoenix and Scottsdale, had experimented with A.I. for years. But after ChatGPT’s release in 2022 and an ensuing frenzy over the technology, the hospital decided it needed to work more with A.I. and find someone to coordinate the efforts.So executives appointed Dr. Bhavik Patel, a radiologist who specializes in A.I., to the new job. Dr. Patel has since piloted a new A.I. model that could help speed up the diagnosis of a rare heart disease by looking for hidden data in ultrasounds.“We’re really trying to foster some of these data and A.I. capabilities throughout every department, every division, every work group,” said Dr. Richard Gray, the chief executive of the Mayo Clinic in Arizona. The chief A.I. officer role was hatched because “it helps to have a coordinating function with the depth of expertise.”Many people have long feared that A.I. would kill jobs. But a boom in the technology has instead spurred law firms, hospitals, insurance companies, government agencies and universities to create what has become the hottest new role in corporate America and beyond: the senior executive in charge of A.I.The Equifax credit bureau, the manufacturer Ashley Furniture and law firms such as Eversheds Sutherland have appointed A.I. executives over the past year. In December, The New York Times named an editorial director of A.I. initiatives. And more than 400 federal departments and agencies looked for chief A.I. officers last year to comply with an executive order by President Biden that created safeguards for the technology.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber?  More

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    Why Doctors and Pharmacists Are in Revolt

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    Dr. John Wust does not come off as a labor agitator. A longtime obstetrician-gynecologist from Louisiana with a penchant for bow ties, Dr. Wust spent the first 15 years of his career as a partner in a small business — that is, running his own practice with colleagues.Long after he took a position at Allina Health, a large nonprofit health care system based in Minnesota, in 2009, he did not see himself as the kind of employee who might benefit from collective bargaining.But that changed in the months leading up to March, when his group of more than 100 doctors at an Allina hospital near Minneapolis voted to unionize. Dr. Wust, who has spoken with colleagues about the potential benefits of a union, said doctors were at a loss on how to ease their unsustainable workload because they had less input at the hospital than ever before.“The way the system is going, I didn’t see any other solution legally available to us,” Dr. Wust said.At the time he and his colleagues voted to unionize, they were one of the largest groups of private-sector doctors ever to do so. But by October, that distinction went to a group that included about 400 primary-care physicians employed in clinics that are also owned by Allina. The union that represents them, the Doctors Council of the Service Employees International Union, says doctors from dozens of facilities around the country have inquired about organizing over the past few years.And doctors are not the only health professionals who are unionizing or protesting in greater numbers. Health care workers, many of them nurses, held eight major work stoppages last year — the most in a decade — and are on pace to match or exceed that number this year. This fall, dozens of nonunion pharmacists at CVS and Walgreens stores called in sick or walked off the job to protest understaffing, many for a full day or more.The reasons for the recent labor actions appear straightforward. Doctors, nurses and pharmacists said they were being asked to do more as staffing dwindles, leading to exhaustion and anxiety about putting patients at risk. Many said that they were stretched to the limit after the pandemic began, and that their work demands never fully subsided.“We’re seen as cogs in the wheel,” Dr. Alia Sharif said, “You can be a physician or a factory worker and you’re treated exactly the same way by these large corporations.”Jenn Ackerman for The New York TimesBut in each case, the explanation runs deeper: A longer-term consolidation of health care companies has left workers feeling powerless in big bureaucracies. They say the trend has left them with little room to exercise their professional judgment.“People do feel put upon — that’s real,” said John August, an expert on health care labor relations at the Scheinman Institute at Cornell University. “The corporate structures in health care are not evil, but they have not evolved to the point of understanding how to engage” with health workers.Allina said that it had made progress on reducing doctors’ workloads and that it was partnering with health care workers to address outstanding issues. CVS said it was making “targeted investments” in pharmacies to improve staffing in response to employees’ feedback, while Walgreens said it was committed to ensuring that workers had the support they needed. Walgreens added that it had invested more than $400 million over two years to recruit and retain staff members.Professionals in a variety of fields have protested similar developments in recent years. Schoolteachers, college instructors and journalists have gone on strike or unionized amid declining budgets and the rise of performance metrics that they feel are more suited to sales representatives than to guardians of certain norms and best practices.But the trend is particularly pronounced in health care, whose practitioners once enjoyed platinum-level social status at high school reunions and Thanksgiving dinners.For years, many doctors and pharmacists believed they stood largely outside the traditional management-labor hierarchy. Now, they feel smothered by it. The result is a growing worker consciousness among people who haven’t always exhibited one — a sense that they are subordinates constantly at odds with their overseers.“I realized at end of the day that all of us are workers, no matter how elite we’re perceived to be,” said Dr. Alia Sharif, a colleague of Dr. Wust’s at Allina who was heavily involved in the union campaign. “We’re seen as cogs in the wheel. You can be a physician or a factory worker, and you’re treated exactly the same way by these large corporations.”‘We were all partners.’ Then came the metrics.Pharmacists at Walgreens and CVS have complained of understaffing and overly aggressive performance targets. Spencer Platt/Getty ImagesThe details vary across health care fields, but the trend lines are similar: A before-times in which health care professionals say they had the leeway and resources to do their jobs properly, followed by what they see as a descent into the ranks of the micromanaged.As a pharmacy intern and pharmacist at CVS in Massachusetts beginning in the late 1990s, Dr. Ed Smith found the stores consistently well staffed. He said pharmacists had time to develop relationships with patients.Around 2004, he became a district manager in the Boston area, overseeing roughly 20 locations for the company. Dr. Smith said CVS executives were attentive to input from pharmacists — raising pay for technicians if there was a shortage, or upgrading clunky software. “Every decision was based on something that we said we needed,” he recalled.Dr. Wust looked back on his days in an independent practice of about 25 doctors with a similar wistfulness. “We were all partners,” he said. “It was relative workplace democracy. Everybody got a vote. Everybody’s concerns were heard.”Over time, however, consolidation and the rise of ever-larger health care corporations left workers with less influence.As so-called pharmacy benefit managers, which negotiate discounts with pharmacies on behalf of insurers and employers, bought up rivals, retail giants like Walgreens and CVS made acquisitions as well, to avoid losing market power.The chains closed many of their newly owned locations, driving more customers to existing stores. They sought to cut costs, especially labor costs, as the benefit managers reined in drug prices.Around 2015, Dr. Smith stepped down from his role as a district manager and became a frontline pharmacist again, reluctant to supervise co-workers under conditions he considered subpar. “I couldn’t ask my pharmacists to do what I couldn’t accomplish,” he said.Among his frustrations, he said, was the need to strictly limit the number of workers each pharmacy could schedule. “Every week that you’re over your labor budget, you get a call, regardless of prescription volume, from your district manager,” Dr. Smith said. “If your budget for tech hours is 100 and you used 110, you get a phone call. It’s not much money — maybe $180 — but you’re getting a call.”Asked how labor budgets were applied, CVS said managers were “provided guidance” based on expected volume and other factors, with adjustments made to ensure adequate staffing.Dr. Smith and other current and former CVS and Walgreens pharmacists said their stores’ allotment of hours for pharmacists and pharmacy technicians had dropped most years in the decade before the pandemic.The pharmacists also described being held to increasingly strict performance metrics, such as how quickly they answered the phone, the portion of prescriptions that are filled for 90 days rather than 30 or 60 days (longer prescriptions mean more money up front) and calls made urging people to fill or pick up prescriptions.For years, Walgreens and CVS pharmacists could largely ignore these narrower metrics so long as overall profits and customer satisfaction stayed high. But in the early to mid-2010s, both companies elevated the importance of these indicators, several pharmacists said.At Walgreens, many pharmacy managers began reporting to a districtwide retail supervisor rather than a supervisor trained as a pharmacist. “It coincided with more pushing of the metrics,” said Dr. Sarah Knolhoff, a Walgreens pharmacist from 2009 to 2022.“Never having been a pharmacist, they would push the pharmacy the same way they would push the front end,” Dr. Knolhoff added, alluding to the rest of the store.CVS said that performance metrics were needed to ensure safety and efficiency for patients but that in recent years it had reduced the number of metrics it tracked. Walgreens announced last year that it would no longer rely on “task-based metrics” in performance reviews for pharmacy staff members, though it still used them to track store-level performance.‘Corporate tells you how to manage your patient.’At health systems like Allina, doctors have incentives to talk to patients about conditions that may not be relevant to their immediate care. Health experts say it can help ensure that high-risk conditions are attended to.Jenn Ackerman for The New York TimesThe transition for doctors and nurses came around the same time. As independent medical practices found they had lost leverage in negotiating reimbursement rates with insurers, many doctors went in house at larger health systems, which could use their size to secure better deals.The passing of the Affordable Care Act in 2010, along with federal rule-making efforts, rewarded bigness by tying reimbursement to certain health outcomes, like the portion of patients who must be readmitted. Getting bigger helped a hospital system diversify its patient population, the way an insurer does, so that certain groups of high-risk patients weren’t financially ruinous.Administrators increasingly evaluated their medical staff according to similar metrics tied to patients’ health and put a variety of incentives and mandates in place.Doctors and nurses chafed at the changes. “Corporate tells you how to manage your patient,” said Dr. Frances Quee, president of the Doctors Council, which represents about 3,000 doctors, most of them at public hospitals. “You know that’s not how you’re supposed to manage your patient, but you can’t say anything because you’re scared you’re going to be fired.”At Allina, primary care doctors are given incentives to talk to patients about their high-risk or chronic medical conditions, even if those conditions are well managed and aren’t relevant to a visit.“Is that a valuable use of our 25 minutes together?” said Dr. Matt Hoffman, a primary care doctor at an Allina clinic that unionized in October. “No, but it means Allina gets more money from Medicare.”Dr. Wust said hospital administrators increasingly relied on management theories borrowed from other industries, like manufacturing, that sought to minimize excess capacity.For example, he said, obstetricians at Allina had one or two hold spots a day of 15 minutes each, in case of a patient emergency, when he began working at the system. Several years ago, Allina took away these buffers, instructing obstetricians to double book instead.Asked about the hold spots, Allina said, “We’re always looking at how we’re using our resources to deliver high-quality care.” It said the incentives tied to high-risk conditions could still be achieved if a doctor stated that the problem was no longer relevant. Dr. Josh Scheck, another Allina primary care doctor, said he found the nudge helpful and not very time consuming to address. He said the health system had allowed his clinic to experiment with ways to make its work flow more efficient.Other health workers complained that some of the metrics they’re evaluated on, like patient satisfaction, made them feel like retail clerks or dining employees rather than medical professionals.Adam Higman, an expert on hospital operations at the consulting firm Press Ganey, said consolidation and the increased use of metrics had arisen in response to a need to lower U.S. health care costs, long the world’s highest per capita, and ensure that the spending actually benefits patients.He pointed to data showing that more empathetic and communicative doctors and nurses — factors that affect patients’ experience — lead to healthier patients.But Mr. Higman acknowledged that many health systems had increased tensions with doctors and nurses by failing to involve them more in developing and putting in place the system of metrics on which they are judged. “The progressive, smart health systems and medical groups are listening to physicians, looking at their experience and turnover and creating venues to have discussions,” he said. “If not, that’s one of the contributing factors to organizing.”‘I would not have put unions and physicians in the same mind.’Nurses went on strike for three days in January at Mount Sinai Hospital in New York to protest understaffing.Gregg Vigliotti for The New York TimesThe pandemic magnified these strains.As retail chains rolled out Covid-19 vaccines, pharmacists complained of being overworked to the point of skipping bathroom breaks and said they worried constantly about making mistakes that could harm patients. (CVS said it began closing most pharmacies for 30 minutes each afternoon last year to give pharmacists a consistent break. Walgreens said “dedicated pharmacist meal breaks” began in all stores in 2020.)Doctors and nurses found that their already backed-up inboxes were suddenly bursting, as frightened patients clamored for medical advice. Administrators sought to squeeze more patients into overloaded hospitals and clinics.The breaking point came when the height of the pandemic passed, but conditions barely improved, according to many workers. Although health systems had promised to add staffing, many found themselves running deficits amid inflation and a shortage of doctors and nurses.Professionals who had never considered themselves candidates for union membership began to organize. When she started at Allina in 2009, Dr. Sharif said, “I would not have put unions and physicians in the same mind — it would have been a totally alien concept.” She reached out to the Doctors Council last year for help unionizing her colleagues.Dr. Quee, the union president, said that inquiries from doctors were up more than threefold since the second group of Allina doctors unionized last month — and that as a result, the Doctors Council was hiring more organizers. (Allina is appealing the outcome of the union vote at the hospital but not at its clinics.) Even pharmacists are reaching out. “Two days ago, pharmacists called me from Florida,” she said. “We’ve never done pharmacists before.”In September, Dr. Smith, who long ago shifted from CVS district manager to frontline pharmacist, took on an additional role: labor organizer. After CVS fired a district manager who had refused to close some stores on weekends to address understaffing, Dr. Smith helped organize a series of coordinated sick days and walkouts in the Kansas City, Mo., area, where he has worked for the company in recent years.The walkouts affected roughly 20 locations and drew the company’s chief pharmacy officer and a top human resources official to town for a meeting with the renegades. A few weeks later, CVS said it would rein in vaccination appointments and add work hours for pharmacy technicians, though it had not increased their pay.CVS said several Kansas City-area pharmacists had called in sick on certain days in September, “resulting in about 10 unexpected pharmacy closures” on one day and part of another. In response, it said, executives met with pharmacists to listen to and address their concerns.During an interview in October, while Dr. Smith and his colleagues were still awaiting the company’s response, he made clear that his patience had run out. “I’ve been asking and asking and asking for improvements for years,” he said. “Now we’re not asking any more — we’re demanding it.” More

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    Doctors at Allina Health Form Union

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    The physicians, at Allina Health in Minnesota and Wisconsin, appear to be the largest group of unionized doctors in the private sector.In the latest sign of growing frustration among professionals, doctors employed by a large nonprofit health care system in Minnesota and Wisconsin have voted to unionize.The doctors, roughly 400 primary and urgent-care providers across more than 50 clinics operated by the Allina Health System, appear to be the largest group of unionized private-sector physicians in the United States. More than 150 nurse practitioners and physician assistants at the clinics were also eligible to vote and will be members of the union, which will be represented by a local of the Service Employees International Union.The result was 325 to 200, with 24 other ballots challenged, according to a tally sheet from the National Labor Relations Board, which conducted the vote. In a statement, Allina said, “While we are disappointed in the decision by some of our providers to be represented by a union, we remain committed to our ongoing work to create a culture where all employees feel supported and valued.”The doctors complained that chronic understaffing was leading to burnout and compromising patient safety.“In between patients, your doctor is dealing with prescription refills, phone calls and messages from patients, lab results,” said Dr. Cora Walsh, a family physician involved in the organizing campaign.“At an adequately staffed clinic, you have enough support to help take some of that workload,” Dr. Walsh added. “When staff levels fall, that work doesn’t go away.”Dr. Walsh estimated that she and her colleagues often spend an hour or two each night handling “inbox load” and worried that the shortages were increasing backlogs and the risk of mistakes.The union vote follows recent walkouts by pharmacists in the Kansas City area and elsewhere over similar concerns.A variety of professionals, including architects and tech workers, have sought to form unions in recent years, while others, like nurses and teachers, have waged strikes and aggressive contract bargaining campaigns.Some argue that employers have exploited their sense of mission to pay them less than their skills warrant, or to work them around the clock. Others contend that new business models or budget pressures are compromising their independence and interfering with their professional judgment.Increasingly, doctors appear to be expressing both concerns.“We feel like we’re not able to advocate for our patients,” said Dr. Matt Hoffman, another doctor involved in the organizing at Allina. Dr. Hoffman, referring to managers, added that “we’re not able to tell them what we need day to day.”Consolidation in the health care industry over the past two decades appears to underlie much of the frustration among doctors, many of whom now work for large health care systems.“When a physician ran his or her own practice, they made the decisions about the people and technology they surrounded themselves with,” Dr. Robert Wachter, chair of the department of medicine at the University of California, San Francisco, said in an email. “Now, these decisions are made by administrators.”Doctors at Allina say that staffing was a concern before the pandemic, that Covid-19 pushed them to the brink and that staffing has never fully recovered to its prepandemic levels.Relatively low pay for clinical assistants and lab personnel appears to have contributed to the staffing issues, as these workers left for other fields in a tight job market. In some cases, doctors and other clinicians within the Allina system have quit or scaled back their hours, citing so-called moral injury — a sense that they couldn’t perform their jobs in accordance with their values.“We were promised that when we get through the acute phase of the pandemic, staffing would get better,” Dr. Walsh said. “But staffing never improved.”Allina, which takes in billions in revenue but has faced financial pressures and recently eliminated hundreds of positions, did not respond to questions about the doctors’ concerns.Joe Crane, the national organizing director for the Doctors Council of the S.E.I.U., which represents attending physicians, said that before the pandemic, he would receive about 50 inquiries a year from doctors interested in learning more about forming a union. He said he received more than 150 inquiries during the first month of the pandemic. (Mr. Crane was with another physicians’ union at the time.)Mr. Crane, citing the siloed nature of the medical profession, said that unionization among attending physicians had nonetheless proceeded slowly, but that the victory at Allina could create momentum.In March, more than 100 doctors voted to unionize at another Allina facility, a hospital with two locations. Dr. Alia Sharif, a physician involved in that union campaign, said doctors were under pressure there not to exceed length-of-stay guidelines for patients, even though many suffer from complex conditions that require more sustained care.Allina is appealing the outcome of that vote to the National Labor Relations Board in Washington; a board official rejected an earlier appeal.Even as rates of unionization have languished among attending physicians, they have increased substantially among medical residents. A sister union within the S.E.I.U., the Committee of Interns and Residents, has added thousands of members over the past few years.Dr. Wachter said this could herald an increase in unionization among doctors outside training programs. “When these physicians finish training and enter practice, they are more comfortable with a world in which unionization doesn’t automatically conflict with their notions of being a professional,” he wrote. More

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    Colleges Have Been a Small-Town Lifeline. What Happens as They Shrink?

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    For decades, institutions of higher education provided steady, well-paid jobs in small towns where the industrial base was waning. But the tide of young people finishing high school is now also starting to recede, creating a stark new reality for colleges and universities — and the communities that grew up around them.As Americans have fewer children and a diminishing share of young adults pursue a degree, the once-burgeoning market for college slots has kicked into reverse. Although undergraduate enrollment stabilized somewhat in 2022, it’s still down about 7.6 percent since 2019.“It looks like the future is declining numbers of young people likely to attend college, even in growing areas like the Mountain West,” said Nathan Grawe, an economics professor at Carleton College in Minnesota who studies the demand for postsecondary education. “We’ll start to have some tough stories.”Evidence of a shrinking student body is everywhere in the western Pennsylvania borough of Clarion, population 3,880, which has taken immense pride in the graceful campus of Clarion University since the institution was founded as a seminary 156 years ago.Since 2009, when it had 7,346 students, the university has shrunk by nearly half. With the drop in enrollment has come the loss of nearly 200 staff members, mostly through attrition. Last year, the school even lost its name, as it was merged with two of the 13 other universities in the Pennsylvania State System of Higher Education, creating a multicampus university called PennWest.Tracy Becker, who looks out on Main Street from her broad desk at the city’s chamber of commerce, says there aren’t as many young volunteers for community events like the annual Autumn Leaf Festival, which has been held during homecoming weekend since 1953.“Ideally, I would love to see the university stay and thrive,” said Kaitlyn Nevel, a cafe owner, “but you just have to try and have however many backup plans.”Ross Mantle for The New York TimesKaitlyn Nevel’s cafe used to be staffed mostly with university students; now she has one such employee. As foot traffic lightened, she branched into catering. “Ideally, I would love to see the university stay and thrive, but you just have to try and have however many backup plans,” Ms. Nevel said.As Ms. Nevel’s resigned optimism suggests, declining enrollment doesn’t necessarily spell doom for college towns. Despite the lower student head count, few empty storefronts mar Clarion’s downtown. It has even attracted new businesses like Mechanistic Brewing, which Chelsea Alexander started with her husband in 2019 after moving back from Washington, D.C.Ms. Alexander is one of 28 people in her family to attend the local university. Since 1905, her family has run a clothing shop in town, which sells a line of T-shirts that trade on alumni nostalgia for favorite eateries that have long since closed and for towering dorms that have been demolished. But as graduating classes shrink, even alumni visits will taper off.The State of Jobs in the United StatesThe labor market continues to display strength, as the Federal Reserve tries to engineer a slowdown and tame inflation.Mislabeling Managers: New evidence shows that many employers are mislabeling rank-and-file workers as managers to avoid paying them overtime.Energy Sector: Solar, wind, geothermal, battery and other alternative-energy businesses are snapping up workers from fossil fuel companies, where employment has fallen.Elite Hedge Funds: As workers around the country negotiate severance packages, employees in a tiny and influential corner of Wall Street are being promised some of their biggest paydays ever.Immigration: The flow of immigrants and refugees into the United States has ramped up, helping to replenish the American labor force. But visa backlogs are still posing challenges.Ms. Alexander’s father, Jim Crooks, operates the store, and he has organized local merchants to spruce up the compact main street and market their businesses to potential visitors who may have no such connection to the town.“For many years, the university was carrying a lot of the businesses,” said Mr. Crooks, who has also converted four apartments above the shop from student housing into Airbnb lodgings. “Everybody’s just saying, ‘We can’t depend on the university.’”F.L. Crooks & Company, a family-owned clothing store, has served Clarion since 1905. Two apartments above it have been converted from student housing to Airbnb lodgings.Ross Mantle for The New York TimesAlthough Pennsylvania’s university system had been shrinking for a decade, along with the rest of higher education, it experienced a sudden shock when students disappeared during the pandemic. Among those who noticed: the leaders at the Federal Reserve Bank of Philadelphia, whose territory across Pennsylvania, New Jersey and Delaware has a higher density of colleges and universities than most.Along with large hospital systems, which are often affiliated with universities, educational institutions make up a substantial share of local economies that used to be dominated by manufacturing, logging and mining. Patrick T. Harker, the president of the Philadelphia Fed, wanted to find out how big that share was — since the education and medical sectors were starting to show cracks as well.“Traditionally, ‘eds and meds’ have been thought of as recession-proof,” Dr. Harker said. “This pandemic showed that is not true.”Not all of those institutions are equally vulnerable, however. Rural hospitals have been drying up even as large health care chains build new facilities in fast-growing suburbs, while the dwindling pool of students flocks to state flagships. “They’re stronger than ever, while the regional systems are really struggling,” said Deborah Diamond, a staff economist at the Philadelphia Fed.Dr. Diamond put together a tool that showed how much different regions depended on health care and higher education. The places at the top of the dependence list were predictable, like the Durham-Chapel Hill area of North Carolina, with two powerhouse universities. But they also included smaller areas, like the one surrounding Bloomsburg, Pa., two and a half hours east of Clarion on Interstate 80. There, institutions including Geisinger Health and Bloomsburg University — another state-owned school — make up 21.9 percent of local employment and 18.3 percent of regional income.“As we’ve seen some declines in manufacturing employment, their economic relevance is higher than it’s ever been,” said Fred Gaffney, the president of the area’s chamber of commerce.A local merchant is encouraging others to market to customers without a connection to the town’s university.Ross Mantle for The New York TimesClarion Hospital is the second-largest employer in the county.Ross Mantle for The New York TimesA similar set of factors is evident in Clarion County, where the university is still the largest employer, followed by Clarion Hospital. Walmart comes next, and then a few plants making building materials and prefabricated housing, several social service organizations and the county government. The county used to have more manufacturing, including a large glass plant that closed in 2010. As that receded, so did the county’s population; its labor force dropped to 16,000 in 2022, from about 21,000 in 2008.In the same period, Clarion University’s enrollment began to fall, as did state funding, raising the price of attendance. In 2021, Daniel Greenstein, the chancellor of the State System of Higher Education, proposed forming two clusters of three schools each, to consolidate operations and offer more classes across campuses.“We had to align our costs with our new enrollment numbers,” Dr. Greenstein said in an interview. “We were built out as if we were still having 120,000 students when we had 85,000. You just can’t do that. Like every American family, you have to live within your means.”At the same time, Mr. Greenstein requested more money from the State Legislature to enable the system to freeze tuition and offer more scholarships, which he said was critical to arresting the slide in enrollment. The state increased the system’s base funding by 15 percent in 2022 and threw in $125 million from a federal stimulus measure. The freshman class grew slightly last fall, but not enough to offset another overall drop in enrollment.For the merged schools, swooning enrollment underestimates the degree to which student presence has faded on campus. To bolster their course catalogs, the schools are offering more of their classes online. That allows some students to show up in person only a few days a week — a trend that may accelerate as the system pursues more adult students, some of whom just need to finish degrees or complete shorter certificate programs.Jennifer Fulmer Vinson, Clarion’s mayor, operates an antiques shop in a century-old house reclaimed from a long-gone fraternity.Ross Mantle for The New York TimesClarion’s mayor, Jennifer Fulmer Vinson — another Clarion graduate — sees that as a loss for the borough. History classes come less often to her antiques shop, which sits in a century-old house reclaimed from a long-gone fraternity, stuffed with curios including an old Coke machine and a cabinet full of war medals.“Why are students going to come pay to live on campus when they never leave their room?” Ms. Vinson said. “It’s become more of a ghost town.” (The university says that the first-year student experience is meant to be campus-centered and that most courses will remain in person.)About an hour’s drive west on Interstate 80 from Bloomsburg, the town of Lock Haven also has a university that last year merged with two others in the state-owned system. As the school has shrunk and well-paid staff members have moved away, the state’s substantial tax-free land holdings have started to grate on local residents.Gregory Wilson, the city manager, has created a handout showing what the median property owner pays in taxes to subsidize Lock Haven University: $186 annually.“I think the hope has always been that the investment they’re making to have the university here is somehow returned to them,” Mr. Wilson said. “But that becomes a harder sell as the university becomes smaller.”The contraction has come alongside another recent and unwelcome development: The local hospital, which the sprawling University of Pittsburgh Medical Center bought in 2017, announced in January that it would shutter its inpatient operations, forcing residents to travel at least a half an hour for serious care.All of it has been profoundly frustrating for Angela Harding, a Clinton County commissioner, who says that while she values the hospital and the university, drawing new residents to Lock Haven becomes harder as those economic anchors lose their grip.“I’m sick and tired of having to fight for every single crumb that we get,” Ms. Harding said.Colleges and the towns they occupy can do little about demographic currents. But they should, experts say, reinforce each other — the university can offer space for community functions and support for small businesses, for example, while the town can throw events for prospective students and their parents. Vacant student housing could be converted into homes for new residents who might be able to work remotely or want a quiet place to retire.Tracy Becker, of Clarion’s chamber of commerce, says there are fewer young volunteers for community events than in the past.Ross Mantle for The New York TimesMatthew Wagner, the director of programs for Main Street America, a group dedicated to the development of small downtowns, says he sees less town-gown tension now that municipalities and schools understand their shared fates.“Much like if you had a manufacturer that was facing headwinds, we need to think of the university as an economic development retention program, and direct our assets and resources that way,” Dr. Wagner said.Lock Haven has taken that idea to heart. Its main street is vibrant, with several new boutiques interspersed with longstanding local restaurants. Fabre Sanders, whose father runs a window-treatment store, moved back from Boston a few years ago to start a candy and gift shop. During the pandemic, she said, residents did everything they could to keep the shops alive.“They looked around and said, ‘If we don’t support the local we have, we’re going to have nothing,’” Ms. Sanders said. More