AAMC Reporter: April 2009

"Peeking Over the Horizon": New AAMC Leaders Look to the Future

Ann C. Bonham, Ph.D., AAMC Chief Scientific Officer Atul Grover, M.D., Ph.D., AAMC Chief Advocacy Officer

The AAMC recently announced two new appointments to key association positions. In early March, Atul Grover, M.D., Ph.D., became the association’s chief advocacy officer. As of July 1, Ann C. Bonham, Ph.D., will be the association's new chief scientific officer.

Before becoming chief advocacy officer, Grover, M.D., Ph.D., served as an AAMC director for government relations and health care affairs. Prior to joining the AAMC, Grover was a senior consultant in health care finance and applied economics for The Lewin Group, Inc. A general internist, Grover practices medicine and holds faculty appointments at the George Washington University (GWU) School of Medicine and the Johns Hopkins University Bloomberg School of Public Health, where he obtained his Ph.D. in health and public policy. He received his M.D. from GWU School of Medicine in 1995 and completed his residency in internal medicine and primary care at the University of California, San Francisco.

In her position as executive associate dean for academic affairs and professor of pharmacology and internal medicine at the University of California, Davis, School of Medicine, Bonham oversaw the school's research, undergraduate medical education, and faculty academic programs. Bonham also played an integral leadership role in the university receiving one of the first Clinical and Translational Science Awards, given be the National Institutes of Health to institutions that partner and collaborate with other organizations involved with health care throughout the nation to transform clinical and translational research and bring new scientific advances to health care. During her tenure, the school of medicine's overall federal research funding increased by almost 60 percent. Bonham earned her doctoral degree in pharmacology from the University of Iowa College of Medicine in 1986.

The Reporter recently spoke with Bonham and Grover about what they believe the near and distant futures hold for academic medicine and the health care system as a whole.

—By Scott Harris

What do you believe are the major issues and challenges facing academic medicine?

Grover: I think we are facing some challenges that are more pronounced than in the past, particularly related to public funding streams and what we are doing with that funding. In terms of money flow, can we maintain our financial sustainability? Yes. Can we do it without sacrificing our missions? I think we can, in most cases. But can we do it without changing? No. I think we need to seriously look at how we conduct business and figure out how we can make progress in health care and research when most of us don't like to change.

Bonham: One is recruiting, retaining, and training a diverse biomedical and health research workforce. Another is expanding the definition of "translational research" to encompass the full range of scholarship aimed at improving human health, from fundamental discovery to clinical and health outcomes research to research targeted toward the social determinants of health. In other words, proteomics, personalized medicine, policy, and poverty—all are important research areas to improve human health.

How do you intend to help address challenges in your community?

Bonham: A major responsibility as I see it is to be a consistent, bold, robust, and collaborative voice for research, so that our constituents and partners know that the AAMC cares about the full range of biomedical research. I intend to fully advocate for things like the AAMC's new Research Means Hope initiative, which aims to support legislators who understand the value of research and research funding. I intend to listen to and engage perspectives from all our constituents and stakeholders, from the biggest to the smallest institution, from the most research-intensive to the least research-intensive institutions. Being a bit more specific, I think we need to advocate for innovative training models for biomedical researchers through training grants for basic and clinician scientists. And we can frame our priorities by asking some targeted questions. Are our merit and promotions systems fully aligned with advancing new partners and approaches in biomedical research? Are our training programs fully aligned with the future of biomedical research? What would be the long-term consequences of a lack of attention and resources dedicated to training the future biomedical workforce?

Do you believe there is one key "silver bullet" issue or set of issues that could solve many problems at once?

Grover: There's no one silver bullet here. To think that we can come up with one policy or one set of policies that would change the system overnight is foolish. If forced to choose one issue, however, it would have to be access. I think if you gave people better access to the health care system and tried to understand how we get health care to people who are living in areas of the country that are hard to get to or don't have a lot of physicians or health care professionals, I think that is important. But also, how do we get care to the poor individual who lives perhaps a couple of blocks from many physicians? It's not just giving them an insurance card. I think access involves not only financial coverage but also making sure that health care is accessible to people in a way that benefits their health. While you run the risk of perpetuating some of the system's inefficiencies, I would hope that if you could make health care truly accessible that people would take advantage and get the kind of prevention, education, and treatment they need earlier rather than later. I think that will help us redirect some of the health care dollars to things that are more valuable in the long run both for society and for individuals.

As health care reform continues to gain momentum, what kinds of roles can academic medicine play in that process?

Grover: We are still in a relative period of infancy in terms of measuring outcomes and trying to come up with processes that help improve the quality of care. But by and large those advancements are being developed at medical schools and teaching hospitals by faculty and staff. That is where reforms are happening. But we are still in a place where we need to translate those individual reforms into things that work system-wide, and that is very difficult to do. Although we deliver 20 percent of the health care in the United States, there is the other 80 percent of the system that operates around us, and until we get some movement both from the top down in terms of public policy and the bottom up in terms of what providers and educators and researchers are doing, we are not going to be successful.

Bonham: Our academic medicine community can advocate in a very concrete way for the importance of research and research training in health care reform. Secondly, we have to engage in research that evaluates health care policy and reform efforts in meaningful ways, so that policy makers have concrete data to use when making decisions about health care reform so that we are not having this same conversation 20 years from now.

How do you feel that the AAMC as an association can be most effective in shaping health care reform?

Grover: We need to do a better job of telling the story of how important academic medicine is. It is not just an ivory tower where people are sitting around pondering great thoughts. It is an environment where great community benefit, cutting-edge care, standby care, discovery of new treatments and therapies, and the training of the next generation of health professionals all occur. In terms of public policy, I think what distinguishes the AAMC is that we are exceptionally good at being genuine, honest brokers of information, and I think that needs to continue. We need to make sure that our voice is in the mix and that people hear us, but that we are not just screaming, and are careful about what we say.

How do you think academic medical research will change over the next five years?

Bonham: Our research training has to peek over the horizon if we want to fully engage the future. For example, soon there will be broadband access in areas of the nation that are not now accessible. That opens up entirely new populations for research and the translation of research into practice. The recent advances in induced pluripotent stem cells and the lifting of the federal ban on embryonic stem cell research will accelerate progress in regenerative medicine and sharpen the focus on bioethics and the public trust. With the comprehensive sequence of the human genome we will see great progress toward the goal of improving human health through personalized medicine. We now have and are accumulating large-scale data sets, which introduce new dimensions to research such as computational biology, database management, and health informatics. We have learned from the global economic crisis not to underestimate how much we are a part of a global community. So I think we will see an increased emphasis on biosafety and vaccine development. We will begin to see more collaboration not just between institutions but across the globe. I also think there is going to be an increased emphasis on accountability where the public is going to demand transparency and assurances in how we are conducting ourselves in research, and I think the AAMC has taken a lead in that. This is an exciting time to be part of biomedical and health research.