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Scott Harris
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Elissa Fuchs
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Poll Shows Continued Support For Academic Medicine

The public's support of medical schools and teaching hospitals remains strong, as does support for increased federal funding for academic medical centers, according to the results of a new public opinion poll commissioned by the AAMC.

The national survey's results were released at the AAMC's Sept. 9 "Tomorrow's Doctors, Tomorrow's Cures" (TDTC) conference in Washington, D.C. Conducted earlier this year, the survey's major findings include:

As with the AAMC's original opinion research in 1996, national survey respondents continue to rate the terms "teaching hospital" and "medical school" favorably. (See Figure 1)
Americans perceptions about research have changed since 1996, with more now crediting gains in medical innovations to teaching hospitals and medical schools over private companies and the pharmaceutical industry.
Congressional staff attitudes also have shifted dramatically since 1997 and staff members now believe medical school laboratories have contributed as much to medical innovation as private companies.
Two-thirds of urban-area residents believe that America's medical schools and teaching hospitals are facing funding shortages due to cuts in government funding, cost-cutting by insurance companies, and the growing number of patients who cannot afford health care.

Campaign, survey methodology

Launched in 1998, Tomorrow's Doctors, Tomorrow's Cures is the AAMC's national public education and advocacy campaign. Its aim is to build a strong base of support for sustaining the financial health of medical schools and teaching hospitals.

Now completing its fourth year, the campaign has developed several distinct areas - campaign strategy, issues management, image positioning, and member support - to assist the AAMC and its member institutions in their effort to communicate their key advocacy messages and positions to policymakers, the public, and the media.

Last year, AAMC's Project Medical Education (PME) program also was folded into the TDTC campaign. PME is a day-and-a-half program designed to educate members of Congress and their staffs about the process of medical education, its complex funding mechanisms, and the essential role of government in providing financial support. The project is a unique way to make lawmakers aware of the many contributions that U.S. medical schools and teaching hospitals make to the nation's healthcare system.

"Throughout the evolution of the TDTC campaign, annual public and congressional opinion research projects have served as its foundation," says Patricia Green, associate vice president in the AAMC's Office of Communications, who heads up the TDTC effort. "The knowledge and perspective we gain from this research greatly helps in shaping new activities and resources for the campaign."

The methodology for this year's research project, conducted by the national polling firm Public Opinion Strategies, included a series of focus groups held in Houston and Philadelphia, a national survey of 900 likely voters, with 600 respondents selected from urban areas that include a prominent academic medical center, and a poll of 150 bipartisan congressional healthcare senior staff members.

'Powerful' funding arguments

Bill McInturff, a partner with Public Opinion Strategies who conducted the AAMC research and presented the findings at the Sept. 9 TDTC conference, said it was encouraging that a majority of survey participants support increased federal funding for teaching hospitals. The results, he said, show "very powerful arguments" for continued federal funding.

The arguments to increase funding rated most persuasive by both the public and congressional staff included: the investment in the training of future doctors positively impacts the care available to families and communities; federal funding cuts negatively impact the quality of care at teaching hospitals; funding is important for "future miracles and cures;" and cuts impact teaching hospitals' ability to provide care for the uninsured.

Nationally, Americans credit teaching hospitals and medical schools as being most responsible for gains in medical innovation. (See Figure 2.) At 21 percent and 20 percent, respectively, awareness of advances in surgery and other medical research done at these institutions increased more than awareness of private company research (18 percent), federal government funding (14 percent), and drugs developed by the pharmaceutical industry (13 percent).

Survey and focus group participants indicated they feel safer in a teaching hospital than in a community hospital because of the advanced technology, and said the teaching environment offers more thorough patient care and diagnosis. They consistently noted that new technologies and research are a characteristic differentiating teaching hospitals from community hospitals.

Congressional staff members, however, now give equal credit to medical school laboratories and private companies as the leaders of medical innovation. The survey showed that "break- through research at medical school laboratories" was ranked favorably by 25 percent of the participants, the highest percentage in its category and more than double the 11 percent figure from a survey taken in 1997.

Despite the growing recognition among the public and congressional staff of the contributions medical schools and teaching hospitals make to the advancement of medicine, knowledge gaps within these groups persist.

One particularly dismaying finding for teaching hospitals shows that a majority of the surveyed public now do not believe that their local academic medical center provides healthcare services for low-income or uninsured patients (See Figure 3.)

Further, only a minority now believe that their local teaching hospital is a not-for-profit institution. Both these finding indicate significant shifts from AAMC research conducted in 1996.

Residents viewed favorably

The majority of urban-area residents surveyed - 69 percent - indicated they thought that medical care provided by medical residents would be "very good" or "excellent."

Nationally, the term "resident" received a relatively high favorable rating from respondents, with residents scoring a 57 percent positive rating. This was second behind "community hospitals" (61 percent), and ahead of "academic medical centers" (48 percent) and "medical school faculty" (42 percent).

Survey results showed a level of public and congressional awareness about the ongoing resident duty hours issue, though few knew the rationale for residents' traditionally long hours, such as the ability to follow the full course of a patient's illness and recovery.

While many considered the issue of an 80-hour week for residents a "step in the right direction," most felt that recommendation did not go far enough. One focus group respondent said, "I think giving these guys a break for some period of time is the right way to go."

Indicative of this reaction, when asked specifically about the number of weekly hours in which residents are involved in training and patient care, both the public and congressional staff members underestimated residents' duty hours. The public estimated these hours at 66 hours per week, while congressional staff estimated 72 hours per week.

- Michael G. Malloy, mmalloy@aamc.org