AAMC Reporter: November 2008
Medical Schools, Teaching Hospitals Focus on the Future at AAMC Annual Meeting
As voters were charting a course for America's future,
medical school and teaching hospital leaders convened to
examine the future of medical education and health care at
the 2008 AAMC Annual Meeting.
Those who attended the meeting, which had a theme of
"Creating a Better Tomorrow," were encouraged to explore
the widespread challenges and opportunities facing
academic medicine's key mission areas of education,
patient care, and research, as well as the ways in which
medical schools and teaching hospitals might take the
initiative to change even as a new presidential administration
and Congress begin to evaluate potential reforms to
the nation's health care system.
"I hope we stand ready to face some of the toughest
questions for academic medicine and move closer to
individual and collective answers and action," said
AAMC President and CEO Darrell G. Kirch, M.D., in his
President's Address at the meeting.
"The reality is that
we have been living with far too much injustice in our
current health system. As a profession, we have been
waiting for someone else to fix the system, just as we, as
a nation, have been waiting for a new leader to fix our
country. Are we prepared to make some individual and
institutional sacrifices without waiting for someone to
change the system for us?" Kirch said.
In his keynote address, veteran broadcast journalist Ted
Koppel echoed that sentiment, on a larger scale, when he
said "I cannot remember a more dangerous time than the
one we find ourselves in today," and said that personal
responsibility was key to confronting urgent national
problems including mountainous debt, geopolitical
instability, and an unsustainable energy supply.
"We all have to be prepared to give up something,"
Koppel said. "Ours is the era of perceived entitlement."
Koppel, who spoke three days before the election, predicted
Barack Obama would win, and said he was "excited that
finally a black man is going to be elected to the highest
office in the land." He added that he believed Obama could
be a good president, but "was not Superman," and would
need the public's help in effecting change.
During his speech, Kirch urged the medical school and
teaching hospital communities to respond to what he
said were "the tough questions" that faced them,
including preventing conflicts of interest; addressing the
disparity of resources among medical schools and
teaching hospitals and the economic inequality among
medical specialties; finding true balance in academic
medicine's mission areas of education, research, and
patient care; achieving flexibility and responsiveness in
preparing a new generation of doctors; and leading
improvements to health care quality and safety.
"Do we need to free ourselves much more aggressively
from perceived conflicts of interest with industry, and
will that be enough to preserve the public trust in
medicine?" Kirch asked in his address. "This question is
fundamental to our institutions and our daily work."
Several academic medical institutions and professional
groups discussed ways of avoiding conflicts of interest in
medical education and research, while leaving beneficial
business relationships intact.
"Industry wouldn't be spending tens of billions of
dollars on promotion if it didn't work," said Arthur S.
Levine, M.D., who as University of Pittsburgh senior
vice chancellor for health sciences and dean of the
University of Pittsburgh School of Medicine has helped
create one of the nation's most comprehensive conflictof-
interest policies for the University of Pittsburgh
Medical Center. "[Academic medicine has] not built an
effective firewall between academia and
industry...There's a good way to do it, and a bad way to
do it."
With the presidential election on everyone's mind, many
conversations turned to the nation's health care system.
Karen Davis, Ph.D., president of The Commonwealth
Fund, a health care research foundation, provided a
framework for how she believed the system could reduce
costs while improving health outcomes. Davis, who
delivered the meeting's John A.D. Cooper Lecture, said
that health IT, financial changes such as episode-of-care
payments, and more initiatives to raise the quality of
care (as well as studies on the effectiveness of those
initiatives) could lead to improvements. She named
academic medical centers she said were making progress
in these and other areas, and echoed the message of
Kirch and Koppel by encouraging medical schools and
teaching hospitals to "play a leading role" in health care
reform.
"There's no alternative to seizing the day," Davis said.
"Academic medicine has the potential to show us the
way, and make the United States the new model of
health care for other nations."
In the Jordan J. Cohen Lecture, Madeline H. Schmitt,
Ph.D., professor emeritus at the University of Rochester
School of Nursing, said that interprofessional
education—and, by extension, a future generation of
physicians that work more in concert with other
providers—can improve health care delivery and ease
the impact of a widely predicted physician shortage,
particularly among primary care specialties.
"Evidence is rapidly emerging that links teamwork to
improvements in patient care," Schmitt said, "but this
work is only now getting off the ground."
Schmitt recommended that all health professions jointly
develop an "ethical framework" for health care delivery,
and that medical students learn about other health
professions.
In his address to the membership, AAMC Chair Robert
J. Desnick, Ph.D., M.D., professor and chair of the
Department of Genetics and Genomic Sciences at the
Mount Sinai School of Medicine and physician-in-chief
of the Department of Medical Genetics and Genomics at
The Mount Sinai Hospital, said that genomic medicine
could affect the future landscape of medicine.
"Genome-based medicine will be the medicine of the
21st century," Desnick said. "We need to teach it, we
need to be comfortable with it, and our patients will
benefit from it."
The 2008 AAMC Annual Meeting took place Oct. 31–Nov. 5 in San Antonio, Texas.
—By Scott Harris
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