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A Word from the President: Are We Meeting the Public’s Expectations?

AAMC President and CEO, Darrell G. Kirch, M.D.

Many of us have had the experience of flying somewhere and having our seatmate ask, “So, what do you do?” Frequently, we find that our response prompts a story about that individual’s experience with the health care system. Sometimes, these stories are tales of wonder but, more often than any of us would like, they are tales of woe. While these anecdotes give us valuable feedback from the public, they do not yield the data we need to answer the question, “Are we meeting the public’s expectations?”

To monitor public perceptions of medical schools and teaching hospitals and to probe opinions on specific issues related to medical education, patient care, and medical research, the AAMC has commissioned opinion research on a regular basis since 1996. Our most recent study gives us a sense of how we are viewed by the public and the expectations that the public and policy leaders have for us in fulfilling our missions following the enactment of health care reform.

AAMC members can now access detailed results of this research on our website, www.aamc.org/data/public_opinion_research (member login required). In this column, I want to focus on how these results support the changes we are trying to make in many areas and point to the path we need to pursue in others.

The good news is that medical schools and teaching hospitals have enjoyed positive and stable levels of public support since we began tracking this information in 1996. Voters who have been patients in teaching hospitals tend to have slightly more favorable opinions of our member institutions than voters who have not had personal contact with a teaching hospital. Voters also understand the importance of medical schools and teaching hospitals to local economies. When asked what benefits medical schools and teaching hospitals bring to communities, opinion and community leaders say they help drive innovation through research, bring top doctors and prestige to the communities in which they are located, and play an important role in providing health care for the poor and uninsured.

When it comes to our medical education mission, eight of 10 voters surveyed said that medical schools do an “excellent” or “good” job educating doctors about new medical knowledge. But there was room for improvement, with one-third of voters surveyed saying that we only do a “fair” or “poor” job of teaching doctors good bedside manner.

Clearly, teaching these skills in our curriculum can only take us so far. We also must examine who we admit to medical school and the criteria we use to assess applicants. That is why, in our current review of the MCAT® exam and other admissions tools, we are exploring ways to assess the personal characteristics of aspiring doctors to identify those who have not only the intellectual rigor and scientific foundation we expect, but also the personal qualities to be both outstanding clinicians and compassionate, caring physicians. Diversity is a driver of excellence, and this work will combine to advance the holistic review of medical school applicants.

Turning to our patient care mission, teaching hospitals significantly outperform other hospitals when it comes to innovation, according the voters we surveyed. They believe that these institutions do an excellent job of conducting research to find new treatments and cures, developing and providing access to new medical technologies, and improving the overall quality of health care.

But voters identified several areas where we could improve, including reducing medical errors, decreasing health care costs, increasing access to care, and helping to control patients’ out-of-pocket costs.

The health care policy leaders we interviewed for this research expanded upon the areas for improvement. They would like to see medical schools and teaching hospitals lead health care redesign. They want us to provide care more cost effectively and to develop new models of care. And perhaps most important, they want us to be the ones that institutionalize these changes first, while maintaining our commitment to research and discovery.

Implementing the Healthcare Innovation Zone (HIZ) concept—which the AAMC helped develop and which was included in the new health care reform law as one of the models to test innovative approaches to high-quality, lower-cost care—offers one path to achieving many of these goals. I am gratified that a number of our members are actively exploring the establishment of HIZ pilots that would bring their academic medical centers together in partnerships with local health care providers to care for patients in a specific area.

Other ways our community is working together to improve performance, make care safer, and provide care more cost effectively include our Integrating Quality initiative; our effort to understand and reduce unnecessary variations in care; and our focus on creating cultures of safety through proven protocols, comparative effectiveness research, and the incorporation of the lessons learned into the education of new doctors.

Central to the many changes that will be required to improve the health care system is a fundamental shift in the culture of academic medicine to one that is more collaborative, non-hierarchical, and team-based. Faculty Forward, the AAMC’s first step in our long-term plan to increase our talent management and leadership development programming for institutional and faculty leaders, is a valuable tool that is helping AAMC members better understand their cultures as well as suggest the steps they must take to shift their cultures to better achieve their missions.

With a long and proud history as hubs of innovation, medical schools and teaching hospitals have set the standard of care that has transformed the practice of medicine and improved health. Now, the public and policymakers expect us to apply our considerable skills and knowledge to leading the change that must occur in our health care system. I believe—as I know so many of you do as well—that we can and must continue our legacy of innovation and rise to meet these expectations for better doctors, better care, and better value for our heath care dollar.

Darrell G. Kirch, M.D.AAMC President and CEO