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A Word from the President: Realizing Just How Much We Have in Common

AAMC Reporter: July 2011

AAMC President and CEO, Darrell G. Kirch, M.D. There is a saying in academic medicine, “If you’ve seen one academic medical center, you’ve seen one academic medical center.” But as I visited with our members and constituents in nearly 50 meetings so far this year, I was struck by the remarkable symmetry in the challenges and issues with which our community is grappling and just how much we in academic medicine have in common.

The first issue on everyone’s mind is how to fund our missions in a climate of ongoing fiscal austerity. In education, the most recent report by the State Higher Education Executive Officers group shows that state and local support for higher education fell 0.7 percent between 2009 and 2010 and that state revenues are declining at an unprecedented rate. In fact, the decline in public support for education would have been much steeper without the American Recovery and Reinvestment Act. At the federal level, the Obama administration’s budget for FY 2012 proposes eliminating support for the Children’s Hospitals Graduate Medical Education (GME) Payment Program, the president’s fiscal commission proposes a two-thirds reduction in Medicare support for GME, and the new Medicare program envisioned by House Budget Committee Chairman Paul Ryan (R-Wis.) does not include any funding streams for GME. States are considering (or have already implemented) major reductions in spending on Medicaid and other health programs as they struggle to balance annual budgets during a time of declining state revenues. Research funding is a continuing challenge, with FY 2011 National Institutes of Health funding cut $320 million over 2010 levels. The outlook for the next several years is equally daunting as negotiations for reducing the federal budget deficit focus on significant, sustained cuts in both discretionary and mandatory spending. Clearly, a different approach will be needed for our institutions to continue to meet our missions in the face of these financial constraints.

Second, we are all grappling with the challenge of how best to gain and preserve public trust and support of our work as the delivery system changes rapidly, millions gain access to health insurance, and the baby boom generation ages and enters the Medicare program in record numbers. Because we provide the public goods of research, patient care, and the education of tomorrow’s doctors, it is up to us to set and maintain the highest standards for the quality and safety of patient care. With nearly one in three physicians set to retire during the next 10 years, we must work to ensure that projected physician shortages do not impede access to timely medical care and be attuned to any erosion of the public’s trust in the health care system if important safety net programs are eliminated due to federal budget cuts. Further, in this time of tremendous financial constraint, we must be more vigilant than ever in managing our relationships with industry and ensure that these are principled partnerships based on the highest standards of professionalism.

A third challenge we share is defining our role in an evolving health care delivery system. I have said in many venues that academic medicine is in a unique position to lead the change our delivery system requires and create “true” health care reform. After all, AAMC-member institutions provide 20 percent of the nation’s hospital care and are the places where new cures are discovered and where the nation’s health care providers receive training. It is imperative that we clearly communicate our special leadership position at the intersection of these areas to policymakers and to the public. We will have to articulate which components of the future health system have our support as well as the role we play in designing and implementing new models of care delivery.

Finally, we have in common a desire for a seamless continuum of medical education, supported by changes in both learning and assessment. Educating the physician of the future requires the integration of quality and safety instruction and practice into the curriculum of our medical schools, along with a strong emphasis on educating interprofessional health care teams. Achieving this integration will include modifying current methods of assessment so that students are evaluated on the level of competency they demonstrate in target areas, rather than on the number of facts they learn. Since imparting new skills to students will require a new kind of teaching, we also must foster active partnerships with faculty members on the frontlines of education and help them develop the skills needed to train our students for the new health care environment in which they will practice.

In recognition of these common challenges that “keep our members up at night,” we will implement special programming at the 2011 Annual Meeting in Denver where we can gather to work through some of these issues. Called the “transformation arc,” the meeting will offer three sessions devoted to creating and sustaining change. Each of these sessions will focus on change of a different magnitude, from transforming our world, to transforming our communities, right down to transforming ourselves. Please check in with our website for more details.

Being united in facing our common challenges is only a first step. While all sectors of our community share these concerns, it will take a diversity of perspectives to reach the desired state we all envision: a high-quality health care system; competent, patient-centered physicians; and a research enterprise that brings science to health care delivery. In synthesizing what I have heard from our members and other stakeholders, I am more confident than ever that together we can create a future that inspires. As I indicated in my November 2010 column, the AAMC is poised to become a more engaged partner in addressing the myriad challenges facing our community and continuing to provide leadership for academic medicine to help speed the transformational changes that will create a better and healthier future for us all.

Darrell G. Kirch, M.D.

AAMC President and CEO