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A Word From the President: A Super Failure and a Supreme Decision

AAMC Reporter: December 2011

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

When the “super committee” announced its failure to reach a deficit-reduction agreement late last month, you could almost hear the collective groan around the nation. Immediately, it seemed that every news outlet reveled in publishing headlines mocking the “super failure” of our nation’s political system to make the difficult choices that will put our nation back on a sustainable fiscal track.

The super committee’s inability to save the nation $1.2 trillion over 10 years means that automatic, across-the-board cuts are scheduled to take effect January 2013. At this point, it appears that government agencies will have little discretion in how they implement the cuts. Under the current provisions, they must simply apply what the Congressional Budget Office estimates would be a nearly 8 percent reduction to all non-defense programs in FY 2013,including many essential to the missions of medical schools and teaching hospitals. Certain programs such as Social Security and Medicaid are exempted from the cuts, and Medicare provider payments would be cut by a maximum of 2 percent. It appears that in the worst case scenario, AAMC members are facing Medicare provider cuts of at least $1 billion a year between FY2013 and FY2021. The National Institutes of Health would be cut by as much as $2.3 billion in the first year, and Title VII programs, the National Health Service Corps, and other programs important to our work also would be significantly affected. Predictably, talk of “unwinding” the automatic cuts already has begun, meaning everything will be on the table again next year for deficit reduction.

Our community can be very proud of the work we did this year to let Congress know that cutting funding for doctor training at a time when we face a shortage of more than 90,000 doctors by 2020 would have serious consequences for the nation’s health. Your meetings with legislators and congressional staff, calls, letters, and opinion editorials temporarily averted cuts to graduate medical education and let legislators know that these cuts will hinder our ability to engage in the kind of innovation that could dramatically change our delivery system for the better.

But our work is far from done. We must continue to educate policymakers and the public that the missions of medical schools and teaching hospitals are vital investments in our nation’s future, as well as key economic engines in local communities. According to a new economic impact analysis conducted for the AAMC last month by Tripp Umbach, federal- and state-funded research conducted at medical schools and teaching hospitals in 2009 added nearly $45 billion to the economy, supporting nearly 300,000 (or 1 in 500) U.S. jobs. In addition, despite a dismal national unemployment rate between 2007 and 2010, total hospital employment in the United States increased by 4 percent. But two Tripp Umbach analyses published earlier this year show that funding cuts to GME would trigger a loss of between 20,000 and 73,000 jobs at AAMC-member hospitals, and cause up to $10 billion in annual losses for the economy.

Adding to the challenges we face on the fiscal front are serious legal challenges to the Affordable Care Act, with the Supreme Court scheduled to consider the constitutionality of the new health care reform law in March. At this point, we can only guess what the Court will decide, but among the key areas it will address are whether provisions, such as the individual mandate to acquire health insurance or the Medicaid coverage expansion, are constitutional. If the individual mandate is found to be unconstitutional, the Court is likely to decide whether the rest of the law can stand absent the mandate (in other words, is the mandate “severable”) or whether the entire law must be struck down.

If there is one lesson this year’s political wrangling should teach us, it is that academic medicine cannot wait for Washington to reach consensus about health care reforms. It is up to us to make the changes required to improve the nation’s health, especially in the current fiscal environment.

I am gratified, however, to see signs of change all around us. The AAMC’s first Readiness for Reform Health Care Innovation Challenge, which attracted 45 submissions, shined a light on your efforts to effect change. Designed to recognize programs at AAMC-member institutions that transform health care delivery and integrate education and research, this year’s challenge recognized three institutions for innovative residency training efforts, a telemedicine program, and an inpatient diabetes initiative.

The University of Cincinnati College of Medicine was recognized for its year-long ambulatory resident training experience in internal medicine that gives resident physicians experience in a primary care, group-practice environment while enhancing patient care through a patient-centered medical home. Another winner, the Arizona Health Sciences Center, is reducing disparities in health care access between urban and rural populations through the use of telemedicine. Through a network of more than 100 health services facilities that provide more than 60 clinical subspecialty services and 1 million consultations, they are reducing turn-around times for diagnostic procedures and reducing costs. The third winner, the Medical University of South Carolina, standardized care across all medical and surgical units for its large diabetes patient population by creating an individualized plan for each patient and providing education to better self-manage the disease, among other features. You can learn more about the innovation challenge and this year’s winners at the AAMC’s iCollaborative resource at

So despite the gridlock on Capitol Hill, and the uncertainty of what will transpire when the Supreme Court delivers its decision next year, medical schools and teaching hospitals are moving ahead, leveraging our unique position at the intersection of research, education, and patient care, and driving the innovation that will improve the health of all.

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