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A Word From the President: One Step Forward, Two Steps Back—Time to Take Action

AAMC Reporter: March 2015

In January, I had the privilege of going to the White House for a preview of the new Precision Medicine Initiative, first announced in President Obama’s State of the Union address. Precision medicine is a field that has the potential to transform the way we diagnose and care for patients with critical illnesses. We at the AAMC were pleased to see funding for the new initiative included in the president’s proposed budget, issued in early February. The initiative was just one part of an almost $1 billion proposed increase to the National Institutes of Health (NIH) funding, an investment that, for the first time since 2004, would at least bring medical research funding in sync with the rate of biomedical inflation.

When the budget was announced, the AAMC issued a press release titled “President’s Proposed Budget Would Be One Step Forward, Two Steps Back for America’s Patients.” My colleagues and I felt conflicted about how to respond to the president’s budget proposal. While we welcome the administration’s proposed increase to NIH funding and appreciate their recognition of the value of funding medical research, the budget also proposes $16 billion in cuts to programs that support complex patient care and physician training at teaching hospitals. These funding cuts would negatively affect the core mission areas of academic medicine, with the potential to force teaching hospitals to cut vital services and reduce the number of residency positions they support. If implemented, these cuts would have a disastrous impact on the institutions that are on the front lines in times of crisis, such as the Boston Marathon bombing and last fall’s Ebola scare.

The reduction in funding would disrupt not only the educational and patient care missions of teaching hospitals, but also would sharply undercut the same research mission that the administration seeks to bolster with its proposed increase to NIH funding. Though more than half of the funding NIH allocates for external research is awarded to researchers at medical schools and teaching hospitals, that funding is still not enough to cover all of the costs of the medical research that takes place at our institutions. Academic medical centers spend billions of dollars out of their own budgets each year to make up for shortfalls in research funding, including investments in establishing or refitting new laboratories, faculty salaries, and institutionally funded research. The proposed 10 percent cut to Medicare support for physician training and complex patient care would drastically reduce the ability of our institutions to fulfill their medical research missions, even when taking the proposed additional funding for NIH into account. Our three mission areas are deeply intertwined, and we cannot have a healthy research enterprise with severe funding cuts to clinical care and physician training.

We fully understand the fiscal realities of the debt, the deficit, and other issues confronting the president and Congress, but we must speak up when something threatens to destabilize the academic medical centers upon which our nation depends. In that regard, the AAMC will continue to be deeply engaged in discussions with policymakers about whatever final form this budget takes. We will encourage the progress in funding for medical research, while working to prevent the kinds of destabilizing cuts that this budget proposes.

It is not enough, however, for the AAMC and our member institutions to advocate for our interests at the White House and on Capitol Hill. Each and every member of our community needs to be more engaged in the national conversation around health care and research costs—the future vitality of academic medicine depends on it. To that end, the AAMC has developed a new initiative, with the aim of involving the individuals at the core of academic medicine in advocating for our most central issues. AAMC Action is an online advocacy initiative with the goal of building a grassroots “army” of aspiring doctors, medical students, residents, and other stakeholders. This grassroots community will be the foundation for mobilizations to advance academic medicine’s major advocacy objectives, empowered to drive action around the major legislative goals of the academic medicine community.

Launched in October, the AAMC Action community currently has 153,000 members. With an initial campaign focused on expanding support for graduate medical education and lifting the cap on congressional funding for residency positions, thousands already have participated in outreach actions, such as adding their names to a list of supporters for expanding our country’s investment in GME and signing thank-you letters to congressional champions for expanded GME funding. AAMC Action also recently released a graphic novel-style video as part of the American Doctor Shortage campaign, which can be viewed at www.thedoctorshortage.com. The initial campaign is focused around GME, but if it succeeds as we hope, we will explore engaging the grassroots community around other key issues, including expanded NIH research funding. I invite you to sign up at aamcaction.org to join us in this effort.

Academic medicine is on the ground in communities across the length and breadth of this country. The strength of our community is in our people: our doctors, learners, and staff are on the front lines when we need them most, whether responding to a crisis, discovering cures and novel treatments, or caring for patients with complex and critical needs. One out of every 40 wage earners—3.5 million Americans—owes his or her job to an academic medical center. When we talk about engaging our grassroots, we are referring to 148,000 faculty members, 83,000 medical students, 115,000 resident physicians, and nearly 2 million employees nationwide. A healthy enterprise of academic medicine is central to a healthy, prosperous, and resilient nation. At 3.5 million strong, when we raise our voices together, we will be heard.

Darrell G. Kirch, MD

Darrell G. Kirch, MD


"Each and every member of our community needs to be more engaged in the national conversation around health care and research costs—the future vitality of academic medicine depends on it."