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A Word From the President: Looking Back and Moving Forward: Council of Teaching Hospitals Turns 50

AAMC Reporter: September 2015

This fall, the AAMC celebrates the 50th anniversary of the Council of Teaching Hospitals and Health Systems (COTH). Before COTH was formally established in 1965, the AAMC was known foremost as an organization for medical school deans. However, the need to increase the interconnectedness of medical schools and teaching hospitals was becoming increasingly apparent. In his groundbreaking 1965 report, Lowell Coggeshall, MD, suggested broadening the AAMC by forming councils comprising medical school and teaching hospital leaders. COTH was born from this vision, which involved elevating the association’s Medical School-Teaching Hospital Section, established in 1958, to full council status with a voting representative on the AAMC Executive Council. COTH is now one of three AAMC councils represented on the AAMC Board of Directors, and most of the nation’s major teaching hospitals are COTH members.

Creating a central role within the AAMC for teaching hospitals and health systems was essential to achieve academic representation across the continuum of medical education. Without this integration, medical education was at risk of becoming fragmented as health care became increasingly specialized. COTH, alongside the AAMC Council of Deans and the Council of Academic Societies (now the Council of Faculty and Academic Societies), set in motion an era that established the AAMC as an umbrella organization for medical school deans, faculty leaders, and teaching hospital leaders. As a result, the AAMC was able to focus on advancing academic medicine’s tripartite mission of education, clinical care, and medical research. Bringing CEOs and other institutional representatives from the nation’s teaching hospitals and health systems into a central role within the AAMC also made our community more effective in responding to the dramatic changes in health care over the past half-century—from the introduction of Medicare and Medicaid in 1965, to the passage of the Affordable Care Act and its transformative effect on our nation’s health care system.

Today we see medical schools’ strong bond with teaching hospitals and health systems reflected in how they partner to train and educate tomorrow’s physicians. These are the settings where medical students first observe surgery, assist in care, and examine a patient in an ambulatory care clinic. Academic medical centers offer vital opportunities for students, residents, and fellows to experience the entire clinical platform—from the campus hospital setting to associated surgery centers, outpatient clinics, ambulatory clinical centers, and more. These institutions, recognized for their innovative and revolutionary clinical practices, have been responsible for many “firsts,” including laparoscopic surgery, clinical trials that led to better treatments, and complex organ transplants.

Because of their size and nature, teaching hospitals and health systems support the entire spectrum of care, from primary care to every specialty and subspecialty. With so many care providers under one roof, these institutions can diagnose and treat patients with complex diseases or combinations of chronic or life-threatening illnesses. They provide Level I trauma centers, burn units, comprehensive cancer services, and pediatric intensive care—critical services often unavailable at other hospitals. In addition, they provide 23 percent of health care services to Medicare beneficiaries and 37 percent of all hospital-based charity care.

Beyond this national impact on health, teaching hospitals are anchors in their local communities and major economic drivers at the local, state, and national levels. They infuse billions of dollars into the economy through job creation, state tax revenues, and direct spending by out-of-state patients and their visitors. U.S. medical schools and teaching hospitals supported nearly 3.5 million jobs directly or indirectly in 2011, according to an economic impact analysis by the consulting firm Tripp Umbach.

By bringing together patient care, biomedical research, and medical education, teaching hospitals also are well positioned to develop innovative strategies to improve care quality and safety, lower costs, and expand access to more patients. For example, teaching hospitals have been leaders in the implementation of electronic health records and now lead the development of new payment models, such as bundled payments, that raise the level of care and create greater cost efficiency through a shift to a value-based care system.

Teaching hospitals also are piloting more effective ways to deliver health care. Alongside their mission to train new physicians, teaching hospitals train nurses, physician assistants, and other health care professionals in team-based approaches. As pioneers of telehealth, teaching hospitals are enhancing patient autonomy and increasing flexibility and access to care in rural and urban underserved communities, too. These initiatives will become more important as the nation faces an impending physician shortage.

Looking ahead, there are many challenges for our institutions. Improving health care access and lowering costs will remain an important task for teaching hospitals. The threat of ongoing funding cuts will continue to require teaching hospitals to find more efficient ways to serve their communities and patients. We need to identify and secure additional federal support for graduate medical education and physician training programs to ensure our nation has enough physicians for our growing aging population, too.

As COTH moves forward, teaching hospitals must continue to develop strategies and new delivery models to increase patient safety, expand price transparency, and promote insurance exchanges that meet patient needs. In addition, our institutions will work closely with the Centers for Medicare and Medicaid Services to integrate accountable care organizations, test new Medicaid models, and implement new regulations such as the two-midnight rule.

Academic medicine will continue to evolve with changes in health care. The formation of COTH was a landmark moment for academic medicine that helped transform the AAMC into a modern association. Two years after the establishment of COTH, the AAMC embraced another key suggestion from the Coggeshall Report—we moved our headquarters to Washington, D.C., ensuring the association and its member institutions would have a stronger voice in health care policy.

Today we celebrate COTH for bringing all corners of academic medicine together. This decision strengthened the continuum of medical education, raised the quality of our physicians, enhanced our ability to influence health policy, and, above all, improved the care of the patients we serve. We look forward to the next 50 years.

Darrell G. Kirch, MD

Darrell G. Kirch, MD