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New Year, New Challenges

January 19, 2011

Changes in the political landscape and the nation’s fiscal realities are sure to make for some tough choices in 2011. One more tough reality is that the new year brings a milestone in American demographics—on January 1, over 10,000 Baby Boomers turned 65…and that trend will continue every day for the next 19 years. Though many communities already are experiencing shortages of physicians, the aging U.S. population will make unprecedented demands on the health care system over the next two decades, even as we renew attempts to invest in prevention and primary care.

I was struck by the recent article in the New York Times by an internal medicine resident at my alma mater, the University of California, San Francisco, describing one patient’s challenge to access timely surgical services only to cost the health care system—and his own health—far more than the original procedure.

That’s why I was particularly alarmed to see that President Obama’s bipartisan National Commission on Fiscal Responsibility and Reform (NCFRR) had included in its recommendations a two-thirds reduction in support for physician training and the patient care missions of teaching hospitals. Last month, the bipartisan Hope Street Group  reported that the nation will face a shortage of almost 100,000 doctors in the next 10 years; cuts to Medicare GME would reduce the number of doctors and reduce vital services such as trauma and burn care. Not to mention that the NCFRR proposal also would lead to an immediate loss of tens of thousands of jobs in health care, from custodial staff to trauma nurses. A poor treatment plan for a grave diagnosis.

Medical Schools Moving the Medical Home Forward

Improving efficiency in health care is essential, and medical schools and teaching hospitals are looking to find solutions in ways that change clinical care and education while still moving cures from bench to bedside.

In a new report from the AAMC, my colleagues highlight several institutions that have moved the medical home concept into practice and into physician education and training. While medical schools and teaching hospitals have long been known for developing vaccines and new technologies and caring for the most ill and vulnerable patients, there is a growing recognition that a healthy community will require a healthy system of primary care and a commitment to community-based medicine.

Over the last few weeks, I’ve spoken with leaders from several institutions that also have created programs to improve patient safety and to take what we know works in health care and translate those lessons into everyday practice. Many of these examples come from institutions that are best known for their contributions to biomedical research, but which have also managed to become community leaders in improving health care for patients.

Making the Nation’s Health a Budget Priority

Four months into FY 2011, federal agencies still don't know what their budgets for the current fiscal year will be—and they may not know until the year is half over. Unfortunately, this delay in the appropriations process has become an annual exercise; this year it is especially troubling because of threats to slash domestic discretionary spending to FY 2008 levels. For medical schools and teaching hospitals, this would have a devastating effect on initiatives to improve the nation's health—all for a negligible impact on the deficit.

Over the years, "boom and bust" funding cycles for the National Institutes of Health have proven counterproductive, as the multi-year nature of medical research—and medical progress—requires sustainable, predictable funding growth. The long-term nature of health professions training also necessitates consistent, reliable support, but funding for HRSA's health professions training programs has been erratic. Fiscal responsibility is a goal we all share, but it requires just as much commitment to wise investment as divestment (and a willingness to discuss ways to raise revenues for important policies).

Similarly, public health funding has oscillated over time, with funding waning just when people rely on such services the most: in economically challenging times. The Prevention and Public Health Fund was created last year as a way to ensure that funding is reserved each year for those activities that help keep people healthy. It's important to prioritize prevention and the nation's health in any economic climate, and it's also the fiscally responsible thing to do.

AAMC on the Radio

Those of you inside the Beltway may have heard AAMC radio ads on WAMU and WTOP. Supporting this campaign is a new Web page noting the incredible response of University of Arizona Medical Center to the Tucson shootings as well as highlighting information on ways medical schools and teaching hospitals are hubs of innovation transforming the practice of medicine every day.

On a Personal Note

The recent news coverage of the tragic shootings in Arizona has reminded me of why I am so lucky to do what I do. It's been a long time since I've staffed a trauma center or emergency department, but the events of this month and the actions of the health professionals at University Medical Center serve as a stark reminder of the unique responsibilities that teaching hospitals face every day. An article in the New York Times written one week after the tragedy captures what happens on a very personal level when disaster strikes.

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About the Author

Atul Grover, MD, PhD AAMC Executive Vice President

Atul Grover, MD, PhD
AAMC Executive Vice President

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For More Information

Peters Willson
Sr. Specialist, Policy and Constituency Issues
Telephone: 202-862-6029