AAMC President and CEO David J. Skorton, MD, and AAMC Board of Directors Chair Lilly Marks today called on the leaders of the nation’s medical schools and teaching hospitals to change how they carry out their missions in order to confront social and economic challenges that threaten their ability to deliver the best care to people in need.
“The status quo is not working,” Skorton told a record crowd of more than 4,800 attendees gathered at Learn Serve Lead 2019: The AAMC Annual Meeting, in Phoenix, Ariz.
In his first address to the academic medicine community since taking the helm of the AAMC in July 2019, Skorton praised his colleagues in medicine and academia for delivering the best care possible, developing a generation of doctors and medical professionals, and making “incredible strides in medical research and the battle against disease.”
Despite those gains, he said, “the system still fails for so many” — from medical students overburdened by debt to patients who lack access to affordable, quality care to physicians frustrated by their loss of autonomy and the burdens of electronic health records.
“We serve our patients well,” Skorton said, “but we need to step up and lead beyond the boundaries of our institutions to improve the nation’s health.”
He focused on three challenges that require bold new approaches: diversity, equity, and inclusion in medicine; mental health and substance use disorders, and the exorbitant cost of health care in America.
While the country has grown more ethnically diverse, Skorton said, that demographic change is not reflected in the health care workforce. He cited statistics showing how black men as well as Latinx, American Indian, and Alaska Native populations are especially underrepresented in the medical field. That’s not just unfair, he noted; it also undermines the effectiveness of the entire health care system.
“To bridge the enormous disparities in health within communities, we must first confront the racial gaps in our own community of academic medicine and foster more diverse and inclusive environments in our institutions,” Skorton said.
Regarding mental health and substance abuse, Skorton cited three factors behind alarming rates of mental illness, suicide, and substance use disorders: the stigma of seeking treatment, inadequate access to trained mental health professionals, and inadequate insurance coverage for mental health care.
"We in the medical community need to do more to help address America’s struggles with mental illness and substance use disorders, starting with our own institutions,” he said.
Skorton cited the stress, depression, and burnout that afflict college students as well as medical professionals. “Burnout and depression constitute a growing crisis in the medical field, particularly among learners and their mentors,” he said.
He urged academic and medical leaders to, among other things, reduce the stigma of asking for help (for example, by sharing their own stories of struggle); improve education about mental health and substance use disorders across all health professions; work with public health colleagues and local partners to identify opportunities for intervention; and continue working with insurers and pharmaceutical companies to eliminate structural barriers to access and coverage.
“We serve our patients well, but we need to step up and lead beyond the boundaries of our institutions to improve the nation’s health.”
David Skorton, MD, AAMC President and CEO
Turning to the issue of rising health care costs, Skorton said those costs “might be tolerable if Americans were receiving more and better care than people in other countries and had better outcomes. But the opposite is often true.”
Skorton then discussed several strategies to counter that trend, such as reducing volume-based incentives for services and increasing incentives for quality. A cardiologist, he challenged his fellow doctors to think, “Do we really need to perform that extra echo, lab work, or other test?”
He also advocated for accelerating the replacement of the fee-for-service model with physician salaries, incorporating population health approaches into care models, and improving the use of interpersonal teams for patient care.
Academic medicine must move forward on these and other ideas now, he said, rather than allow forces beyond the health professions to dictate the course.
“Who better to challenge the status quo and create the change we urgently need than the people in this room and our colleagues in academic medicine?” he asked. “Who better than our learners?”
Skorton pledged that the AAMC will help to lead those changes.
“Academic medicine can play a central role by acting as a convener — bringing together insurers, pharmaceutical companies, and leaders from the broader medical community, as well as patients, families, and community members, to devise the solutions that patients clearly need. And I intend to convene those conversations.”
“Together, we — all of us — wrote the book,” he said. “Now let’s rewrite it and add some chapters.”
Lilly Marks, vice president for health affairs for the University of Colorado Anschutz Medical Campus and chair of the AAMC Board of Directors, also rallied those at the Leadership Plenary to think and act differently in order to overcome forces that threaten the core of academic medicine.
Marks said demographic, economic, political, and market forces are reshaping the academic medicine landscape and converging “to challenge, and potentially erode” the core missions of education, research, and clinical care that unify its institutions.
“Virtually all our institutions now face the enormous challenge of funding and delivering these public goods in an era when society is questioning the value of higher education, the veracity of science, and the cost and value of the health care services we provide,” Marks said.
She cited significant reductions in state and institutional support for medical school education, which cannot be overcome by continually increasing tuition or squeezing more revenue from clinical enterprises.
“We have a duty to ensure that the integration of the clinical enterprise does not lead to the disintegration of the academic enterprise. We must ensure that our necessary efforts to evolve do not inadvertently compromise the essence of who we are and the unique role we play in American medicine.”
Lilly Marks, AAMC Board of Directors
These and other challenges reflect not a trend, she observed, but the “new normal” in health care, which is defined by the “inexorable rise in health care costs” triggered by the mounting pressures of an aging society; the impact of unaddressed social determinants of health; and the “enormous power, profits, and leverage of a market-driven and rapidly consolidating health care industry.”
“America has created the most expensive health care system in the world — a system that we, the richest country in the world, can no longer afford,” Marks said.
She warned, however, that institutional responses must not disrupt the collaborative relationship between their academic and medical enterprises. For example, she said that while many schools have placed more priority on growing the clinical enterprise, she sees the “locus of power” within those schools shifting from the academic institution toward the clinical side.
“Our ability to fuse the latest learning and medical discovery with the clinical care we provide is the defining characteristic of academic medicine,” Marks said. “It is the secret sauce that differentiates us from other clinical providers.”
She called for a new mindset and a more holistic approach to change.
“We have a duty to ensure that the integration of the clinical enterprise does not lead to the disintegration of the academic enterprise,” she said. “We must ensure that our necessary efforts to evolve do not inadvertently compromise the essence of who we are and the unique role we play in American medicine.”
Success will require institutions to view themselves not as victims of external forces they can’t control but as drivers of their fates. That will require leaders to implement proactive, big-picture strategies rather than respond to each challenge piecemeal.
“We can choose to be the architects of change, responding boldly, resolute in the belief that our actions will make a difference,” she said. “It is my hope that we will choose to meet this moment with leadership, creativity, collaboration, and courage.”