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    10 wishes for the new year

    From more affordable health care to greater humanism in medical education, AAMC President and CEO Darrell G. Kirch, MD, outlines his aspirations for 2019.


    With a new year comes reflection about where we are and where we aspire to be. In 2019, I see tremendous potential for academic medicine to achieve even greater things.

    Over the last few years, many of our institutions have become anchors in their communities. They identified gaps in community health and provided services beyond their walls to aid victims of gun violence, care for the homeless, bring health services to underserved urban and rural areas, and help stem the opioid epidemic. Building on that, if I could have 10 wishes for the coming year, I would wish that ...

    1. Academic medicine continues to strive to use our values, skills, and resources to improve society as a whole.
      I believe that our institutions, rich in diversity and deeply committed to service, can lead this country by example. By modeling the world we want to see — one with compassion and civility, where everyone is welcome — medical schools and teaching hospitals can inspire the public and other institutions around them.
    2. Humanism comes to the forefront in medical education.
      Let the bold experiments and exciting innovations in teaching and learning flourish at our medical schools. Let the competency-based learning and assessment models thrive. At the same time, though, I hope that educators will continue to affirm the role of humanism as the core of our profession. Instilling empathy, cultural sensitivity, and altruism in our students and residents must be a priority.
    3. Health care becomes affordable and accessible to all.
      In our work as physicians, simply doing no harm is not sufficient while health outcomes in this country are influenced by income, skin color, gender identity, and zip code. Ensuring that every American has access to adequate, affordable health insurance coverage is our ethical responsibility. We need to dig deeper to address the social determinants of health that contribute to injustice and poor health outcomes among the nation’s most vulnerable.
    4. Health care spending continues the shift from volume to value.
      The United States spends $3.7 trillion dollars per year on health care. And this spending pattern is projected to rise faster than the Gross Domestic Product, up to 19.7% by 2026. For a sustainable future, we must increase our efforts to bend this cost curve. Our teaching hospitals and academic physicians have made great headway on implementing value-based care and population health models. I want us to continue on this path to reduce health care costs in 2019 while also working with policymakers so they recognize the critical role teaching hospitals and their physician faculty play in caring for their communities.
    5. We receive another robust increase in federal support for biomedical research.
      I began my career as a researcher at the National Institutes of Health (NIH) and continue to be inspired by the extraordinary scientific advancements by physicians and scientists in academic medicine which have been made possible by funding from the agency. Since 2015, Congress has provided four consecutive years of substantial increases to the NIH that have expanded its budget by a total of $9 billion, with much of it spent at our institutions. This boost has helped the NIH start to recover capacity lost to effectively flat funding for over a decade. Yet, we still remain 9% below the historical inflation-adjusted peak for program dollars in FY 2003.
    6. Our institutions are models of diversity and inclusion.
      Teaching hospitals have made real progress in diversifying their workforce. However, we still face challenges of unconscious and conscious bias, as well as lapses of civility and respect. For 2019, my wish is that we rise to a place of zero tolerance and serve as a voice for all who are excluded or vulnerable. Key to this will be intensifying our efforts to increase under-represented minorities (especially black male and Native American physicians) in our ranks, and by promoting more women and minorities to leadership positions at our institutions.
    7. Congress gives bipartisan support to addressing key challenges for academic medicine.
      I have several wishes for Congress this year:
      • Address the physician shortage by lifting the 21-year-old Medicare cap on Graduate Medical Education funding.
      • Continue support for Direct and Indirect Graduate Medical Education payments to teaching hospitals.
      • Postpone or repeal scheduled cuts to Medicaid Disproportionate Share Hospital payments.
      • Protect the 340B Drug Pricing Program.
      • Rescind the policy reducing Medicare reimbursements to off-campus hospital outpatient departments.
      • Reauthorize the Patient-Centered Outcomes Research Institute and its related trust fund.
    8. We end the stigma surrounding physicians seeking mental health care.
      We cannot turn our backs on the extent of physician burnout and the related depression, anxiety, and suicides that have been longstanding problems in the medical profession. I believe that stigma is the biggest enemy standing in the way of physician well-being and resilience. Our institutions must encourage physicians to seek counseling and support without negative consequences. And let each of us have the courage to ask for help if we need it and urge our colleagues to do so when professional strains threaten to derail us.
    9. Academic medicine is a beacon of hope for the nation.
      Academic medicine is the solution, not the problem, as we try to better our health care system. There is no one more capable than the collective minds and hearts at our institutions to raise health care to the next level in this country. To realize this vision, we need to think interdependently and across disciplines and work in concert with every stakeholder in health care. I am more hopeful than ever that we can meet these challenges with our strong personal resolve, growing cadre of transformational leaders, and unparalleled expertise in a full array of disciplines.
    10. Lastly, as I pass on the torch in July, I wish that AAMC President-Elect David J. Skorton, MD, enjoys the same warm and enthusiastic welcome that I received when I started this job 13 years ago.
      I hope you all come to know him as the principled, exceptional leader that I have appreciated working with over the years.

    May the AAMC continue to shape and influence the future of health care with wisdom, vision, compassion, and justice in the coming year and for many more.