The first phase of the AAMC’s strategic planning process is the environmental scan.
The environmental scan is an analysis of the trends and forces shaping academic medicine, and the AAMC. The scan identified five main themes of large-scale change that present challenges and opportunities—now, and in the near future.
1. Macro/Societal Trends
The macro/societal view includes forces that will shape all institutions and aspects of society. This view can include economic, political, environmental, social, demographic, and technological trends.
U.S. demographics are profoundly affecting society and social policy.
- The nation continues to grow more racially, ethnically, and culturally diverse.
- The recent three-year downturn in life expectancy in the U.S. is the longest decline in a century and is marked by disparities based on race, class, income, geography, and education.
- Health care and biomedical research are dependent on international students, trainees, and professionals, yet overall documented immigration is declining. Proposed policy changes would remove protections for the grown children of undocumented families.
- By 2030, Americans age 65 and older will make up 21% of the U.S. population, up from 15% today.
- Supreme Court decisions on immigration, race-conscious admissions, DACA, reproductive rights, and other areas may be disruptive.
A technological revolution will change education, research, and clinical care.
Technological revolutions are occurring in five areas: gene editing, artificial intelligence (AI) and automation, quantum information science, brain-computer interfaces and augmented reality, and blockchain and cryptocurrencies.
- As precision medicine therapies and AI clinical decision support systems become more prevalent, the expectations of clinicians and the settings in which care is delivered will change.
- Such trends will require different skill sets from the ones physicians and researchers have now, with greater emphasis on data science, mathematics, statistics, and computational skills.
- Increasing use of technology may only heighten existing disparities and introduces new and more menacing security vulnerabilities.
Rising health care costs are unsustainable.
Controlling for inflation, health care spending per capita has increased from $1,700 in 1970 to more than $10,700 in 2018.
Policymakers, the press, and the public continue to express grave concerns about excessive costs and increasing doubts about value.
- Tomorrow’s patients and payers will increasingly demand access to care at lower cost and greater convenience.
- Corporate interests are increasingly entering the marketplace (e.g., Amazon Care), creating potential threats and opportunities for traditional health care providers and the public.
Globalization will have an increasing impact on academic medicine.
The core mission areas of academic medicine have become global. Research and discovery are conducted across international boundaries. U.S. health care systems are expanding their clinical care beyond U.S. borders.
Since 2015, almost 20% of academic physicians in the U.S. have been international medical graduates ― and among them, more than 15% of full professors have graduated from medical schools outside the U.S.
2. The Environment for Patients, Families, and Communities
There is growing recognition that patient, family, and community engagement is important for the overall improvement and transformation of the health care system.
The cost of access is too high, and deficits persist in access and coverage.
The cost of accessing health care remains out of reach for many Americans, particularly those in underserved and under-resourced communities and populations.
- Despite decades of attention, deficits in both access and coverage persist. This is especially true among people with the most severe socioeconomic challenges and in rural/frontier settings.
Health inequities are increasing; racism and bias are major factors.
Increasing health inequities are adversely affecting low-income communities, rural/frontier communities, racial and ethnic minorities, sexual and gender minorities, veterans, and people with disabilities, among other groups.
- A growing corpus of research shows that racism, bias, and segregation are major factors in health care inequities.
Health care institutions are not sufficiently diverse.
Recent research suggests teams that are more diverse are more effective.
- American health care, and particularly the leadership (including in academic health centers), remains insufficiently diverse.
Patient, family, and community perspectives and engagement contribute to innovation; partnerships with these groups are increasing across all academic medicine missions.
- Engagement and partnerships with patients, families, and communities can improve health equity, physician education, research, care experiences, quality, safety, and health outcomes.
- The number of meaningful partnerships in health care delivery and improvement is increasing among health care professionals, patients, families, and other caregivers.
Social risks and determinants of health cannot be ignored.
Patient-level health-related social needs (HRSNs) and community-level social determinants of health (SDOHs) are potent forces in health.
- Of the factors that affect Americans’ health, 60% are unrelated to health care or an individual’s behavior and genetics but are, rather, related to social determinants of health.
Gun violence, the maternal mortality rate of women of color, the opioid epidemic, and the lack of mental health parity are national crises.
- The rate of gun-related deaths, the maternal mortality rate of women of color, and the climbing number of daily opioid-related overdoses are examples of public health crises.
- Awareness of the role of the medical community in both perpetuating and addressing these issues is increasing throughout the nation.
- Substance use disorders and the rising rate of suicides have increased attention to and concern about the need for more work toward mental health parity.
Patients and families want access to medical records and interoperability.
The availability of medical information and patient records online has led to increasing demands for access to these records by patients and families (with the patient’s permission).
- The proliferation of electronic health record systems has increased the desire for interoperability among them.
3. The Environment of Academic Medicine and Health Care
This domain examines the most significant trends facing medical schools and teaching hospitals and health systems as well as the overall health care system.
Changing health care delivery systems is the new norm.
Hospitals, physicians, health care systems, and payers are seeking ways to provide better care, enhance access, improve population health, and lower costs.
- There is a slow and persistent shift of emphasis from volume-based care to value-based care.
- Health care is rapidly changing to provide services to patients in more convenient and innovative ways (e.g., walk-in clinics at CVS and recent efforts by Walmart, Apple, and Google).
- With these changes, mergers, acquisitions, and partnerships will continue to unfold and redefine the health care landscape.
Academic medicine remains dependent on financial resources generated by the clinical mission.
Patient care revenue is the primary financial resource for academic medicine.
- The cost of educating an MD student, concerns over tuition and fees, diminishing state support, and student debt are impacting the education mission.
- Challenges to the federal budget and the cost of infrastructure threaten the research mission.
- Concerns over the sustainability of the medical school business model are increasing.
- Many are wondering how to keep the “academic” in academic medical centers.
Changes and challenges are rampant in medical education.
- The clinical learning environment is a complex setting of interprofessional, team-based care.
- Learners face information overload, high debt, and stress related to the transition to residency.
- Burnout is ubiquitous in medical education, from learners to educators. Clinician-educators face challenging productivity expectations and a lack of connection to the academic mission.
- Questions persist about the preparation of learners to enter medical school and of physicians to enter residency and practice.
- The role of accreditors of UME programs, as regulators or catalysts for change, continues to be debated.
The health care workforce is not sufficiently large nor diverse.
- Recent workforce predictions indicate a shortage of 46,900 to 121,900 physicians by 2032.
- Over the past 30 years, the numbers of African American or black, American Indian or Alaska Native, and Latino students and individuals from economically disadvantaged communities entering medical school have only increased slightly for some groups and not at all for others.
Biomedical research and innovation need collaboration and advocacy.
- Institutions can no longer afford to “go it alone” in their research programs; collaboration among institutions is an important way to be more efficient and cost-effective.
- Training the next generation of researchers continues to be important, as does supporting early-career academics, particularly physician-scientists.
- The NIH needs the active support of the research community to persuade Congress of the value of conducting research as a way to improve care.
- Medical schools need to collaborate with their health care partners to show the value of research for the institution and the community.
Academic health centers are focusing on community vitality.
- Multiple challenges and opportunities are pushing academic health centers to increase their efforts in their local communities.
- The confluence of these factors and growing recognition that up to 60% of health outcomes are attributed to social determinants, such as housing, access to quality food and education, and employment, are catalyzing the centers to broaden their missions.
- Strategies of some AAMC-member institutions are already evolving from community engagement to community investment.
4. The Environment of Associations and Professional Organizations
This view examines the trends affecting nonprofits and membership associations.
Members are demanding associations deliver increasing value.
Associations need to focus on how they demonstrate and articulate value to their members.
- Association members may want personalized or tailored products and solutions, requiring associations to adapt existing one-size-fits-most approaches.
- Membership models will need to reflect members’ organizational structures, with benefits aligned with offerings.
- Our constituents expect the AAMC to work collaboratively with peer organizations in the spirit of engaging individuals more efficiently and effectively while achieving shared goals.
Successful engagement extends beyond membership.
Associations need to make connections with people and organizations beyond members and peer organizations.
- Issue-specific relationships may involve government, industry, communities, patient groups, and other associations.
- Members and constituents expect associations to work collaboratively and creatively across boundaries to achieve their missions.
Online communities are driving engagement and transforming organizations.
Online communities have become an effective tool for driving engagement and deepening connections among association members.
- These communities can improve participation in an association, allow more individuals to be seen and heard, enable participation without high registration and travel costs, and tangibly demonstrate membership value.
Associations are providing lifelong learning that is relevant, timely, and cost-effective.
The market for training and education has expanded because of the increasingly widespread expectation that health care professionals engage in life-long learning.
- Adult learners served by associations demand relevant, timely, and cost-effective programs targeted to specific audience needs.
Demographic shifts are driving a need for new communication models.
Attracting, engaging, and retaining a multigenerational workforce and membership base are among the greatest challenges facing associations today.
- Associations need to understand the motivations and information requirements of each segment of their constituency and target their programs and communications accordingly.
Associations are facing critical challenges in managing, exploiting, and securing data.
Forward-looking associations will make better use of existing data, leverage unstructured data sets to gain insights into members’ needs, and create tailored solutions for constituencies.
- Pressures to remain vigilant about protecting data will continue.
- The legal landscape for data privacy and individuals’ rights to control their personal data will evolve.
5. The Environment for the AAMC
This domain analyzes the AAMC’s internal operations, culture, and environment.
AAMC faces competition across the enterprise.
- The AAMC’s services, advocacy, data analysis, publishing, and professional development efforts are critical benefits of membership, and members increasingly expect more.
- The AAMC faces competition in each of these domains.
- Advances in technology, data, and communications platforms might allow other organizations to introduce low-cost options to disrupt existing services.
AAMC needs a shared internal approach and commitment to diversity, equity, and inclusion.
- The AAMC has a responsibility to develop a culturally responsive and diverse internal and external workforce. It is also essential that we foster a climate of inclusion and high engagement to enable employees to deliver on the strategic focus.
- Diversity, equity, and inclusion efforts require greater consistency across the organization and need to be key component of continuous improvement and organizational effectiveness.
- A recent evaluation indicates the AAMC should focus on recruitment and advancement, provide diversity, equity, and inclusion education to employees and leaders, ensure inclusive climates across the organization, and build leadership capability.
AAMC maintains legacy technology systems.
- The AAMC depends on technology to effectively deliver our mission focus and services to external stakeholders as well as to enable a high-functioning and collaborative team.
- Currently, the AAMC manages a tension between maintaining critical legacy systems for continued operations of our services and planning and implementing an IT-modernization strategy.
- Legacy systems would benefit from improvements in performance and scalability.