Over the past decade, many observers predicted the demise of the academic
medical center (AMC) due to competition from community hospitals and physicians,
fragile finances, inefficiency, and organizational complexity. In 2004, we
interviewed 23 AMC and community hospital administrators to determine why
those predictions have proven unfounded, learn the leaders’ current
concerns and priorities, and to identify desirable changes. Chief concerns
were reimbursement uncertainty, federal research policy, ineffective internal
decision-making, and clinical quality (mentioned in more than 75% of interviews).
Priorities included ensuring sufficient investment capital, revising undergraduate
and graduate curricula, strengthening ties with physicians and community hospitals,
attracting faculty, and meeting regulatory requirements. We advocate that
the AMC: (1) modify the research model to allow greater collaboration with
institutions and researchers; (2) enhance free and open export of new and
proven clinical techniques and knowledge; (3) devote greater attention to
meeting patients’ increasing needs for counsel and guidance, not just
intervention, given the plethora of complex new technologies and their promotion
in the popular media; and (4) simplify their organizations. To accomplish
this, it is desirable for future leaders to gain experience outside the AMC,
and for faculty and institutions to be less inwardly focused and more attentive
to preserving the public’s trust.
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