Tuesday, February 03, 2004

From today's New York Times: Multiple Missions Put Teaching Hospitals at Risk.

For more than a century, Americans have expressed confidence that an ever-increasing, well-trained cadre of physicians and medical scientists will protect and enhance their health. So for much of this period, the steady expansion of medical schools, research laboratories and teaching hospitals has been justified as an agent of public good.
More recently, however, with the fiscal crisis in health care, experts are beginning to question whether the nation's academic medical centers are financially sustainable in these times when Americans tend to worship the free market.
It has become increasingly difficult in recent years simultaneously to educate and train young doctors, treat patients, advance medical research, and hew to the bottom line. All these endeavors require more and more costly technology. Salaries and health care delivery expenses continue to rise. And the competition among all medical centers, whether affiliated with universities or independent, is ferocious.

Much like in the non-academic centers, things are not always warm and fuzzy between the faculty and the administrators, university and hospital alike:

More pointedly, Dr. Guy McKhann, a professor of neurology and a former member of the Johns Hopkins Hospital's medical board observed: "In many academic medical centers, there is a real split between those who run the hospitals and those who run the medical school. They'd rather undercut each other than survive."......What has changed most over the past century is that today's academic medical centers are almost or completely financially independent from their parent universities. To make matters more precarious, when economic times are good, many university presidents look to their hospitals' profits to support other growth plans in the less lucrative schools or colleges. But when these revenues are threatened or reduced, they often seek ways to minimize the university's financial responsibility to its academic medical center.

And some view a role in the future of the academic medical center as an instrument for social change:

Dr. Robert P. Kelch, chief executive of the University of Michigan Health System, predicts that research-oriented medical centers will need to be run and financed differently from the centers that focus mainly on patient care and the training of doctors and nurses.
"The free market never gets things right," Dr. Kelch said. "In this case, it has led to a more stratified health care system that may lead to a real crisis as the baby boomers age. My hope is that academic medical centers will help Americans come to a national consensus that will not only ensure the highest quality of health care and medical science but also universal access."

Sounds like herding cats to me.

BTW...here is the link to the book, Governance of Teaching Hospitals: Turmoil at Penn and Hopkins mentioned in the article.
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