Current and future challenges facing academic medicine

Excerpt

These are very anxious times for academic medical centers. They are confronted by the challenges of managed care, decreases in reimbursement, restrictions on house staff working hours, heightened scrutiny of clinical research, declining federal support for medical education, and the growth of formidable competitors, such as non-academic hospital chains and large groups of practitioners who attempt to provide high-margin services. Academic centers can no longer be complacent about their financial health or their reputation as the best places to receive care. Many of these institutions have political clout and access to considerable private wealth, but none of them can count on a bail-out from government or donors if they flounder. If we put this current state in perspective for the medical student or resident who is interested in an academic career, one can start to see how the future of academic medicine may not be one that nurtures and nourishes our best potential academicians. Most academic centers still have a mindset that if someone is in an academic setting they are expected to work and be financially productive but, at the same time, perform scholarly activities in the form of research and the publication of manuscripts. What, unfortunately, happens in many situations is that the most productive people are penalized because others in the department are not as productive and a significant amount of the money they generate must be dispersed to other divisions or other individuals. This has resulted in a mass exodus of skilled productive clinicians and researchers who are moving out into the private sector. Historically, policies that emanate from “Ivory Towers” often have an adverse impact on the people in the field who are bringing in revenues. …