• Karan R Chhabra, Adrian Diaz, Mary E Byrnes, Abishek Rajkumar, Phillip Yang, Justin B Dimick, and Hari Nathan.
• National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
• Ann. Surg. 2022 Jun 1; 275 (6): 122112281221-1228.

ObjectiveTo explore challenges and opportunities for surgery departments' academic missions as they become increasingly affiliated with expanding health systems.Summary Background DataAcademic medicine is in the midst of unprecedented change. In addition to facing intense competition, narrower margins, and decreased federal funding, medical schools are becoming increasingly involved with large, expanding health systems. The impact of these health system affiliations on surgical departments' academic missions is unknown.MethodsSemistructured interviews with 30 surgical leaders at teaching hospitals affiliated with health systems from August - December 2019. Interviews were transcribed verbatim and coded in an iterative process using MaxQDA software. The topic of challenges and opportunities for the academic mission was an emergent theme, analyzed using thematic analysis.ResultsAcademic health systems typically expanded to support their business goals, rather than their academic mission. Changes in governance sometimes disempowered departmental leadership, shifted traditional compensation models, redirected research programs, and led to cultural conflict. However, at many institutions, health system growth cross-subsidized surgical departments' research and training missions, expanded their clinical footprint, enabled them to improve standards of care, and enhanced opportunities for researchers and trainees.ConclusionsAlthough health system expansion generally intended to advance business goals, the accompanying academic and clinical opportunities were not always fully captured. Alignment between medical school and health system goals enabled some surgical department leaders to take advantage of their health systems' reach and resources to support their academic missions.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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