Academic medicine : journal of the Association of American Medical Colleges
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This is the report of a study undertaken by the Association of America n Medical Colleges to estimate the total amount of clinical revenues that are used to support the academic mission of U. S. medical schools. The study was prompted by an awareness that recent market-driven changes in health care organization and financing threaten the structure of medical school financing that has evolved over the last half-century. ⋯ However, unravelling the complex web of subsidies and cross-subsidies that characterizes medical school-hospital relationships proved to be beyond the capability of the present investigation. There is considerable evidence that changes in health care organization and financing will make it unlikely that the current level of support from practice plans and volunteer faculty can be sustained and that in some cases it is already diminishing. The restructuring of medical school financing to absorb the impact of this decline of support, which comes on top of reductions in indirect cost recoveries and pressures to lower state appropriations, constitutes one of the major challenges medical schools will face in the years ahead.
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Comparative Study
Comparing the hospitalizations of transfer and non-transfer patients in an academic medical center.
By accepting and caring for patients transferred from other institutions, academic medical centers have been able to develop comprehensive training and research programs. Whether academic institutions can continue to do this in the future is questionable. To the extent that transfer patients are more complex and severely ill than non-transfer patients, they are likely to consume more resources, and in managed care payment systems, they could place accepting hospitals in financial jeopardy. ⋯ The transfer patients stayed longer and consumed more hospital resources than did the non-transfer patients. Age, sex, case-mix, and insurance status did not account for these differences. To limit the financial liability that transfer patients pose, academic medical centers could be forced to abandon their traditional role of caring for such patients. The consequences of this possibility should be explored.
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Despite the fundamental transformations occurring in health care, academic medicine can maintain, and actually enhance, its value to society. But to do so will require a shared vision of where academic medicine should go. The author offers his own vision, one that includes (1) establishing true partnerships between medical schools and the communities they serve; (2) elevating prevention and health maintenance to equal status with diagnosis and treatment; (3) addressing pressing social problems, such as drug abuse, teenage pregnancy, and domestic violence; (4) assuming a leadership role in containing health care costs; (5) harnessing information technology to develop, disseminate, and implement comprehensive clinical information systems, and to provide the public with reliable medical information; (6) fostering racial, ethnic, and gender parity in medicine; (7) carrying out appropriate downsizing and restructuring of the academic medicine enterprise; (8) addressing forcefully the workforce needs for physicians and medical scientists; (9) improving the education of medical students and residents and fostering the conduct of clinical research by creative use of the integrated academic health care systems that teaching hospitals are becoming; (10) developing regional educational consortia to guide important aspects of medical students' and residents' education; (11) building a learning network so that meaningful cross-talk and dissemination of lessons learned can occur among all segments of the academic medicine community; and (12) creating a permanent planning process to guide academic medicine's future. The author concludes that if academic medicine adheres to its tradition of public service and professionalism, its future can be as glorious as its past.
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Using national databases of the Association of American Medical College, the authors employed logistic regression analysis to show the relative predictive influences of selected demographic, structural, attitudinal, and educational variables on the specialty careers choices of 1995 U. S. medical school graduates. Plans to pursue certification in family practice or an unspecified generalist career could be predicted with moderate success, while choices of general internal medicine and general pediatrics could not. ⋯ In terms of the predictive values of the input variable in this study, career decisions for the other two generalist specialties--general internal medicine and general pediatrics--were essentially a crapshoot, either because the tactics to promote interest in these fields were ineffective (or confounded), or because the efforts were underdeveloped. Moreover, the statistical models of this study employed quantifiable variables that can be discerned and manipulated to guide the result, whereas medical students tend to identify less tangible elements as more powerful factors influencing their career choices. The results sharpen the strategic focus, but must be combined with those of other, descriptive analysis for a more complete understanding of graduating students' career decisions.