Howard R J
Department of Surgery, University of Florida, Gainesville.
Arch Surg. 1994 Nov;129(11):1123-30. doi: 10.1001/archsurg.1994.01420350021001.
The coming changes in the organization and financing of medicine will lead to dominance of government and business in the American health care system. These changes will have a profound effect on academic medical centers (AMCs). To compete for managed care contracts and maintain their patient bases, AMCs will have to compete with private providers on cost, something they are ill-equipped to do because of their high cost structures. The AMCs are likely to have lower patient care revenues and alter the makeup of their faculties to reduce the number of specialists and increase the number of primary care physicians. Undergraduate and graduate medical education and research are also likely to suffer adverse consequences as a result of these changes. With the number of specialist residency positions decreased, it will be difficult for faculty to replace residents with physicians' assistants or nurse clinicians. Faculty may have to devote more time to patient care, and research and education may suffer. The decreased revenues of AMCs will affect the Surgical Infection Society and other academic societies. Society members may limit the number of societies to which they belong as their incomes or those of their departments are threatened.
医学组织和融资方面即将到来的变革将导致政府和企业在美国医疗保健系统中占据主导地位。这些变革将对学术医疗中心（AMC）产生深远影响。为了争夺管理式医疗合同并维持其患者群体，学术医疗中心将不得不与私立医疗机构在成本上展开竞争，而由于其高昂的成本结构，它们在这方面准备不足。学术医疗中心的患者护理收入可能会减少，并改变其教职员工的构成，以减少专科医生的数量，增加初级保健医生的数量。由于这些变化，本科和研究生医学教育及研究也可能会受到不利影响。随着专科住院医师职位数量的减少，教职员工将难以用医师助理或护士临床医生取代住院医师。教职员工可能不得不将更多时间投入到患者护理中，研究和教育可能会受到影响。学术医疗中心收入的减少将影响外科感染协会和其他学术团体。随着协会成员自身或其所在部门的收入受到威胁，他们可能会限制自己所属协会的数量。
