Academic medicine: as threatened as most would have us believe?

All academic health centers (AHCs) are threatened by the complexity of health care reform and by the speed with which it is occurring. We have been forced in all areas of our academic and clinical life to reassess the way in which we have traditionally operated. We must, in fact, do more than reassess. We must change fundamentally. This is true whether one considers medical education, biomedical research, or clinical services. Practically speaking, health care reform forced on us by the business community of America realistically means downsizing unless faculties are willing to change and pursue novel contemporary opportunities. It means less money and the need to do more with what we have. Educationally, we must emphasize the training of generalist physicians. On the research side, it means interdepartmental collaboration around core program project initiatives. It means a sharing of resources (including space) and the need to develop quality relationships with industry and philanthropic organizations. On the clinical side, we must develop a fully integrated, highly competitive, cost-efficient physician/hospital organization, and most AHCs must become part of a larger integrated delivery system to protect not only clinical but academic interests.