Forum on the future of academic medicine: session IV--the realities of the health care environment.

At the fourth meeting of the AAMC's Forum on the Future of Academic Medicine in December 1997, Dr. Paul Griner and Dr. David Blumenthal discussed findings from their in-depth case studies of how ten academic medical centers (AMCs) were responding to the changing, more competitive marketplace and what these AMCs were doing to sustain the missions of their medical schools and teaching hospitals. Rapid, wide-ranging internal changes are taking place, such as centralizing management, down-sizing operations, partnering or merging with other schools or hospitals, revising legal relationships to state governments (for public schools and hospitals), creating independent corporations, and increasing alliances with industry. But AMCs will not be able to sustain their vital balancing act between academia and the health care system unless they can develop ways that both enlist faculty to meet the demands of the marketplace and also protect academic productivity. Reforms in faculty governance are taking place, dealing especially with issues of reciprocal AMC-faculty accountability. Robert Z. Gussin, vice president for science and technology of Johnson & Johnson, then spoke concerning how his vast company was dealing with changing conditions, and discussed the relationships, roles, opportunities, and problems of academia and industry in carrying out pharmaceutical research. Members then discussed the future of biomedical research funding, which was seen as being reasonably stable and a beneficiary of industry's partnering with AMCs and increased federal support. The meeting closed with a continuation of an earlier meeting's inquiry about the characteristics of the ideal medical school in the next century and what barriers would be faced in reaching this ideal. The group agreed again that service to society should remain schools' major goal, and they described and discussed several barriers to change, many of them internal. The group had a number of suggestions about dealing with the barriers, but there was no consensus. The members did agree, however, that the forum discussions are worthwhile, and one participant urged that in planning for the future the AAMC broaden its agenda, since the core values of medicine, nursing, and public health all relate to the AAMC's mission.