Big Changes in Store for Academic Medicine?

The financial pressure on academic medical centers has never been more intense than it is now, according to Mark Laret, CEO of UC-San Francisco Medical Center and outgoing chair of the Association of American Medical Colleges. The association, representing 141 medical schools across the country, held its annual meeting over the weekend in San Francisco.

“We have tried to use clinical income to make up for budget losses [that used to support medical schools],” Laret said. “And now that NIH (National Institutes of Health) budgets have flattened, that’s putting more pressure on, too, and increasingly we’ve had to use clinical income to support research, as well.”

In the recent past, Laret said, academic medicine has absorbed the decline in financial support for medical schools and research, but that’s changing, he said.

“Now clinical income is under attack,” Laret said, “and that puts the academic enterprise at risk like never before.”

“As much as we might like, we’re not going back to the old days,” Laret said. “And we can see that as a problem, or we can see it as an opportunity.”

Laret said declining resources can act as an agent of change, since medical institutions are being forced to address inefficiencies.

“It’s true in every business, that when you have that decline in revenue, you need to look at how to improve quality and safety and reduce costs,” he said. “There are lots of examples of how that’s been done.” For instance, at UCSF, he said, a conversion to a robotic pharmacy has reduced medical errors and reduced costs. “We need to take that kind of concept,” Laret said, “and put it on steroids.”

For instance, he said, medical schools might want to collaborate and combine resources. “Why do six medical schools need six different medical boards? And why are six medical schools taught by six completely different faculties?” he asked. There’s no reason professors at UCSF couldn’t also teach at UC-Davis Medical Center, and vice versa, Laret said. “There are definitely ways to have higher quality education at a lower cost,” he said. “It’s the kind of imperative that we’re looking at.”

A number of technological advances could help that effort, such as mobile technology, real-time glucose or heart-rate monitors, he said. Mostly, Laret said, it’s a question of re-examining existing systems and seeing what can be done better.

“There are a bunch of things we do because that’s how we’ve always done it, so this is a chance, an opportunity to do things differently,” Laret said. “I’m certainly not at the front of the parade saying, go ahead and cut our resources, but it’s the political and economic reality, so we need to rethink how we work.”

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