The Future of Academic Medical Centers in the United States

Abstract

The last 2 decades witnessed remarkable events in the life of academic medical centers (AMCs) in the United States. Twenty years ago, AMCs were thriving as the era of fee-for-service medicine came to a close: clinical departments were expanding, hiring new faculty members, purchasing new equipment as necessary, and funding research projects and protected research time with the abundant clinical revenues. The subsequent 20 years since that golden era came to a close witnessed teh disappearance of these expansionary trends. Departments have contracted, protected research time and start-up funds have declined precipitously, and many faculty members are infected with a sense of malaise and fear for the future.

How to Be a Good Academic Leader

“…Leaders of academic clinical departments face a much more complex set of challenges now than they did 40 years ago 11 .…”

Linking up with the community: a fertile strategy for a university hospital?

“…patient care, medical education, scientific research) are challenged [ 1 , 2 ]. In response, university hospitals adapted successful, but quite defensive, strategies such as merging with teaching hospitals and downsizing the organisation [ 6 – 8 ]. However, some have responded more proactively by linking up with their adjacent communities.…”

“…reducing uncertainty by building monopolies and cartels. These strategies seem to have been successful [ 6 – 8 ]. Apart from that, university hospitals also developed more proactive approaches by building organisational and community linkages through which the multiple missions of academic institutions can be fulfilled and secured [ 9 , 10 ].…”