ACADEMIC HEALTH CENTERS: WILL THEY SURVIVE?

There is common consensus that providers will require a new set of skills in order to meet the healthcare needs of the community in a post- reform environment. The adoption of these critical attributes—team-based care, quality improvement principles, systems-based practice, population health, and comparative effectiveness research—are foundational to new care models like Accountable Care Organizations (ACOs) and Patient Centered Medical Homes (PCMHs). Academic health centers are actively working to integrate these fundamental elements across their tripartite missions.

The AAMC’s "Readiness for Reform" (R4R) initiative—which aims to assist medical schools, teaching hospitals, and their faculty in preparing for the changes brought about by the Affordable Care Act (ACA)—is one effort helping us to identify the specific strategies they are developing to meet the increased demand for health care services. The findings from a “readiness” assessment survey sent to 275 members in the fall of 2010 indicate that many institutions are enhancing their primary care provider base through hiring more primary care physicians, advanced practice nurses and mid-level providers. Our members also indicated increased engagement with community partners such as Federally Qualified Health Centers (FQHCs).

At the same time, Academic Health Centers (AHCs) are moving the medical home concept into practice and into physician education and training. In December, the AAMC released a report (available on the AAMC website) that provides the results of a 2010 survey of primary care residency programs. The survey was conducted to determine how attributes of the PCMH are being incorporated into the clinical education environment. The survey results indicate a growing number of programs are adopting care elements associated with PCMHs. Our members fully realize that a healthy community will require a healthy system of primary care and a commitment to community-based medicine.

The nation faces an overall shortage of physicians, and to address this shortage, AHCs are responding through the opening of new medical schools and the expansion efforts of existing medical schools. Five new medical schools have opened since 2009, and 10 more are being accredited, with many adopting a community-based medical curriculum intent on producing more primary care physicians. We see an increasing number of U.S. medical school graduates entering primary care specialties, as indicated in the 2010 NRMP match results, including a 9 percent increase in family medicine from 2009 to 2010. We have openly acknowledged that the academic medical community still has much work to do in order to be fully ready for reform, and look forward to continued interaction with the ADFM and other professional societies to promote the importance of primary care. This should in no way diminish the innovative work of medical schools, teaching hospitals, and their faculty as they strive to transform healthcare in this new era.

The AAMC represents all 133 accredited U.S. and 17 accredited Canadian allopathic medical schools; approximately 400 major teaching hospitals and health systems; and nearly 90 academic and scientific societies. Through these institutions and organizations, the AAMC represents 125,000 faculty members, 75,000 medical students, and 106,000 resident physicians.

Competing interests:   None declared