The threat of an unfettered competitive market to academic medicine and its vital social missions is real, but it is not appreciated by many key stakeholders or the public at large. People do not understand the term academic medicine or the interdependence of our missions. While in principle they are supportive of teaching and research, and especially the products that result from these activities, they hold major misconceptions about who teaches, who performs medical research, and how each activity is financed. The size and apparent profitability of teaching hospitals disguise their role as major providers of care for the indigent, adding to the perception that AMCs are not at risk. Those inside academic medicine have contributed to these misperceptions by failing to unbundle the functions of patient care, teaching and research, and focus public awareness on the products and costs of each, and demonstrate value in easily understood terms of return on investment.
Research is the possible exception.
Another feature of the environmental change we are witnessing is that for-profit HMOs, hospitals and physician management groups are expanding faster than any other segment of the health care delivery system. Sometimes perverse consequences of this commodification of health care, and its associated profit motive, raise new and profound challenges to the ethic of our profession and its leadership. Never before has the attention of the public, and of the media, been so sharply focused on the ethics of health care, its financing and the implications of contemporary research. Still another widely held concern is that we already have, or are headed toward, an oversupply of physicians, especially specialists. So the issue is not just how to train future physicians, but how many, what types and how to address the growing maldistribution.