Reality, teaching, and the four researchers.

The 112th meeting of the Association of American Medical Colleges (AAMC) was held November 2–7, 2001, in Washington, DC. The theme for the meeting was “Facing the Future,” yet there appeared to be considerable time and concern devoted to the realities of the present. The first plenary session, “The Cost of Compliance: Dollars, Time, and Faculty Morale,” caught the mood of the gathering with a careful analysis of the current costs to academic medical centers of the unfunded mandates for compliance. Russel E. Kaufman, MD, vice dean for education and academic affairs at Duke University School of Medicine, Durham, NC, presented his overview of the cost of compliance in research. Kaufman noted that the cost of the institutional review board at Duke, including record keeping, personnel, and time for protocol development and review of protocols, exceeded $12 million in supporting the medical school–wide research endeavor. Kaufman outlined a study done at Duke in which compliance costs were shown to increase at a rate exceeding that of any other research costs. He warned specifically about the Federal False Claims Act and the unknown potential fiscal effects of the privacy protection rules now pending implementation. Mark E. Erath, a partner in Healthcare Consulting Practice at PricewaterhouseCoopers LLP, San Francisco, Calif, presented the results of a study done by that firm documenting the cost of compliance for clinical healthcare. Erath reported that the Center for Medicare and Medicaid Services (CMS) code is now larger than the Internal Revenue Service code. At one phase in reviewing the data from his study, he noted that the time spent documenting clinical activities equaled the time spent actually performing the clinical activities. Erath suggested that breakthrough changes are required if the system is to survive financially. Primary among these changes that Erath suggested are three initiatives: (a) Unfunded mandates must be carefully examined, (b) the workforce supply crisis must be solved, and (c) the CMS and American public must eventually deal with the demand crisis for medical services. Erath’s study of the cost of compliance to healthcare is available from PricewaterhouseCoopers. This sobering dose of reality was followed by a session about the physician payment situation. The CMS update on the physician payment resulted in a 5.4% decrease in payment per work relative value unit. The 2002 relative value unit payment has declined to $36.23 compared with the 2001 value of more than $38.00. Of equal concern is the decrease in the technical component payment for radiologists of about 5%. This makes the overall “hit” for radiology departments about 11% for the year 2002. The AAMC and other professional organizations are working diligently to mitigate the effect of the suggested reductions. The general impression was that the best we could ever come away with is to reinstate the 2001 payment scale. The most likely scenario was that the reductions recommended by the CMS would stand. George F. Sheldon, MD, the Zack D. Owens Distinguished Professor of Surgery and chairman of surgery at the University of North Carolina, Chapel Hill, delivered an analysis of the 21st century workforce in medicine. Sheldon predicted a major upcoming physician shortage. Sheldon showed demographic data for medical resource that suggested a crucial shortage of physicians and, in particular, specialty trained physicians, is likely to develop during the next 10 years. We in radiology can certainly resonate with that opinion. Sheldon suggested a workforce study group for graduate medical education (GME) whose tasks would include documentation of the need to increase class size in the nation’s medical schools and support of an increase in the size of GME training Acad Radiol 2002; 9:834–836