PRESERVING MEDICAL-SCHOOLS ACADEMIC MISSION IN A COMPETITIVE MARKETPLACE

To gain a better understanding of the effects on medical schools of tr ansformations in medical practice, science, and public expectations, t he AAMC in 1994 formed the Advisory Panel on the Mission and Organizat ion of Medical Schools and appointed six working groups to address rel evant issues. This article is a report of the findings of the Working Group on Preserving Medical Schools' Academic Mission in a Competitive Marketplace, which was charged with exploring how medical schools cou ld acquire and/or preserve an adequate patient base for teaching, rese arch, and income generation in a competitive marketplace. The other gr oups' reports will appear in future issues of Academic Medicine. To un derstand the diversity of approaches that schools have taken to achiev e this goal and to preserve their missions, the group interviewed repr esentatives of nine medical schools, selected to represent a cross sec tion of U.S. medical schools. The interviews took place on four occasi ons between June 1995 and March 1996. The information and comments sha red by participants helped the working group gain insight into the fun damental issues it had been charged to address, including those of new delivery structures, what value schools offer to delivery structures, how education and research can be incorporated and supported financia lly, possible new pressures on relationships between medical schools a nd teaching hospitals, changes in faculty physicians' employment relat ionships and terms, and the role of the medical school in graduate med ical education. In collecting and analyzing the data, the working grou p focused on the distinction between protecting an institution's exist ing enterprise and preserving an institution's core mission. This arti cle gives a detailed overview of the information and comments each sch ool presented, organized under the appropriate question. The working g roup's conclusions and commentaries on the findings follow. An appendi x presents more detailed summaries of the schools' presentations, orga nized as case studies. The picture that emerges is complex. The workin g group concluded that medical schools will take a variety of approach es to define and preserve their missions. Most, but not all, medical s chools will be able to secure the patient bases necessary to fulfill t heir missions even in a competitive marketplace. However, the nature o f many of the schools is likely to change, and it is not clear whether the core missions of education and research will continue at their pr esent levels at all schools.