ORGANIZATIONAL MODELS OF MEDICAL-SCHOOL RELATIONSHIPS TO THE CLINICALENTERPRISE

The authors analyzed existing relationships between medical schools an d clinical enterprises in order to develop models of these relationshi ps. The conceptual framework for the models uses three variables to as sess the nature of the relationships: (1) high academic control-high c linical enterprise control; (2) high academic influence-low academic i nfluence; and (3) self-contained system-open system (i.e., the extent to which the resources needed for clinical education are provided by t he relationship between the clinical enterprise and the medical school ). The authors present four conceptual models of the relationship betw een the medical school and the clinical enterprise: (1) The ''single o wnership; owned integrated system'' is characterized by a closed clini cal delivery system owned or controlled by the academic institution. ( 2) The ''general partner'' organization emphasizes an open clinical en vironment in which the medical school forms alliances with clinical en tities, and the school is a dominant partner. (3) The ''limited partne r'' organization operates with an open clinical delivery system that t he school relates to through affiliations and contractual relationship s, and the school is a less dominant partner. (4) The ''wholly owned, subsidiary'' organization operates in a controlled clinical environmen t in which the medical school is a subsidiary of the larger integrated delivery system. Each model is presented in its pure organizational f orm, then augmented with descriptions of the different ways that the m edical school and other components may relate to each other. Also, the advantages and disadvantages of each model for the medical school are discussed. The authors emphasize that no model is superior to the oth ers; instead, the best choice for a medical school depends on the hist ory local circumstances, and leadership of the school and other organi zations. The authors' intent is to assist the leaders of medical schoo ls as they design strategies for the future relationships of their ins titutions.