HEALTH-CARE REFORM AND MEDICAL-EDUCATION - FORCES TOWARD GENERALISM

The transformation of U.S. health care is driven by underlying princip les. The tensions between what exists now and what will emerge over th e next 15 years pervade health care delivery and financing, the doctor -patient relationship, the provider-payer relationship, and the atmosp here within educational institutions for the health professions. The i nstitutions that early on develop the capacity to forge and sustain st rategic partnerships will be well positioned to take advantage of the opportunities of a rapidly changing system, but those that do not will risk being isolated without the diversity of resources needed to make meaningful contributions to health care. The tensions also drive majo r changes in the way health professionals are educated, trained, and d eployed. Health care reforms will dramatically change the culture of t he medical school in areas of patient care, research, and education pr ograms. These institutions face external pressures to change and inter nal barriers to change, not the least of which are the lack of sustain ed leadership and collective vision. Academic medical centers must tak e active steps now to assess their strengths and weaknesses objectivel y, look realistically at options, and construct new, mutually benefici al partnerships that will be the keys to success.