ITS REPORT CARD TIME AGAIN

The author, the outgoing president of the AAMC, presents report cards on how the academic medicine enterprise is faring today and how it may fare in the year 2000 by assigning grades to four spheres of activity : Manpower gets a D today, for the following reasons: (1) There are st ill far too many specialists and too few primary care physicians, and the problem may be worsening: (2) the proportion of underrepresented m inorities is still too low in medical schools and the physician workfo rce, but there are encouraging signs that this problem may be lessenin g, thanks to schools' efforts to fulfill the mandate of the AAMC's Pro ject 3000 by 2000; (3) student indebtedness is increasing, a situation that affects some students' choices of specialties. By the year 2000, the grade for manpower will rise to a C, since most Americans will ha ve access to care, and there will be some - but not dramatic-improveme nt in the generalist-specialist balance. Effectiveness of medical scho ol faculties gets a C today, mainly because although faculties have gr own with no corresponding increase in students, there has been no sign ificant increase in time or effort devoted to teaching. By the year 20 00, the faculty grade will rise to a B, since the faculty will be lean er and may teach better, tenure will have become rare, especially in c linical departments, and faculty practice activities will not usurp ac ademic activities to the extent they do today. Research gets a B+ toda y for solid accomplishments in the face of major constraints. The rese arch priorities of the Clinton health reform plan, which focus on prev ention and health services research, will be difficult to assimilate i nto a research culture that has glorified hard science. By 2000, the g rade for research will remain a B+, for although the proportions of di fferent types of research will change, the quality will remain high. H ospitals and clinical practice are graded A- for their work today, bec ause efforts to provide clinical services have been, for the most part , outstanding. Also, teaching hospitals have continued to thrive econo mically. Health care reform and other pressures will affect teaching h ospitals, but the author has confidence in these institutions' ability to survive and even do well in the new era. By 2000 the grade will sl ip just a little to a B; clinical practice will become more selective and focused. As for the state of the AAMC, the author finds it in good shape. He closes by urging academic medical centers to collaborate mo re and compete less, to pool their advocacy efforts, and to keep such efforts in harmony with the country's welfare. He emphasizes that in t he present era of health care reform, academic medical centers must st op divisiveness and present a united front to preserve, protect, and i mprove their enterprise.