Challenges to academic family medicine in the current health care environment

Background: Changes in health care delivery and funding have placed strains on academic medical centers' ability to meet their multiple missions. To g ain insight into how this new academic landscape is affecting academic prim ary care, this study examined the current status and perceived challenges a t nine departments of family medicine at allopathic and osteopathic medical schools. Methods: Site visits were made to nine academic departments of fa mily medicine where key informant interviews were conducted with several in dividuals in key leadership positions. Sites were chosen to maximize divers ity among departments along a variety of factors, such as location, size, m ission, and type of school (private versus public). Interviews were transcr ibed and analyzed by a three-person multidisciplinary team for key themes. Results: Analysis of interviews revealed five major challenges for academic departments of family medicine: I) adjusting to new clinical demands in th e academic health center 2) organizing and administering new initiatives in community-based education, 3) recruiting and retaining faculty, 4) develop ing and maintaining research capacity and 5) serving multiple missions (edu cation, clinical care, and academic pursuits) in times of financial restrai nt. Conclusions: Significant challenges face academic departments of family medicine. The success or failure of departments of family medicine to meet these challenges could serve as a bellwether for how primary care fits int o the future overall scheme of academic health centers.