The effects of a changing environment on relationships between medical schools and their parent universities

Medical schools differ from other university graduate schools in that commu nity settings, hospitals, and ambulatory care facilities are required for m edical education, and most of these settings are either owned by or closely affiliated with the university. Thus, the extraordinary changes in recent years in the organization, delivery, and financing of health care have requ ired the attention not only of the leadership of academic medical centers ( i.e., medical schools and their owned or closely affiliated teaching hospit als) but also of the administrators and boards of their parent universities . Many university-wide structures and policies that previously served the m edical school well in accomplishing these missions may now be viewed as inf lexible by the faculty and administration of the school. Conversely, the hi storically distant governance and administrative oversight of the medical s chool has become a concern for some at the university, given the huge budge ts of the school, its faculty practice, and its affiliated hospital(s). From information derived mainly from annual visits to 14 medical schools fr om 1996 through June 2000, the authors review the issues between medical sc hools and their parent universities and the strategies being used to resolv e them. These strategies include changes in the governance, organization, a nd management of the medical school, such as unified authority for health a ffairs, reengineered administrative systems, and increased autonomy in deci sion making. The authors conclude that these strategies appear to be workin g on behalf of not only the medical school but, in some instances, the univ ersity at large. They also comment on possible negative implications of the greater separation of the medical school from its parent university.