The future of academic medical centers in the United States - Passing through the valley of the shadow of death

The last 2 decades witnessed remarkable events in the life of academic medi cal centers (AMCs) in the United States. Twenty years ago, AMCs were thrivi ng as the era of fee-for-service medicine came to a close: clinical departm ents were expanding, hiring new faculty members, purchasing new equipment a s necessary, and funding research projects and protected research time with the abundant clinical revenues. The subsequent 20 years since that golden era came to a close witnessed the disappearance of these expansionary trend s. Departments have contracted, protected research time and start-up funds have declined precipitously, and many faculty members are infected with a s ense of malaise and fear for the future.