Mergers involving academic health centers - A formidable challenge

Escalating economic pressures on the clinical enterprise threaten the missi ons of education and research in many of the most prestigious academic heal th centers. Following the model of industry, mergers of the healthcare deli very systems of teaching hospitals and clinics held promise for economies o f scale and an improved operating margin. Failure to follow business princi ples in constructing the merged entity, differences in organizational gover nance and culture, and inability of physician leadership to prioritize, dow nsize, and consolidate clinical programs to optimize operational efficienci es all compromise the success of such mergers in academic medicine. Academi c institutions and their respective governing boards need to exercise great er discipline in financial analysis and a willingness to make difficult dec isions that show favor to one parent institution over another if mergers ar e to be effective in this setting. To date, an example of a vibrant and suc cessful merger of academic health centers remains to be found.