The impact of changes in the health care system on CME: Viewpoint from academia

Abstract

Medical schools are distinguished from other professional schools in their direct participation in the services provided by the profession. Professors at business schools may consult, but they do not manage businesses, nor do law professors practice law on an ongoing basis. Physician faculty, whether they be full-time or volunteer are intimately involved in the provision of health services, and for that reason a medical school cannot be immune from the changes that are occurring within the health care system. However, faculty and indeed the practicing physician, have been trained to emphasize quality rather than cost, which makes adjustment to current cost-containment pressures even more difficult. Moreover, the pressures derived from decreasing payment for health services, a traditional source of indirect support of education, is aggravated by a decreasing applicant pool and a national sense that there may be too many physicians, thus threatening traditional sources of financial support for academic programs. As these pressures mount, so does anxiety, with resulting turbulence.In the midst of this turbulence, how do we manage and respond as organizations, especially since the managerial structure of the academic medical center is not designed to respond quickly to change? Consider the "challenges" of managing in that academic environment. While corporate structures emphasize single tasks, clear reporting lines, unambiguous authority, exclusive loyalty to the organization, and clear productivity measures with appropriate rewards, these characteristics are largely missing in the management organization of an academic medical center. Our approach is "bottom up" rather than "top down" with uncontained decentralization, multiple tasks, blurred reporting lines, and little recognition of authority. In fact. our academic medical centers appear optimally structured to resist change and adaptation. The result is tremendous stress, and much of my time is spent dealing with that stress in its various manifestations.A look into my appointment book brings this concept of rapid change to life. As the vice dean of a medical school, I have responsibilities for research development, the graduate school, medical education at all levels, the library, and other academic functions. Indeed, 1 do spend some of my time with traditional academic types such as other deans, department chairmen, faculty, and students. However, 1 spend as much time with others, including an array of commissioners, 91

Dynamics of the marketplace: Key issues, new linkages, and successful organizational models in academic CME

“…Gerald Escovitz proposed that "academic medical centers will continue to be an important part of the future because the technological improvements and quality that will be demanded by our informed public can best be met by the talent and creativity found within our academic medical centers" (9).…”

“…Gerald Escovitz suggests that opportunities in working with managed care programs may provide other opportunities to implement what we have learned through our research efforts in delivering more focused CME (22). There are also opportunities to create partnerships with third party payors, offering them educational programs, products, and services that enhance their ability to ensure high quality care to their beneficiaries.…”