Book Review

The Future of Academic Medical Centers

N Engl J Med 2002; 346:1100April 4, 2002

Article

The Future of Academic Medical Centers
Edited by Henry J. Aaron. 110 pp. Washington, D.C., Brookings Institution Press, 2001. $38.95 (cloth); $15.95 (paper). ISBN: 0-8157-0236-1 (cloth); 0-8157-0237-X (paper).

The Future of Academic Medical Centers sets forth the often divergent opinions of the nation's top experts on the destiny of academic medical centers. One opinion, the most pessimistic, was echoed by one of our colleagues who saw the title and commented, “Must be a thin book.” Indeed, since the early 1990s, academic medical centers in the United States have had to face unprecedented pressures, which may threaten their very existence. These include scaled-back Medicare payments, the squeeze of managed care, a disproportionate burden of the care of the uninsured, the rising cost of medical technology, and decreasing hospital-bed occupancy rates. The health plan of the Clinton administration (now abandoned) as well as hospital mergers and expansion are responses, but they have been largely unsuccessful.

To address these challenges and possible solutions, a group of hospital chief executive officers, university presidents, analysts, and executive- and congressional-office staff members gathered for a one-day conference. The four chapters that make up this book are the record of that conference. The book is filled with interesting, current, and authentic examples from some of this country's well-known academic medical centers. One of the most interesting features of the book is its format. Each chapter is written by a different participant and is followed by commentary from two other participants, which serves to broaden the perspective and to clarify some of the positions taken. These comments are not unlike two editorials on each chapter.

No one would argue that fiscal strength is not crucial to the future of academic medical centers, but this is not the only important factor. The complexity and variability of the infrastructure of academic medical centers must entail other factors, but these are not mentioned. Some of the notably absent or cursorily examined characteristics are the quality of graduate and undergraduate medical education, scientific and technological advancement, and the unique and unrivaled commitment to patient care in these centers and their surrounding communities. In this era of managed care, cost control, and the rising cost of caring for the uninsured, no one can argue that academic medical centers do not serve a crucial role in delivering care to the indigent, the unemployed, the young, and the old. In fact, these social and scientific obligations not only define success for the constituent physicians of academic medical centers but also form the basis of comparison among centers.

A physician seeking an overview of this topic and opening this book will plunge into graphic displays of economic analysis. This and the unique format of the book, which is designed to offer a comprehensive look at different viewpoints, will be exciting for health care experts but may be confusing to casual readers.

Vineet Arora, M.D.
Ethan Gundeck, M.D.
Holly J. Humphrey, M.D.
University of Chicago Hospitals, Chicago, IL 60637
holly@medicine.bsd.uchicago.edu