Academic Medical Centers under Siege

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Abstract
The future viability of academic medical centers is threatened. These institutions have flourished since the 1960s, even managing to survive the shift toward prospective payment over the past decade, but many are now in danger of becoming seriously compromised. In battles for the rapidly expanding number of managed-care patients, and in vigorous competition with nonacademic hospitals, teaching hospitals and their faculty-practice plans are being forced to negotiate bargain-basement rates of payment. In fact, they are often forced to price services below cost. In response to these pressures, many have reduced the number of faculty members and other personnel.1 At present, . . .

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