Forum on the future of academic medicine

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Abstract
The second meeting of the Forum on the Future of Academic Medicine in March 1997 was devoted to two issues. In a changing and increasingly competitive health care marketplace, (1) how do academic medical centers (i.e., medical schools and their associated teaching hospitals) fund their complex activities and manage their resources; and (2) what issues arise regarding the multiple missions, values, and cultures of academic medical centers (AMCs)? Regarding the first issue, one speaker made clear that medical schools must more closely link their financial statements with their strategic plans, and must find ways to more accurately gauge their financial health. Discussion of various aspects of this task included the need for schools to formulate business strategies; there was general agreement that academic medicine needs to have a better grasp of its enterprise and how much its components cost. Regarding the culture of academic medicine, participants debated the degree to which it must be adapted to recognize the new market-driven environment. More than one speaker stated that culture is a major obstacle to change. The lively discussions and presentations, detailed in this article, make clear that no one has much certainty about how AMCs-particularly medical schools-should be adapted to operate in a more commercial marketplace and what future role government should assume in this transformation. More than one statement was made that the AMC culture would be hard to change, and one speaker disagreed that AMCs' salvation would be found in adopting the principles of private business. The group's reporter closes this article by reflecting on several issues raised in the meeting, and stating that academic medicine is moving into a period when demands for rewriting its social contract will increase.

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