TENSIONS WITHIN THE ACADEMIC HEALTH-CENTER

A variety of forces are converging to unbalance the internal environment of the academic health center, and the dean of the medical school sits uneasily in the resulting vortex of conflicting needs and demands. For example, the introduction of Medicare in 1965 profoundly changed the size and complexity of medical school departments and greatly stimulated the growth of hospitals. More stresses have come from rising health care expectations of the public; the replacement of fee-for-service indemnity health care by managed care and vertically integrated health care systems; the proliferation of academic specialties and subspecialties; and the recent growth in the academic medical center, which is seen as a threat to the academic integrity of the university. Within the medical school there are tensions between basic and clinical research, between education and research, between education and clinical practice, and between the dean and department chairs over allocation of resources. Perhaps the most complex tensions exist between the medical school dean and the academic hospital director. The overarching tension in the academic health center results from striving to balance the need to fulfill academic goals with the need to fill hospital beds to maintain financial solvency. This tension will not lessen so long as there is no common vision for the academic health center as a whole, and will probably increase with the forthcoming changes in health care reform. The dean and the hospital director must forge a strong alliance, and the hospital must realize that for its continuing success, it must support the academic program. Academic health centers will survive, but only those centers where the medical school, the teaching hospital, and the faculty practice plan are integrated will thrive.