The house of gastrointestinal medicine: How academic medical centers can build a sustainable economic clinical model

摘要

Academic medicine, including academic gastrointestinal (GI) medicine, has been founded and has flourished on the tripartite missions of research, teaching/education, and patient care. Academic medical centers (AMCs) have unique and historical responsibilities to translate research discoveries into innovative patient care and train the next generation of physicians in both medical sciences and health care delivery. In this era of fiscal constraint, there are current and anticipated challenges, which are triggered by reductions in the National Institutes of Health budget, implementation of the Patient Protection and Affordable Care Act (PPACA), federal budget constraints ("Sequestration"), and the increasingly complex relationship between health care systems, insurance companies, regulatory entities, the pharmaceutical industry, and medical device companies. In direct and indirect fashions, these events will force leaders of academic GI divisions to reexamine the business infrastructures of their division's clinical practice. Such plasticity and adaptation will serve to invigorate academic medicine and its multifaceted roles. The financial and clinical pressures emerging as a result of the current wave of health care reform have been defined in previous articles within this section of Clinical Gastroenterology and Hepatology, including descriptions of the "Roadmap to the Future of GI Practice," general descriptions of health care reform, and specific pressures on AMCs.