PROCEEDINGS
OF THE 30TH BETHESDA CONFERENCE. THE FUTURE OF ACADEMIC
CARDIOLOGY. BETHESDA, MARYLAND, OCTOBER 26-27, 1998.
JACC Vol. 33, No. 5, April 1999:1091-1135
30th
Bethesda Conference:
The Future of Academic Cardiology*
Task
Force 1: Clinical Care
Henry
DeMots, MD, FACC, Co-Chair, Gilbert H. Mudge,
Jr., MD, FACC, Co-Chair
CONCLUSIONS
The
preceding discussions demonstrate the importance of
subspecialization within the academic division to enhance
cost-effectiveness and to strengthen unique aspects
of the academic division which distinguish it from community
providers. Future strategies cannot be based on surrender
of the clinical mission to community cardiologists but
rather a closer collaborative relationship with them.
The future academic division should not be a small core
of academic physicians involved in basic research or
outcomes research solely on the patients of community
cardiologists. Rather, its future should be based upon
strengthening the subspecialization within cardiology,
so that the academic division continues to provide a
unique expertise across all disciplines in cardiology
which is not widely available in the community. This
model is based on continuing the tradition of the academic
clinician, through patient care, identifying important
areas for future investigation, education and continuing
to provide leadership for the direction of both basic
and clinical research. However, this approach also recognizes
that the era of "triple threat," the academician
capable of performing successful patient care, research
and teaching emulated in the past, is no longer a part
of a viable academic model.
Academic
cardiology divisions must be proactive in redesigning
their purpose and relationship to other providers to
maintain traditional missions. This restructuring should
ultimately benefit all health care providers and improve
access of all patients to the best cardiovascular care.
RECOMMENDATIONS
- To
sustain and expand their commitment to patient care,
teaching and basic and clinical research, academic
cardiovascular programs must respond to the revolutionary
changes in health care by restructuring external relationships
and redesigning their internal organization.
- Academic
cardiovascular programs should redraw their conventional
boundaries by the development of collaborative relationships
with a broad base of practitioners and hospitals for
advancing clinical care, promoting clinical research
and fostering more comprehensive teaching of all health
care professionals.
- Academic
cardiovascular programs should approach their long-term
mission in a more business-like fashion. Incentives
must be aligned, cost-competitive measures instituted
and variation in practice patterns reassessed.
- Academic
cardiovascular programs should reexamine their traditional
relationships to respective departments of medicine
or pediatrics. Reorganization of clinical, research
and teaching commitments with related specialties
in other departments may ultimately enhance the success
of all participants in the academic health center
and improve the access of patients to the best cardiovascular
care and research ideas.
- Academic
cardiovascular programs should promote their unique
capabilities in clinical care, disease management,
outcomes analysis and clinical and translational research
to a broader constituent base of both patients and
providers.
|
