American College of Cardiology

(Apr. 1, 1999) Can academic cardiology survive? Managed care and other changes in the health care field have made it harder to answer "yes" with confidence. Confronted with drastically decreased funding, academic medical centers must now compete against the private sector while struggling to fulfill their tripartite mission of patient care, research, and physician training. For many academic medical centers, the result has been financial distress or even bankruptcy.

Finding ways to resolve this crisis is the focus of a new consensus paper that appears in the April issue of the Journal of the American College of Cardiology. Based on the American College of Cardiology's 30th Bethesda Conference last October, "The Future of Academic Cardiology" offers recommendations for ensuring academic medical centers' survival. The conference was chaired by Dr. Michael H. Crawford, chief of cardiology at the University of New Mexico Health Sciences Center in Albuquerque, and Dr. Kenneth Lee Baughman, director of cardiology at The Johns Hopkins University School of Medicine in Baltimore.

"Academic medical centers have been largely responsible for the medical advances that have dramatically reduced death rates from cardiovascular disease over the last 25 years," says Dr. Crawford. "The only way to advance medical science is to have a milieu where research, education, and patient care are mixed together."

But academic cardiology may be a victim of its own success, suggests the consensus paper's section on clinical care. Success in teaching the next generation has produced clinicians who can compete successfully against the centers that trained them. Success in developing new techniques and technology has improved outcomes for everyone, making it harder to distinguish academic centers from other providers. To survive, the authors argue, academic cardiology should collaborate with other providers, re-examine its tradition of subsidizing other departments, and do a better job of promoting its unique capabilities.

Changes in the health care system have also spelled trouble for research, the focus of the paper's second section. In fact, increased competition for research dollars, academic centers' new emphasis on income-generating clinical activities, and other trends threaten the very existence of the clinician-investigator. The authors suggest a variety of ways to enhance academic cardiology's research capabilities, such as providing clinical training to researchers and research training to clinicians. They also recommend the formation of interdisciplinary clinician-investigator teams that can tackle problems too complex for one individual.

The paper's third section examines teaching. Increased admissions, patient turnover, and documentation requirements have left faculty with less time to teach. To restore teaching's importance, the authors recommend that academic medical centers guarantee sufficient time and resources for teaching, create incentives to enhance teaching's value, and develop innovative teaching tools and methods.

Offering a glimpse of the crisis' human impact, the paper's final section explores faculty issues. Morale has plummeted as academic cardiologists struggle to combine teaching, research, and ever-increasing clinical responsibilities-all for much lower pay than their nonacademic counterparts. Recommendations include revising promotion guidelines to reflect increased clinical demands and customizing incentive packages to reflect faculty members' primary focus.

"The public needs to realize that conducting research and training physicians costs money," says Dr. Crawford. "They need to participate in the discussion about how to provide adequate funding for these two crucial functions."

The ACC, a 24,000-member nonprofit professional medical society and teaching institution, is dedicated to fostering optimal cardiovascular care and disease prevention through professional education, promotion of research, leadership in the development of standards and guidelines, and the formulation of health care policy.

The American College of Cardiology (ACC) provides these news reports of clinical studies published in the Journal of the American College of Cardiology as a service to physicians, the media, the public, and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of the ACC unless stated so.