It has been less than four years since COVID-19 ravaged our world, stressing hospitals and physicians to the brink as they coped with a modern-day plague that claimed the lives of old and young alike. Despite the carnage and the imperfect results of a sometimes-chaotic response, healthcare workers risked their lives daily in the service of others—and were deeply appreciated by a grateful nation. Like so many others, we lost dear friends and colleagues to an invisible enemy that attacked without mercy.
Memories fade and political winds shift with bewildering speed and direction. The eventual nationwide rollout of an effective vaccine has led inexplicably to what? Nothing less than rampant vaccine skepticism at the highest levels of our public health institutions. A disease once virtually extinct—measles—is again claiming young lives. Instead of celebrating the practical benefits of rigorous clinical research, we now find ourselves challenged by abrupt reductions in federal support for scientific inquiry and the haphazard termination of studies that might otherwise lead to life-saving cures for a raft of diseases.
Academic medicine is not well-positioned to reverse these trends any time soon. We can hope that the benefits of evidence-based medicine will eventually re-emerge from the challenges confronting our research institutions.
Still, we are not without recourse. Academic medical centers have one superb and undeniable asset that is not easily depleted: faculty and staff who are dedicated, resilient and incredibly bright. They are, almost to a fault, intensely empathetic and optimistic. Now is the time to join arms to exploit our collective strengths.
Academic medicine must reinvent our strategies to survive—and thrive. We must explore more innovative approaches to our multiple missions and find new ways of envisioning continuing progress in medical care. We must move beyond an evolutionary model that is slow to react to organizational change to a construct of transformational, nimble and accountable leadership behavior.
Within our institutions, we should start by advancing ideas that reinforce our commonalities, not our differences. An openness to differing approaches just might uncover opportunities we do not currently see. In every forum, our leaders need to actively listen to the concerns of our staffs and demonstrate honesty and transparency without Pollyannish platitudes about service and sacrifice. No one can stop us from being kinder to each other and more respectful of each of our journeys, behaving in ways that exhibit humility and a genuine desire to hear other perspectives. Our attention should be directed to identifying strategies that make our daily work easier, more fulfilling and of greater benefit to our communities. Find ways to enhance the core personal characteristics, the “grit” that makes working through these challenging times more tolerable.
Cooperation between our institutions can and should be improved. Academic medical centers are notoriously competitive, even though so many of our hospitals are full beyond capacity. Rather than drive more business to our core institutions, academic medical centers should identify the specific clinical capabilities they could package and export to smaller hospitals to improve care in the community. For example, intensive care coverage could be substantially improved by centralized oversight from experienced intensivists remotely interfacing with less advanced practitioners at the bedside. The academic medical centers in each city could collectively staff an intensive care hub in this way, lowering the cost for each institution while providing considerable benefit to the entire region.
Additional benefits could accrue by cooperating on a unified and coordinated national research strategy. Academic medical centers could then focus on specific areas in which they have unique competencies and pool resources to form more efficient research consortiums. With such a partnership mentality, the academic medical centers in our largest cities could share healthcare accelerators and “venture studios.” The financial rewards of such innovation might be substantial and could attract more than a little interest from pharmaceutical corporations and med-tech companies
Finally, to improve the public’s perception of our usefulness, we could imagine a mutual agreement of all academic medical centers to designate a substantial portion of our media advertising to a joint campaign to highlight the value of academic medicine for the communities we serve and the greater good accruing from our stewardship of biomedical discovery.
All these ideas represent major cultural shifts that will require the highest levels of intentionality, persistence and, especially, selfless leadership from faculty, executives and boards of directors.
It is our time. It is our responsibility. Academic medical centers can help create a better future for American healthcare.
Bruce L. Gewertz, MD, and Michael Nurok, MD, PhD, are academic physicians in Los Angeles. Alan Friedman, MA, is an organizational psychologist in Princeton, NJ.
The views expressed in this column are those of the authors and do not reflect the position of any institution.
