What are the challenges facing academic medicine today? 3 executives weigh in

Academic medical centers' three-pronged mission — patient care, research and education — is both what sets them apart as premier healthcare institutions and situates them to incur unique pressures, compared with hospitals that are not affiliated with teaching institutions.

The challenges facing academic medical centers was one of the topics discussed during a session at the Becker's Healthcare Academic Medical Centers Virtual Forum on Sept. 25. The panel included: 

  • David Lubarsky, MD, vice chancellor of human health sciences and CEO of Sacramento, Calif.-based UC Davis Health 
  • Michael Apkon, MD, PhD, president and CEO of Boston-based Tufts Medical Center and Floating Hospital for Children 
  • Maia Hightower, MD, chief medical information officer at Salt Lake City-based University of Utah Health 

Here's an excerpt from the conversation, edited for clarity. To view the full session on-demand, click here

Question: What are a few of the challenges facing academic medicine today? How are AMCs overcoming these challenges? 

Dr. David Lubarsky: The push to sub-specialization requires ever larger populations to make sure that you get exactly the right people to those super sub-specialists. You know the old joke, when you're sub-specialized, you know more and more about less and less until you know everything about nothing and that your patient population gets diminishing small as you get super sub-specialized.

When you serve a very large region, as we do, actually there's a great opportunity to aggregate the stuff that only we can do and to help your partner institutions do all that they can do. And in the long run, patients get better care from you because you're making sure your catcher's mitt is out for everything that really needs to come to you for that ball that's thrown but you're not getting a bunch of stuff that can be done closer to home. That's really important because, at least for us, our catchment area extends a six hour drive away. 

That means that every time someone needs to come for an appointment or to have a minor procedure that they might've been able to get in their local community, they're taking off a day from work. If they're transporting a loved one, there's two people taking off either a day from work or a day from school. So leveraging technology is really critical. That is the combination of virtual health and local community care is the answer, if you will, to changing both access and outcomes in communities that are not served routinely or easily by our academic medical centers.

Dr. Maia Hightower: On the technology front, there are plenty of really bright spots, especially around our telehealth education. We actually have a really strong education program that is delivered remotely for CME to our primary care providers across the state and across the Intermountain West. Because one thing that was really important during COVID was making sure that providers that don't typically have access to academic medical center type grand rounds and educational resources have access to really critical information so that they could appropriately advise their own patient populations within their community. Our project is called Project Echo, and we've been able to reach thousands of doctors across the Intermountain West with critical information on COVID-19 in addition to our regular programming.

We have really strong education around how to manage diabetics and how to keep up with managing HIV and hepatitis C because again, these patients are coming from such a long way, they are relying on their primary care doctor to be that football player, that coach that helps to coordinate their care but with that connection with the University of Utah with an academic medical center. That's been a key component with keeping our providers across the Intermountain West connected to the academic medical center to up-to-date information.

As far as our challenges, we've all seen on telehealth virtual visits that there's the same huge spike up, 100X adoption that never would have happened before. We did not anticipate having to scale a 100X within two weeks. But fortunately, we had great, already-established telehealth programs.

The infrastructure was already in place and had been laid over years and fortunately, was able to scale in order to maintain business continuity. For many of our providers, it's just being able to provide that care and then for a telehealth to be able to provide that same business continuity with our affiliate partners that span across the Innermountain West, all of our five neighboring states. We don't acquire, we were very much a collaborative organization and our reach has to go to all of our surrounding states: Wyoming, Idaho, Nevada, Arizona and Colorado.

Our biggest challenge though has been the digital divide. The same challenge that has played itself out, whether it's healthcare, whether it's education, whether it's work, who has access to digital and who doesn't? Who has been able to make the leap into a virtual visit and maintain access during these times and who hasn't? Who have we been leaving behind? And this is something of course, that all of us are passionate about when it comes to equity and disparities and COVID just ripped the Band-Aid back open about these healthcare disparities have been a hallmark of systemic racism, bias, gender bias, and digital has been no different.

I wish that we could say we are doing it differently, and I think there's a lot of awareness on how it can transform the way that we deliver our services in order to really provide equity across our patient populations to our digital technology. But that's something that's going to take more than just a couple of weeks to scale. That's going to take some real time and investment and commitment and leadership. I'm sure my colleagues on the call are equally committed to ensuring that we address disparities that are digitally replaying the same disparities that occur already, but widening the gap even further. I think that's one of our big challenges, at least for me, when it comes to technology in the populations that we serve.

Dr. Michael Apkon: What we see around the country is a lot of horizontal and vertical integration across different hospitals, and that's been the path that many places have taken over the last 20 years or so. But what's starting to evolve into different kinds of alliances, networks of organizations that are like-minded, that are sharing to create a bigger research profile to be able to have a bigger patient population to learn from and to be able to transcend some of the barriers around antitrust and other things that get in the way of forming systems that might be of even bigger scale.

We have care alliances with other academic medical centers around some of the quaternary care that we deliver in advanced heart failure and transplant. We are working on clinical integration through all of our system partners but also through community hospitals outside of our health system where we deliver a range of specialty services in a clinically integrated model.

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