Our Concerned Community

Amid national budget and policy uncertainties, the academic medicine community held meetings this spring to discuss how to move forward while staying true to its missions.

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Darrell G. Kirch, MD, AAMC President and CEO

Each spring, many of our AAMC constituent groups and councils hold meetings to discuss academic medicine’s current challenges and opportunities.  Academic medicine is a large tent, and the AAMC represents many individuals with many different roles at our institutions, from physicians and researchers, to students and faculty, to deans and CEOs.  But while the breadth of experiences and perspectives in academic medicine is broad, certain challenges are felt across our entire community.  With significant uncertainty at the national level, I felt that it was important to attend as many group meetings as possible this spring to hear how different institutions and constituencies are affected by our national challenges.  

At every meeting I attended, there was expressed anxiety about the changes and uncertainty surrounding the future of health care policy and delivery.  Top of mind for everyone were the efforts to repeal and replace the Affordable Care Act (ACA) and general concern over the future of health care financing and delivery.  The day congressional leaders pulled the American Health Care Act (AHCA)—proposed legislation to repeal and replace the ACA—from consideration on the House floor, I was at the Council of Deans spring meeting.  As the news broke that the vote was cancelled, leaders of AAMC institutions were already looking ahead:   What can we expect for the future of Medicaid expansion? Should we expect ongoing efforts to enact a wholesale repeal and replace of the ACA?  Or will there be attempts to fix parts of the law?  

I also heard grave concerns about the possibility of funding cuts across our mission areas and at the National Institutes of Health (NIH) in particular.  The Trump administration’s budget blueprint for FY 2018 proposed a $5.8 billion cut to NIH—a reduction that some lawmakers have suggested may be achieved by cutting the important reimbursements institutions receive for facilities and administrative costs.  In addition to concerns about the NIH budget, many worries about other funding challenges across our mission areas—from potential reductions in funding for pipeline programs to changes in federal loans that might affect student debt—were expressed.  Clearly, sustaining our missions in an era of dwindling support and resources is an issue keeping some of us up at night.

Midway through our spring meetings, our institutions celebrated Match Day, with 94% of U.S. medical school seniors matching to a residency training program.  However, Match Day came on the heels of sobering new data released by the AAMC that reaffirmed the United States continues to face a projected physician shortage of between 40,800 and 104,900 doctors by 2030.  I heard concerns from all corners of our community about whether we have an adequate number of residency training positions to train enough new physicians to meet the needs of our growing and aging population.

Another challenge affecting both our physician supply and the futures of individual physicians is the ongoing uncertainty around immigration and students with Deferred Action for Childhood Arrivals (DACA) status.  In academic medicine, we prize the spirit of openness and inclusion that animates our research and brings top physicians and scientists from around the world together.  While the fate of the current executive action on immigration is with the courts, we continue to focus on the importance of immigration for U.S. health care and the practical advantages of bringing together diverse physicians and scientists with unique worldviews and experiences in research and care.

Although we face intensified challenges on the advocacy front, I remain heartened by everything that academic medicine is doing to find solutions.  We are putting the diversity of experience and perspectives within our organizations to work solving the challenges we face as a community.  Our institutions are engaging government leaders to ensure that the academic medicine viewpoint is understood as we work tirelessly to find ways to achieve high-quality health care for all Americans.  Our community is partnering with other stakeholders in higher education and research to help policymakers understand that facilities and administrative expenses are a necessary and important component of medical research.  Medical schools and teaching hospitals are developing more effective clinical practice models, creating cultures of interprofessional team-based care, advancing medical treatments and technology, and improving the competencies and diversity of our health care workforce, even as we work to expand residency training.  And as a community, we are working to protect the ability of students, physicians, researchers, and patients to cross borders to participate in American health care.

We are in as turbulent and uncertain a time as any I have faced in the nearly 11 years I have served as AAMC president.  But I experienced incredible energy and commitment as I attended the spring meetings of our AAMC councils, organizations, and groups.  I remain absolutely confident that, if we work together to bring the innovative spirit that animates academic medicine to bear on our current challenges, we will find solutions and create a healthier future for all.