kirch-2-8-08 amspc.ppt

Darrell G. Kirch, M.D.President and CEO, AAMC February 8, 2008

The Chair of the Future: Crossing the Cultural Divide

Association of Medical School Pharmacology Chairs

© 2008 AAMC. May not be reproduced without permission.

An Historical Perspective

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The Academic Health Center

Medical School

University

Physician Practice

Hospitals and Clinics

© 2008 AAMC. May not be reproduced without permission.

So How Do We All Feel About Academic Medicine 100 Years After

Flexner?

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Connecting Outside the Beltway

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Accreditation Council for Continuing Medical Education

Accreditation Council for Graduate Medical Education

American Hospital Association

American Medical Association

Educational Commission for Foreign Medical Graduates

Federation of American Societies for Experimental Biology

Federation of State Medical Boards

National Board of Medical Examiners

American Association of Colleges of Pharmacy

Association of Governing Boards of Universities and Colleges

Association of American Universities

American Council on Education

National Association of State Universities and Land Grant CollegesWashington Higher Education Secretariat

Institute of Medicine

Alliance for Academic Internal Medicine

American Association of Colleges of Nursing

Connecting Professionally

American Association for Retired Persons

American Association of Directors of Psychiatric Residency Training

American Psychiatric Association

American College of Cardiology

American Dental Education Association

American Medical Student Association

American Public Health Association

American Surgical Association

Association of American Physicians

Association of American Veterinary Medical Colleges

Association for Hospital Medical EducationAssociation of Osteopathic Directors and Medical Educators

Association of Schools of Public Health

Blue Ridge Academic Health Group

Council of Heads of Medical Schools

Council of Medical Specialty Societies

Howard Hughes Medical Institute

Institute for Healthcare Improvement

Joint Commission on Accreditation of Healthcare Organizations

Learning Action Network

Medical Group Management Association

National Health Council National Health Museum

National Medical Fellowships

Association of Professors of Medicine

Society of Medical Administrators

Association of Medical School Pharmacology Chairs

© 2008 AAMC. May not be reproduced without permission.

What is the source of our discontent?

Is it all just about money?

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Some Fiscal Realities NIH Funding, FY 1995-2009 [in billions]NIH Funding, FY 1995-2009 [in billions]

$0

$5

$10

$15

$20

$25

$30

$35

1995 1997 1999 2001 2003 2005 2007 2009

Constant (BRDPI)

Current

(Budget)

© 2008 AAMC. May not be reproduced without permission.

Some Fiscal RealitiesFaculty Compensation vs. the CPI

4.7%5.2%

2.9%

4.1%

2.4%

5.0%

3.6%

3.5%

2.2%

2.9%2.9%2.9%

2.1%

7.1%7.3%

4.8%4.2%

2.7%

4.3%

2.5%

3.3%

2.1%

1.1%

3.2%

3.7%

2.3%

2.2%

2.9%2.6%

2.9%

2.8%3.1%

3.8%

5.6%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07

Compensation % increase

CPI % Increase

Source: AAMC Report on Medical School Faculty Salaries, 1990-1991 through 2004-2005

© 2008 AAMC. May not be reproduced without permission.

Some Fiscal RealitiesProjected Loan Payments as a Percentage of Projected Physician After-Tax Income

Source: “Medical Educational Costs and Student Debt,” AAMC, 2005

© 2008 AAMC. May not be reproduced without permission.

The Ultimate Fiscal Reality – The Federal Deficit

“GAO’s current long-term simulations continue to show ever-larger deficits resulting in a debt burden that ultimately spirals out of control.”

– David M. Walker

U.S. Comptroller General

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What is the source of our discontent?

Have we simply failed to find the right strategy?

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A Decade of Growth: Total Annual Medical School Revenues

0

10

20

30

40

50

60

70

80

1996 2006$ billions

$32 billion

$ 71 billion

© 2008 AAMC. May not be reproduced without permission.

A Decade of Growth: Total Annual Federal Research Funding

0

2

4

6

8

10

12

14

16

1996 2006$ billions

$ 5.8 billion

$ 15 billion

© 2008 AAMC. May not be reproduced without permission.

A Decade of Growth: Total AnnualSupport from Teaching Hospitals

0

2

4

6

8

10

12

1996 2006$ billions

$ 4.8 billion

$ 9.6 billion

© 2008 AAMC. May not be reproduced without permission.

A Decade of Growth: Total Number of Full-Time Medical School Faculty

0

20

40

60

80

100

120

140

1996 2006In thousands

93,240

121,326

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A Decade of Growth: Pharmacology Department Total Expenditures

$756

$371

$

$100

$200

$300

$400

$500

$600

$700

$800

1995 2005

In millions

million

million

© 2008 AAMC. May not be reproduced without permission.

A Decade of Growth: Pharmacology Department Research Expenditures

$188

$456

$

$100

$200

$300

$400

$500

1995 2005

In millions

million

million

© 2008 AAMC. May not be reproduced without permission.

A Decade of Growth: Total Number of Full-Time Pharmacology Faculty

1797 1958

0

1000

2000

3000

4000

5000

1996 2006

© 2008 AAMC. May not be reproduced without permission.

A Profession On the Rise

• A record number of nearly 17,800 students began medical school this year.

• A Gallup poll tells us that the American public continues to view medicine as the “most desirable” profession a young person could pursue.

© 2008 AAMC. May not be reproduced without permission.

If the problem isn’t as simple as money and strategies to build

revenues, where should we turn our attention?

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Embracing a New Culture in Academic Medicine

“Culture eats strategyfor lunch every day”

Andy Grove

Former Chairman of Intel

© 2008 AAMC. May not be reproduced without permission.

© 2008 AAMC. May not be reproduced without permission.

The Traditional Culture of Academic Medicine

• Individualistic

• Autonomous

• Scholarly

• Expert-centered

• Competitive

• Focused

• High-achieving

• Hierarchical

© 2008 AAMC. May not be reproduced without permission.

Embracing an Emerging Academic for Academic Medicine

• Collaborative

• Transparent

• Outcomes-focused

• Mutually accountable

• Team-based

• Service-oriented

• Patient-centered

© 2008 AAMC. May not be reproduced without permission.

What Does This Mean for Medical School Leaders?

If “culture eats strategyfor lunch every day…”

And if a positive culture is a key source of future excellence…

How do we change the culture in our institutions?

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#1 Make values explicit, and

use them visibly in everyday decisions!

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Academic Medicine; June 1996

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Are Stated Values Consistently Aligned with Actions?

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#2 Align governance, leadership, and

management across organizational

and “corporate” divisions!

© 2008 AAMC. May not be reproduced without permission.

The Academic Health Center

Medical School

University

Physician Practice

Hospitals and Clinics

© 2008 AAMC. May not be reproduced without permission.

#3 Use the tools of mission-based management

to realign and maximize resources!

© 2008 AAMC. May not be reproduced without permission.

DiscretionaryFund

The Cauldron

Tuition andAppropriations

Grants andContracts

Clinical Care

Research

Education

Physician andHospital Revenues

A New Model for the Organization – Aligning Revenues with Effort

Source: D. Hefner

© 2008 AAMC. May not be reproduced without permission.

Mission-Based Funds Flow:The Interdependence of Our Missions

+ 25.7m

Hospital

Clinical Enterprise

($16.7m) ($8.4m) +$2.1m ($14.3m)

AdminPhysiciansEducationResearch

Overall Conclusion: At this college of medicine, the hospital and (to a lesser degree) the physician practice, cover negative margins in all other missions.

© 2008 AAMC. May not be reproduced without permission.

Program Assessment

Mission

Contribution

Financial Performance

High/LowHigh/Low

Low/Low

High/HighHigh/High

Low/HighLow/High

© 2008 AAMC. May not be reproduced without permission.

#4 Foster collaboration and accountability,

accepting nothing short of

high performance teams in all mission areas!

© 2008 AAMC. May not be reproduced without permission.

A New Model for the Organization – Creating High Performance Teams

Source: Katzenbach and Smith, 1993

PE

RF

OR

MA

NC

E I

MP

AC

T

TEAM EFFECTIVENESS

Pseudo-Team

Working Group

Real Team

Potential Team

High-performing Team

© 2008 AAMC. May not be reproduced without permission.

The Teams Approach

Mission-Based Teams

Relationship-Based Teams

Resource Teams

Research

Academic

Clinical

IRT

Strategic Relations(including communication and marketing, and development)

Human Resources

Finance

Physical Resources

Teams Council

© 2008 AAMC. May not be reproduced without permission.

#5 Focus leadership recruitment on

organizational fit, and do real succession

planning for long-term stability!

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© 2008 AAMC. May not be reproduced without permission.

© 2008 AAMC. May not be reproduced without permission.

#6 Rethink our approach to education!

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Discontinuity in the Medical Education Continuum

Premedical Medical School

Residency and Fellowships

Practice

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In Search of Transformation – New Models of Continuity for the Process

Premedical Medical School

Residency and Fellowships

Practice

© 2008 AAMC. May not be reproduced without permission.

In Search of Transformation – New Models of Continuity for the People

Premedical Medical School

Residency and Fellowships

Practice

Premedical Medical School

Residency and Fellowships

Practice Life-longLearning

Two-YearCollege

Premedical Medical School

Residency and Fellowships

Practice Life-longLearning

Pre-medical

Medical School

Residency and Fellowships

Practice Life-longLearning

Non-Premed Degree

PracticeRe-training

Life-longLearning

© 2008 AAMC. May not be reproduced without permission.

Embracing an Emerging Academic for Academic Medicine

• Collaborative

• Transparent

• Outcomes-focused

• Mutually accountable

• Team-based

• Service-oriented

• Patient-centered

© 2008 AAMC. May not be reproduced without permission.

Creating a Culture of Teamwork and Collaboration

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Creating a Culture of Reliability and Quality in the Face of High Risk

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Creating a Culture Based on “Evidence” Rather Than “Eminence”

Issacs and Fitzgerald, BMJ 319: 1618, 1999

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Creating a Culture of Trust

© 2008 AAMC. May not be reproduced without permission.

Creating a Culture in Which All Teach and All Learn