COLLABORATION BEWEEN COMMUNITY HOSPITALS AND U N IVERSlTl ES William C. Fetch, M.D.

ineteen attendees participated, coming from N many sections of the U.S.A. and from Can- ada. Most were university-affiliated, a smaller number came from community hospitals, and several represented industry or other interests. There was general agreement that, in the Or- wellian year 1984, collaboration between com- munity hospitals and universities is still desirable.

Several models of such collaborations were described: a hospitals within American Medical Interna-

tional, a for-profit chain, seek help with their CME programs;

b. the Medical College of Ohio sponsors out- reach CME programs for both affiliated and non-affiliated small hospitals in its service area;

c. Area Health Education Centers (AHECs) are found helpful in Ohio and in California;

d. a long-standing audio network in Ohio has proven effective;

e. the LJniversity of Alabama in Huntsville spon- sors a regional CME committee;

f. the University of Washington has its success- ful WAMI program.

Who initiates collaborative arrangements? Nearly always, they are sought by the hospital. Not infrequently, once the hospital gains expertise- and acquires accreditation status - it may decide to sever relationships with the university. Hos- pitals, especially those of some size, now have their own experts on staff as resources and have less need to turn to the university’s “speak- ers’ bureau.” On the other hand, universities

0 1984 by The Regents o f the University o f California for MOBIUS Vol. 4, No. 4 , October 1984.

have (or should have) superior educational re- sources and expertise, and this capability can be supplied to hospitals (e.g., how to assess needs, how to evaluate, etc.).

Universities are in a competitive race to obtain referrals from the field to fill their tertiary care beds, and this is usually cited as a principal reason for universities to enter into collaborative CME arrangements with community hospitals. There is much anecdotal and a little hard evi- dence to support the validity of this rationale. Still, referral patterns are multifaceted; also, much tertiary-type care once done exclusively in university settings is now done in large com- munity hospitals. It may be that other linkages between universities and community hospitals are more important than referrals, even in bud- getary terms (some economic research possi- bilities exist here, in defining and quantifying what those linkages are).

Marketing is the name of the game today, for both parties. In a sense, universities are com- peting with hospitals for markets, but at the same time are trying to collaborate with them - even to the point of teaching them marketing strategies.

Other, less traditional, collaborative arrange- ments between universities and hospitals exist. One method, used extensively in Wisconsin, is the preceptorship, in which fourth year medical students working with practicing physicians pro. vide a variety of linkages. A similar strategy ;it

Vanderbilt, but using fellows instead of students, has met with less success. Telecommunications

FELCH 85

seems to enjoy some favor now; the WAMI satellite project was well received by physician

expensive than audio alone and require careful attention to production/staging values. The use of cable is at hand; the difficulties of obtaining live audiences are noted because of physicians’ time constraints; this can be overcome by VCR technology, but at the expense of losing inter- action.

If marketing is the name of the competitive strategy, budgets and survival are the ultimate problem. New fiscal constraints, mediated through DRGs or other cost containment mech- anisms, will do away with traditional ways of hospitals paying for CME (e.g., through patient care reimbursements) and will push those costs more directly on to staff physicians. In turn, university funds for CME will shrink.

The consequences of the imposition of the DRG system are difficult to predict. The most obvious is the constraining effect on hospital CME budgets referred to above. But there may be positive effects. For one thing, there will be need to conduct CME exercises on the topic of cost containment. In addition, the complex and detailed data that hospitals will be gathering in order to comply with the DRG program may also be a source of needs assessment information.

At the end, participants agreed that, despite certain current difficulties and a decidedly un- certain future, collaboration between community hospitals and universities generally involves a satsifjring relationship for both parties. 00

WlamC.Fe lch ,M.D. Dr. Felch is executive vice president of the Alliance for

participants. Video techniques are much more Continuing Medical ~ducdtion (ACME).