Family Medicine Can Spur Change in Academia, Leaders Say

"Family medicine can help lead the renewal" of academic health centers, or AHCs, says the overview for "Shaping the Future of Academic Health Centers: The Role of Family Medicine Faculty and Departments," a supplement to the September/October issue of Annals of Family Medicine.

Family medicine departments can help AHCs evolve to meet the needs of patients and society "by pushing for substantial change; by helping to reinvigorate the relationship between AHCs and the communities they serve; and by emphasizing fundamental innovation in clinical care, teaching and research," says the overview.

The supplement features case studies for AHC transformation, commentaries by deans and other academic officials, and excerpts from a panel discussion by leaders in academic medicine.

Warren Newton, M.D., M.P.H., president of the Association of Departments of Family Medicine and professor and chair of the family medicine department at the University of North Carolina at Chapel Hill, and C. Annette DuBard, M.D., research associate in the UNC family medicine department, wrote the overview for the supplement. They define AHCs as institutions that include a medical school and a teaching hospital.

"Without substantial change," say the authors, "AHCs risk irrelevance to society's most pressing needs." Those needs are changing as people live longer, as more patients have chronic diseases and as more people from different cultures immigrate to this country, say Newton and DuBard. They target medical errors, health status rankings in which the United States falls behind other Western countries, and disparities in health care outcomes related to race/ethnicity and socioeconomic status.

Referring to the Institute of Medicine’s report Academic Health Centers: Leading Change in the 21st Century, Newton and DuBard note that the IOM and others “believe that AHCs must evolve dramatically" to ensure they can meet the needs of the communities they serve. In a recent interview, Newton emphasized, “There’s broad consensus within academic medicine that academic health centers risk irrelevance if they don’t change dramatically. It’s not just family medicine saying that. We aren’t just a group of barbarians outside the gates chanting.”

The 2004 Future of Family Medicine report, which gave impetus to the supplement, called on family medicine departments to help rejuvenate academic health centers. The ADFM wrestled with the challenge proposed in Future of Family Medicine report, but, according to Newton, the association already had a “best practices” process for sharing creative ideas and knew "excellent examples of family medicine departments that are taking leadership roles" in changing AHCs, so members decided to showcase some best practices during an audience with academic leaders and teaching hospital CEOs.

That audience occurred at the 2005 fall meeting of the Association of American Medical Colleges in Washington, D.C. The AAMC presentations, which are included as case studies and companion commentaries in the Annals supplement, pertain to AHC missions related to ambulatory and primary care, indigent care, education in community and international settings, workforce policy and practice, and translational research. The case studies are

Excerpts from a panel discussion at the AAMC meeting form the supplement's conclusion. During the discussion, panelist Macaran Baird, M.D., M.S., professor and head of the family medicine and community health department at the University of Minnesota, Minneapolis, said, "We have a dilemma: Like baby birds with their mouths open, the public is ever more needy, but our ever more resource-constrained delivery system is trying to deliver less care instead of more. As with barn raisings, the community can help. … It isn't necessarily about more money; it is more about opening boundaries, listening and reframing the problem."