Academic medicine in turbulent times

Long respected as centers of research and educational excellence, many traditional academic medical centers (AMCs) realize that their research and educational missions will be difficult if not impossible to sustain, if all the federal funding cuts discussed in anticipation of the "fiscal cliff" occur. To set the context for this perfect storm, we will review the many issues that will affect all hospitals and then focus on the three that will disproportionally affect academic medical centers ... and keep "CEOs up at night." Aside from a case of CEO chronic insomnia, how do we expect AMCs to weather this perfect storm? Whereas the fundamental emphasis remains on highly specialized and complex care, AMCs are increasingly developing innovative approaches for managing patients across the continuum of care and strengthening their ability to manage patients with high-cost, chronic conditions.