Governance of Academic Medical Centers Is Indeed a Complex and Unique Operation

As academic medical centers (AMCs) have extended their operations into their communities, partnered with new organizations, and developed new modes of operation to achieve their missions, new governance approaches are required. Chari and colleagues, in this issue of Academic Medicine, describe the development and application of criteria to evaluate governance options for the University of California (UC), which has a number of public AMCs, almost all of which are components of individual UC universities. Although many of these criteria may also be applicable to smaller AMCs, a more individual approach to governance is required-that is, one must step back and first ask about the organization, structure, and goals of the entities to be governed. The major nonfederal and nonspecialty teaching hospitals in the United States are about evenly split between those that are university owned or controlled and those having an independent relationship with their associated medical school. However, the challenges, obstacles, and desired end points are similar. The development of a successful governance structure will require identifying and appreciating many factors.