Strengthening academic medicine's public mandate in a time of intense challenge

The field of academic medicine, through its tripartite mission, has for decades driven scientific achievement, translated biomedical research into improved clinical outcomes, and educated the next generation of researchers and medical practitioners. Throughout its history, it has remained resilient in the face of changing political and funding environments and evolving attitudes toward science and medicine. However, rarely has academic medicine confronted changes as abrupt and destabilizing as those unfolding today. To successfully navigate this moment and preserve its essential mission of advancing research, patient care, and medical training, the authors propose a roadmap for leadership at academic medical centers(AMCs). AMCs must stand firm in the face of political and policy pressures, defend core principles, and remain committed to the mission. They should bolster financial stewardship through increased operational efficiency, prioritization of mission-critical programs and core academic functions, and consolidation of nonaligned activities. This will include developing strategic partnerships, especially with philanthropy and industry, to unlock new opportunities and diversify funding, as well as remodeling research and education and innovating with artificial intelligence. Importantly, AMCs must strengthen commitment to the workforce, particularly through support for vulnerable early-career trainees and faculty. Finally, AMCs should align research and clinical priorities with public priorities to strengthen the social compact between medicine and the communities it serves and increase public trust.