Health care reform continues: themes for academic medicine

The challenge for U.S. academic medicine in this decade is to redesign itself to serve its classic functions--teaching, research, and special service to patients--while filling the needs of what is evolving into a comprehensive integrated system of health care. First, in the absence of federally legislated comprehensive health care reform, the health care community must develop a consensus on the purposes, scope, and content of health care to bring some reason and order to the short-term, market-driven incrementalism that governs today's health care. Specifically, the author proposes that the issues of health care be defined in a broad social context, that the gap between public health and medicine be lessened, and that perspectives of public health and health promotion and disease prevention be more effectively incorporated into medical education. Second, there is an urgent need for new approaches to funding and financial management of teaching, research, and patient care in academic health centers to counter the erosion of traditional sources of support. Third, to sustain generalist physician practices of high quality, a conceptual basis for generalism must be defined in affirmative functional terms, and the generalist's frame of reference and intellectual tools and processes must be formulated. Last, many forces are now acting to reduce the intellectual content of medical practice and teaching. Academic medicine--in teaching and in research--must nurture and promote the intellectual content and standards of all aspects of medicine to sustain the quality of clinical practice over time.(ABSTRACT TRUNCATED AT 250 WORDS)