“A healthier future for all.”
This is the vision behind a new and comprehensive strategic plan developed by the Association of American Medical Colleges (AAMC) and launched on October 27 to guide medical schools and teaching hospitals in their response to the rapidly changing environments of medical education, health care and biomedical research.
Developed in partnership with the AAMC Board of Directors and Leadership Team, and after soliciting broad input from AAMC members and the academic medical community, the Strategic Plan outlines this new vision and 10 plans of action designed to rethink the national approach to patient care, strengthen the continuum of medical education, support the scientific workforce and address decades of inequity.
“The nation faces many seemingly intractable challenges in health care,” herYes AAMC President and CEO David J. Skorton, MD. “As the only association dedicated to transforming health through medical education, patient care, scientific research and community collaborations, the AAMC is ready to meet these challenges and lead the way to a brighter future. healthy.”
AAMCNews sat down with Skorton to discuss the biggest challenges facing medicine today, the 10 action plans in place to address them, and the way forward for AAMC and medical schools, teaching hospitals, health systems, and academic societies that together constitute academic medicine.
This interview has been edited for brevity and clarity.
The AAMC Strategic Plan was developed after a comprehensive environmental scan of the academic landscape in the areas of medical education, healthcare, and biomedical research. Can you briefly talk about the results of this analysis and the biggest challenges facing academic medicine today?
Over a period of several months – with considerable input from AAMC staff, Learn Serve Lead 2019 Annual Meeting attendees and others – we conducted an extensive environmental scan that was expertly designed by our colleague, [AAMC Senior Director of Strategy and Innovation Development] Bill Mallon. The results weren’t entirely surprising, but they were striking and showed how far we have to go to achieve our goals.
First, the demographics of the United States profoundly affect society and social policy, especially the increase in diversity in all dimensions. The costs of health care and the lack of affordability of health care are absolutely unsustainable. By the way, this affordability problem has gotten even worse since the start of the pandemic. In equilibrium, about half of the population derives its health care benefits from occupational health insurance. The pandemic-related economic downturn has put many people out of work. So you lose your job and you get two bad news. First, you lost your paycheck and a lot of security for you and your family, and second, very often, you lost your health insurance.
Another major area where we are lagging is in diversity, equity and inclusion. Our failure to create a more diverse medical workforce and more diverse, equitable, and anti-racist institutions has caused countless problems, gross health inequities, distrust of the medical system in communities color and, heartbreakingly during the pandemic, much higher rates. infections, hospitalizations and deaths among marginalized and minority communities.
The strategic plan articulates a vision to ensure a healthier future for all through four pathways: learning, discovery, healthcare and community collaborations. Can you explain how the plan proposes to:
- Strengthen the learning environment for students, residents and beyond?
One of the areas in which I believe the AAMC is universally respected and recognized is the quality of our work and thinking about medical education. We are honored by the leadership of [AAMC Chief Medical Education Officer] Alison Whelan, MD, and [AAMC Chief Academic Officer] John Prescott, MD, who has extensive expertise in this area. Medical education is truly a continuum, especially if you look at the entire life cycle: the foundations one acquires in high school and college, the knowledge imparted by undergraduate medical education, the refinement of skills in higher medical education, then continuing medical education. . The innovations in our member institutions’ curricula are breathtaking, but the things that have been done during COVID are also truly amazing. The strategic plan will examine many of these elements to help learners – from medical students to practicing physicians – adapt and pivot to meet changing health care needs.
- Support and strengthen our scientific workforce?
Even though the NIH budget has grown quite vigorously over the past five or six years, in terms of purchasing power, we’re just back to where we were in 2003. So that means students and postdocs can watch their mentors and seeing people who have had a long and challenging training and then find themselves in a place where it’s really hard to get funding. So I worry about people who still aspire to a career in research. I am also concerned about the flow of funds within our academic medical centers in the sense that much of the research is funded by the clinical enterprise. So if something happens – as it did during the pandemic – to clinical revenue, it could well have a negative impact on research funding within the institution.
In a way, this is the greatest moment of my life for medical research. What would we do if we didn’t have research leading to a vaccine? What would we do if we didn’t have research leading to effective antivirals? I remember the very early days of the HIV epidemic, when learning you were HIV-positive was a death sentence. And then, thanks to medical research and the participation of the affected population, we have now turned the situation around so that with adequate access to care and adequate access to medicines and with confidence in the health system, people live longer and healthier. This is just one example, but we have to follow a paradigm like that for what is happening now.
- Making health care more equitable and affordable for all?
One of the great strengths of the United States and one of the great challenges of policy change in the United States is the distributed nature of decision-making. The 10th Amendment to the Constitution states that “powers not delegated to the United States by the Constitution, nor prohibited by the States, are reserved to the States.” So we first have to realize that any issue we have – whether it’s how we raise our children in the K-12 system, policing protocols, affordability of health care – will often depend on the situation in states and local communities. Federal policies alone cannot do the job.
Nonetheless, we now face a dilemma where the Affordable Care Act is being challenged in the Supreme Court, which could have a huge impact on patients’ ability to access care. Even now we have tens of millions of people without insurance coverage. And we know that people without insurance coverage are less likely to see a doctor, sometimes delaying their care until they are very sick and need to go to the emergency room. So if we really want to improve health and not just treat acute illnesses, we need to make sure that people have the financial means to access care and that that care is delivered locally.
- Learn from and work with community leaders to meet local health needs?
When we did the environmental scan and started talking about patients, families and communities, we were so struck by the need to include a community perspective that we decided to broaden the mission traditional tripartite of academic medicine which has been health care, education, and research to include community collaborations. The most important part of any collaboration is two-way communication: we have to listen to what our communities are telling us. We need to understand the lived experiences of our patients and their families. And we don’t have to be so sure we have all the answers and open ourselves up to this absolutely invaluable contribution.
With the launch of this plan, do you see a fundamental change in the functioning of the AAMC?
I don’t think the core attributes of the AAMC: operate on the basis of evidence; listening to our members; being willing to tell the truth and be involved in the political process – we’re apolitical, we’re non-partisan, but we’re very involved in the political process – those things aren’t going to change. But the details of how we make them is. One thing we already do is speak out, and not just in medical journals. If we have something to say, if it’s in our field, we have to come out and say it.
With this plan, we are establishing two entities that will help us bring our expertise to the fore: the AAMC Research and Action Institute led by Atul Grover, MD, PhD, and the AAMC Center for Health Justice, led by Philip Alberti, PhD, and co-supervised by Malika Fair, MD, MPH. They will bring their research and experiences to solving some of the toughest problems we face.
A strategic plan is never meant to be a catalog of everything an organization does. It’s meant to do the hard work of focusing for greater impact. If resources are limited, they always are; if people’s time is limited, which it always is, the way to achieve maximum impact is to focus as much as possible. And so, we focus on these 10 action plans. We are devoting resources to it — human resources and financial resources.
Given all the challenges facing academic medicine during this pandemic – our physicians continue to treat the sickest COVID-19 patients, researchers in academic laboratories are developing COVID-19 tests and treatments, and learners have been called upon to practice at the highest level of their training — why did you decide to launch the plan now?
Sometimes a crisis makes us realize that the status quo is unacceptable. I think there is no better time than the present to address long-standing issues that have been highlighted by the pandemic.