From Medical School
Applicant to Health
Reform Leader
University of South Carolina
School of Medicine
Darrell G. Kirch, M.D.
President and CEO, AAMC
March 16, 2011
The Legacy of Abraham Flexner for
Medical Education
© 2010 AAMC. May not be reproduced without permission.
The Culture of the University
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The Legacy of
James B. Wyngaarden, M.D. for
Biomedical Research
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The Culture of Biomedical Research
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The Legacy of Lyndon B. Johnson for
Health Care
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The Culture of Health Care
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Academia as a Major Provider of
Health Care
AAMC-member teaching hospitals represent 6% of all
hospitals
Their work represents:
• 40% of all Medicare inpatient days
• 22% of all Medicaid inpatient days
• 40% of all hospital charity care
They provide:
• 79% of all burn center beds
• 40% of neonatal intensive care beds
• 83% of all ACS-verified Level 1 regional trauma centers
Overall, AAMC-member teaching hospitals provide 20%
of all hospital care
© 2010 AAMC. May not be reproduced without permission.
Our national political reality!
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A Bipartisan Moment…
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…Followed by a Partisan
Statement…
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…Followed by Conflict at the
State Level
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The State of the Union
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Our national economic reality!
© 2010 AAMC. May not be reproduced without permission.
© 2010 AAMC. May not be reproduced without permission.
© 2010 AAMC. May not be reproduced without permission.
Source: NEJM. April 1, 2010. Vol.362(13). 1166-1168.
© 2010 AAMC. May not be reproduced without permission.
Our national health care reality!
© 2010 AAMC. May not be reproduced without permission.
“Recession Contributes To Slowest
Annual Rate Of Increase In Health
Spending In Five Decades”
2009 Total Health Expenditure
$2.5 trillion
4% from 2008
17.6% GDP
1% from 2008
Source: Health Affairs, 30, no.1 (2011):11-22
© 2010 AAMC. May not be reproduced without permission.
Deficits in Insurance Coverage
Number of Uninsured Children and Non-elderly Adults- 2004-2009
45
45.7
50
Millions
43 44.4 46.5
“Uninsured Rate Soars, 50+ Million Americans
Without Coverage”
— Kaiser Health News
16 September 2010
Source: The Uninsured: A Primer. Kaiser Family Foundation. December 2010.
© 2010 AAMC. May not be reproduced without permission.
Deficits in Access
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Deficits in Outcomes
U.S. Comparison to Developed Nations
2007 Life
Expectancy
2006 Infant
Mortality
2006 Adult
Obesity*
Bottom third
4th Highest
1st
(77.9 yrs compared
to Japan at 82.6)
(6.7% compared to
average 5.1%)
(Over 1/3 of U.S.
population)
*Only 5 nations reported data on this indicator
Source: OECD Health Data 2010, June 2010
© 2010 AAMC. May not be reproduced without permission.
South Carolina Health Status
U.S. average
Life expectancy
South
Carolina
75.8 years
Infant mortality rate
9
6.8
92.9
190.9
9.3
5.5
62.8%
60.8%
78 years
(per 1,000 live births)
Heart disease rate
(per 100,000)
Diabetes rate
(per 100 adults)
Overweight/obese adults
Source: statehealthfacts.org
© 2010 AAMC. May not be reproduced without permission.
Percent GDP
Government Social Spending - 2007
Source: Social expenditure: Aggregated data, OECD Social Expenditure Statistics (database)
doi: 10.1787/20743904-2010-table1
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In the face of these realities,
have we really “reformed”
health care?
© 2010 AAMC. May not be reproduced without permission.
Can We All Commit to “Fixing” Health
Care?
American Expectations
Care
Model
Professional
Issues
Economic
Model
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Can We All Commit to “Fixing” Health
Care?
American Expectations
Care
Model
Health
Insurance
for All
Professional
Issues
Economic
Model
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Rational
Payment
System
Can We All Commit to “Fixing” Health
Care?
American Expectations
Care
Model
Professional
Issues
Economic
Model
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Can We All Commit to “Fixing” Health
Care?
American Expectations
Creating
True Teams
Confronting
Care
Workforce
Model
Shortages
Professional
Issues
Economic
Model
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Can We All Commit to “Fixing” Health
Care?
American Expectations
Care
Model
Professional
Issues
Economic
Model
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Can We All Commit to “Fixing” Health
Care?
American Expectations
Care
Model
Changing the
Focus From
“Sickness” to
“Wellness”
Professional
Issues
Creating True
“Medical
Economic
Model
Homes”
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Can We All Commit to “Fixing” Health
Care?
American Expectations
Care
Model
Professional
Issues
Economic
Model
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
An Emerging Culture for Health Care
Hierarchical
Collaborative
Autonomous
Team-based
Competitive
Service-based
Individualistic
Mutually accountable
Expert-centered
Patient-centered
© 2010 AAMC. May not be reproduced without permission.
Can We All Commit to “Fixing” Health
Care?
American Expectations
Care
Model
Professional
Issues
Economic
Model
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
What Americans Want From
Health Care
I want it now!
I want the
latest in
health care!
Adapted from T. Gorrie
© 2010 AAMC. May not be reproduced without permission.
I want
someone else
to pay the
bill!
I want to
prolong life
as long as
possible!
If anything
goes wrong, I
want to sue
someone!
Can We All Commit to “Fixing” Health
Care?
American Expectations
Care
Model
Professional
Issues
Economic
Model
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Healthcare Innovation Zones
Source: Patient Protection and Affordable Care Act, H.R. 3590
© 2010 AAMC. May not be reproduced without permission.
Will we have the health care
professions workforce to take
care of us?
© 2010 AAMC. May not be reproduced without permission.
Rising to the Challenge of
Workforce Shortages
With PPACA
91,500
Without PPACA
58,000
64,100
30,200
7,400
25,200
Projections prepared by the Lewin Group for the AAMC
© 2010 AAMC. May not be reproduced without permission.
First-Year Medical School Enrollment
Projected to Increase 21% by 2012
Existing + New Schools
Existing Schools
16,488
Source: AAMC Annual Survey of Medical School Expansion Plans
© 2010 AAMC. May not be reproduced without permission.
Will we create a true continuum
of medical education?
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Can We Rethink Our Approach to
the Medical Education Continuum?
Premedical
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Medical
School
Residency
and
Fellowships
Practice
AAMC
Medical
Schools
FSMB
AHME
State
Boards
NBME
MCAT
USMLE
Subject
Exams
Premedical
LCME
ABMS
CMSS
AMA
AHA
Specialty
Societies
Specialty
Boards
Cert
Exams
CME
Recert/
MOC
In-Training
Exams
Medical
School
ACGME
© 2010 AAMC. May not be reproduced without permission.
Residency and
Fellowships
ACCME
Practice
NCQA
JCAHO
Creating a True Continuum of
Medical Education
Learning
Premedical
Medical
School
Assessment
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Residency
and
Fellowships
Practice
In the end, is this all just a
matter of politics?
© 2010 AAMC. May not be reproduced without permission.
Source: JAMA. 2009;301(14):1482-1484
© 2010 AAMC. May not be reproduced without permission.