Changes in health care challenge teaching hospitals

Should teaching hospitals accept government subsidies to shrink the number of residents they train? Probably.

Will for-profit management of university hospitals jeopardize the quality of care? Maybe, maybe not.

Should academic medical centers speed up their clinical research to satisfy pharmaceutical companies? Probably not.

Such was the rough consensus of the medical professionals gathered in the Medical School's Dunlop Auditorium on Monday, Feb. 2, for the third annual Thomas Langfitt Jr. Memorial Symposium, co-sponsored by the Office of the Vice Dean for Medical Education and the Leonard Davis Institute of Health Economics.

The panelists, representing Wall Street, the private sector and academe, discussed three case studies drawn from recent events that illustrate trends affecting academic medical centers today.

One trend is a looming oversupply of specialists, a condition the federal government hopes to cure by reducing resident subsidies over time. Thomas W. Langfitt, the chairman of the Commission on the Future of Medical Education, thought the idea made sense, but Institute on Aging Director Risa Lavizzo-Mourey cautioned that the forecasts used to justify cutbacks may prove inaccurate.

The private-sector panelists made two main points about for-profit management and the quality of care at teaching hospitals: the for-profit revolution has already changed the way non-profit medical centers operate, and a for-profit operation must maintain quality to keep its beds full. "The last thing investors would want is for you to take risks with treatment that would cause headlines and ruin your image," said L. Patrick Oden, senior advisor for health care services at Ziegler Securities.

Health System CEO and Medical School Dean William Kelley seconded these points, noting that "even an academic medical center must scramble to produce a surplus to maintain its bond rating, meet capital needs and fulfill its academic mission." And Alan B. Miller, board chairman, president and CEO of Universal Health Services, felt that for-profit organizations fare best when they "do the right thing and manage for the long run. Your market capitalization may go down today, but it will come back up tomorrow."

But Center for Bioethics Assistant Professor Mildred K. Cho cautioned, "It's true that [non-profit] medicine has always had a 'for-profit' component, but there's a question of fiduciary duty. At a non-profit institution, care of the patient comes first."

Cho expressed similar reservations about revamping clinical research to meet the time demands of pharmaceutical companies. "There's a potential conflict-of-interest issue involved," she said, noting that doing so may result in cutting corners to save time. Premier Worldwide Research economist Jonathan Seltzer also noted that "the culture of drug companies is different from that of academic medical centers," remarking that the drug firms' need for speed conflicts with the nature of academic medical research.

Originally published on February 12, 1998