Thoughts About Change in U.S. Healthcare: Edmund F. Funai, M.D.

I initially trained as an obstetrician and then as a high-risk maternal fetal medicine specialist. I did that for a number of years and really got a lot of satisfaction out of improving the lives of patients. But early in my career I got an opportunity to also take a leadership role in not only providing direct patient care, but creating systems and policies and procedures and cultures that provided the best possible care for hundreds, if not thousands, of patients.  It was a a career changing opportunity for which I will always be grateful.  What I learned in the process is that I’m just as happy to be one step removed and in the background making it all work seamlessly and improving the lives of many without necessarily being front and center and being the one who receives the thanks from the patient individually. So, I found that this can make an even bigger impact by putting some of the analytic skills and problem solving skills that I developed over time to rea...

The question for today is whether academic medicine is at risk for extinction. To answer that question, let's take a deeper dive and look at how the average medical school funds itself. The data from the AAMC shows that only about 4% of the medical school budget is covered by tuition -- this may be surprising to many of you who are still paying off your student loans. The majority of the funding for a medical school is from clinical revenue, be it hospital contracts or faculty practice collections. The real take-home message is that it's the clinical practice that cross-subsidizes the research and education mission in academic medicine.  So, when the clinical mission catches a cold, the rest of the academic medical center gets pneumonia. The big problem is we're now in perennial flu season. And why is that? Well, let's look at how much we spend as a nation on healthcare. By 2018 or 2019, about 20 cents of every dollar in the U.S. economy is going to be...

Time to Rethink Where We Are Many experts agree that the U.S. healthcare system is in the midst of its greatest period of uncertainty in a generation. We live in a dynamic health care delivery environment. Old paradigms focused almost exclusively on volume, driven by fee-for-service (FFS) reimbursement. New paradigms are evolving for health care delivery driven by value innovation – better outcomes for lower cost. Coincident with value-based care is a new emphasis on patient safety, evidence-based medicine and better coordination of care. The future is also likely to see new health care market segmentation with capitated populations co-existing with concierge-style care and traditional FFS payments. Academic Health Centers (AHCs),  to which I have devoted my career thus far, are exceptionally vulnerable to these changes,  Having a tripartite mission:  clinical care, research, and the education of the next generation of physicians, introduces unique inefficienc...