darrell g. kirch, m.d. president and ceo, aamc march 16, 2011 from medical school applicant to...
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Darrell G. Kirch, M.D.President and CEO, AAMCMarch 16, 2011
From Medical School Applicant to Health Reform Leader
University of South Carolina School of Medicine
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The Legacy of Abraham Flexner for Medical Education
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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
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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!
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© 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!
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“Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades”
Source: Health Affairs, 30, no.1 (2011):11-22
2009 Total Health Expenditure
17.6% GDP
4% from 2008
1% from 2008
$2.5 trillion
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Deficits in Insurance Coverage
43 44.4 46.5 45 45.7
Mil
lio
ns
Number of Uninsured Children and Non-elderly Adults- 2004-2009
Source: The Uninsured: A Primer. Kaiser Family Foundation. December 2010.
“Uninsured Rate Soars, 50+ Million Americans Without Coverage”“Uninsured Rate Soars, 50+ Million Americans Without Coverage” — Kaiser Health News
16 September 2010
50
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Deficits in Access
© 2010 AAMC. May not be reproduced without permission.Source: OECD Health Data 2010, June 2010
Deficits in Outcomes
U.S. Comparison to Developed Nations
*Only 5 nations reported data on this indicator
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South Carolina Health Status
South Carolina
U.S. average
Life expectancy 75.8 years 78 years
Infant mortality rate (per 1,000 live births)
9 6.8
Heart disease rate (per 100,000)
92.9 190.9
Diabetes rate (per 100 adults)
9.3 5.5
Overweight/obese adults 62.8% 60.8%
Source: statehealthfacts.org
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Government Social Spending - 2007
Source: Social expenditure: Aggregated data, OECD Social Expenditure Statistics (database) doi: 10.1787/20743904-2010-table1
Per
cen
t G
DP
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In the face of these realities, have we really “reformed” health care?
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Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
Health Insurance
for All
Rational Payment System
© 2010 AAMC. May not be reproduced without permission.
Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
Confronting Workforce Shortages
Creating True Teams
© 2010 AAMC. May not be reproduced without permission.
Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
Changing the Focus From
“Sickness” to “Wellness”
Creating True “Medical Homes”
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Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
CollaborativeHierarchical
Autonomous
Competitive
Expert-centered
Mutually accountableIndividualistic
Team-based
Service-based
Patient-centered
An Emerging Culture for Health Care
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Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
I want the latest in
health care!
I want to prolong life as long as possible!
If anything goes wrong, I want to sue someone!
I want it now!
I want someone
else to pay the bill!
Adapted from T. Gorrie
What Americans Want From Health Care
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Care Model
Professional Issues
Economic Model
Can We All Commit to “Fixing” Health Care? American Expectations
Institutional Culture
© 2010 AAMC. May not be reproduced without permission.
Healthcare Innovation Zones
Source: Patient Protection and Affordable Care Act, H.R. 3590
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Will we have the health care professions workforce to take care of us?
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Rising to the Challenge of Workforce Shortages
7,400 25,20030,200
64,100
91,500
58,000
With PPACA
Without PPACA
Projections prepared by the Lewin Group for the AAMC
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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
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Will we create a true continuum of medical education?
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Can We Rethink Our Approach to the Medical Education Continuum?
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AAMC FSMB AHME ABMS CMSS AMA AHA
Medical Schools
State Boards
NBMESpecialty Boards
Specialty Societies
MCAT USMLECert
ExamsCME
Recert/ MOC
Subject Exams
In-Training Exams
PremedicalMedical School
Residency and Fellowships
LCME ACGME ACCME NCQA JCAHO
Practice
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Creating a True Continuum of Medical Education
Learning
Assessment
Premedical Medical School
Residency and
Fellowships
Practice
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In the end, is this all just a matter of politics?
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Source: JAMA. 2009;301(14):1482-1484
