Question

1. Discuss the transition from academic medical centers to academic health centers (Chapter 6) and briefly describe:
   1. The graduate medical education consortia
   2. Delineation and growth of Medical Specialties
   3. Specialty Boards and Residency performance
   4. Discuss the transition from academic medical centers to academic health centers (Chapter 6) and briefly describe:

Answer 1

# TRANSITION FROM ACADEMIC MEDICAL CENTERS TO ACADEMIC HEALTH CENTERS

1950s & 1960s federal grants: support research-oriented medical schools & teaching hospitals in technology advances

1965-1974: Regional medical program funded upgrading medical knowledge about heart disease, cancer & stroke with research, training, regional networking

Academic medical centers broadened to Academic Health Centers (AHCs) with other professional schools: nursing, pharmacy, dentistry, allied health

AHCs with affiliated hospitals became primary sites of health professional training, basic medical and clinical research; affiliated hospitals:

Major providers of most complex tertiary care, e.g. neonatal, trauma, burn, neurologic, heart disease; major providers of primary care for low-income patients in outpatient clinics

6% of nation's hospitals but provide 50%+ of care to underserved

AHCs technology, teaching requirements generate the highest costs of American system; pressures to reduce costs

Teaching requires ordering more tests, procedures, consultations

Medical school revenues: faculty clinical practice plan contributions, research grants & contracts, state & local government, tuition & fees, other grants, contracts, endowments; Medicare & Medicaid subsidy reductions

A. GRADUATE MEDICAL EDUCATION CONSORTIA

Formal associations of medical schools, teaching hospitals, other organizations involved in residency training to improve organization, governance, MD supply and distribution through local coordination.

MD: allopathic physicians (138 schools); DO (Doctor of osteopathy- 29 schools); degrees are equivalent

No national licenses; state medical boards license with specific requirements; 3-7 yr. residency accredited by Accreditation Council for Graduate Medical Education (ACGME) required.

ACGME: not-for-profit independent organization dedicated to quality of residents' training Accredits ~ 9,000 U.S. residency programs; also addresses MD distribution and supply 2012 transition to outcomes-based evaluation system to measure competencies.

ACA: redistribute specific resident training slots to needed specialties and areas with Medicare reimbursement flexibility

B. DELINEATION AND GROWTH OF MEDICAL SPECIALTIES

AMA concerns began in mid 1800s: Fragmented care (not treating "whole patient") AMA slow response prompted specialists to form their own societies

Late 1800s: specialty associations formed in ophthalmology, otology, obstetrics & gynecology, pediatrics

Deficient training of medical specialists

At 1910 Flexner Report, huge variations in specialty training duration & quality; virtually any physician could call themselves a "specialist."

1917 WWI army recruitment revealed shocking "unfit" to practice as "specialist" MDs and some overall "unfit"

American College of Surgeons est. oversight & practice standards for certifying surgeons in 1917

1924: AMA Council on Medical Education began approving hospitals for residency specialty training programs; for next 40+ years, poorly conducted programs persisted

AMA: Citizens Committee on GME, chaired by John Mills; 1966 report eliminated independent internships, awarding residency accreditation to institutions, not hospital departments; report led to current residency requirements

1970: "internship" dropped; AMA endorsed first year graduate training in a program approved by a "residency review committee (RRC);" by 1980 AMA issued training recommendations for the first postdoctoral year.

Current curriculum for specialization: well defined & standardized: medical school graduation-> approved residency program-> pass qualifying examination(s).

C. SPECIALTY BOARDS & RESIDENT PERFORMANCE

American Board of Medical Specialties (ABMS) est. 1933 as independent not-for-profit entity; to maintain, improve medical care quality by assisting member boards in developing and using professional & educational standards for certifying specialists in U.S. & internationally.

ABMS member boards ensure proper instruction & resident performance by exam & practice in 24 medical specialties & 130 subspecialties trained in fellowships for subspecialty practice and/or research .

Hospitalists

Growing field outside of formal specialty training; sole responsibility caring for hospitalized patients; 30,000 in practice in 70% of U.S. hospitals .Most trained in internal medicine or pediatrics

Hospitalist benefits: expedite & improve coordination of hospital care, reduce costs, enable continuity, improve patient satisfaction