Read the passage and answer the following question.
History has shaped academic medical centers (AMCs) to perform 3 functions: patient care,research, and teaching. These 3 missions are now fraught with problems because the attempt
to combine them has led to such inefficiencies as duplication of activities and personnel,
inpatient procedures that could and should have been out-patient procedures, and unwieldy
administrative bureaucracies.
One source of inefficiency derives from mixed lines of authority. Clinical chiefs and prac-
titioners in AMCs are typically responsible to the hospital for practice issues but to the med-
ical school for promotion, marketing, membership in a faculty practice plan, and educational
accreditation. Community physicians with privileges at a university hospital add more com-
plications. They have no official affiliation with the AMC’s medical school connected, but
their cooperation with faculty members is essential for proper patient treatment. The frag-
mented accountability is heightened by the fact that 3 different groups often vie for the loy-
alty of physicians who receive research. The medical school may wish to capitalize on the
research for its educational value to students; the hospital may desire the state-of-the-art treat-
ment methods resulting from the research; and the grant administrators may focus on the re-
searchers’ humanitarian motives. Communication among these groups is rarely coordinated,
and the physicians may serve whichever group promises the best perks and ignore the rest —
which inevitably strains relationships.
Another source of inefficiency is the fact that physicians have obligations to many different illnesses cost, and of how other institutions treat patient conditions, they would be better
practitioners, and the educational and clinical care missions of AMCs would both be better
served.
groups: patients, students, faculty members, referring physicians, third-party payers, and staff
members, all of whom have varied expectations. Satisfying the interests of one group may
alienate others. Patient care provides a common example. For the benefit of medical students,
physicians may order too many tests, prolong patient visits, or encourage experimental studies
of a patient. If AMC faculty physicians were more aware of how much treatments of specific.
A bias toward specialization adds yet more inefficiency. AMCs are viewed as institutions
serving the gravest cases in need of the most advanced treatments. The high number of spe-
cialty residents and the presence of burn units, blood banks, and transplant centers validate
this belief. Also present at AMCs, though less conspicuous, are facilities for ordinary pri-
mary care patients. In fact, many patients choose to visit an AMC for primary care because
they realize that any necessary follow-up can occur almost instantaneously. While AMCs
have emphasized cutting-edge specialty medicine, their more routine medical services need
development and enhancement.
A final contribution to inefficiency is organizational complacency. Until recently, most
academic medical centers drew the public merely by existing. The rising presence, however,
of tertiary hospitals with patient care as their only goal has immersed AMCs in a very com-
petitive market. It is only in the past several years that AMCs have started to recognize and
develop strategies to address competition.
