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    Adaptability shapes survival of academic health centers

    Peter J. McDonnell, MD, shares views related to deluge of data, training, practice management


    Q Some people compare academic health centers with dinosaurs and say they face extinction. How do you respond to that?

    I once heard a professor at a business school talk about the velociraptor. Velociraptors were super smart, fast, and could hunt in groups. They were the most lethal machines that ever zoomed around the planet.

    This professor said back in that day, velociprators probably stood around the water cooler saying, “We are the baddest dudes on the planet. Obviously, our future is secure. It’s simply a matter of how hungry we are as to how much we’re going to hunt today and how much we’re going to eat.”

    Look what happened to them. They were not able to evolve and now there are no velociraptors.

    The same is true with academic health centers. They need to adapt or go out of business. That’s actually probably true for many of us in practice as well. Society is asking us to do things differently. Academic health centers are perceived as too expensive and not giving enough quality for the cost.

    Large populations of patients no longer can go there, or they have to make a co-payment through a tier system that they find prohibitive. Some academic health centers are no longer filled with patients. There will be no bail out for a preferred payment system to protect the academic health centers. We need to adapt.

    Academic health centers are vulnerable because we teach. With young residents and medical students taking (on average) twice as long as faculty to perform certain tasks, such as cataract surgery, we inherently will cost more.

    The ophthalmologists we have trained are fantastic. We are the envy of the world in that regard. But trained physicians don’t just emerge fully formed. It takes years.

    We need to let them do things—like order more tests or do additional things—that more experienced clinicians and professors might not see as necessary. It is part of the experience and the growth of an ophthalmology resident.

    Also, we have standby costs. We have trauma surgeons at all times for those occasional patients with severe medical problems that the community centers cannot handle. A significant part of the time, those teams are not generating revenue.

    And, of course, our patients tend to be sicker. Other medical institutions send us patients who need cataract surgery, but who also have other severe health problems that require them to be managed in a special way. That adds to our financial burden. Overall, we are inherently less efficient than community practices and community hospitals.

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