Impact of the Health Care Crisis on Surgery

The managed care revolution has crippled the ability of medical schools and their affiliated hospitals to accomplish their traditional goals of education, research, specialized clinical service, and innovation in clinical care. As academic health practice has had to become cost competitive, little time is left for teaching and research. Other factors, including the increasing focus on outpatient care, dropping numbers of residents, and the increasingly complex patient mix in academic health centers (AHCs), have contributed to the degradation of the surgical learning environment. In response, AHCs must develop mechanisms to adapt while at the same time preserving their core missions. Examples of adaptive mechanisms include remaining cost-effective, moving training to the outpatient setting, protecting teaching and scholarly activities of faculty by creating new mechanisms of funding, and training future surgeons in health care policy and administration.