The Bulletin - Summer 1998, Volume 83, No. 1

Dean Donald E. Wilson

One of the most pressing issues facing medical school deans across the country is the challenge of making the case to the public that academic medical centers, through their educational, research and patient care missions, are the backbone of the nation's health care system. It has become increasingly clear that we need to do a better job of informing and educating the public on how work accomplished at academic health centers (AHCs), such as the University of Maryland, touches millions of lives each day. By definition, an AHC includes a medical school, a teaching hospital, and at least one additional health professional school, such as nursing, dentistry, pharmacy or schools of allied health. At the University of Maryland, the disciplines of physical therapy, medical and research technology, and genetic counseling are departments in the School of Medicine.

While the public has great respect for biomedical research, they do not know that medical schools and teaching hospitals are the major sources of many of the most important medical innovations and therapeutic advances of the century. For example, consider just some of the recent medical milestones at the University of Maryland:

developed Maryland's first Brain Attack Team to respond rapidly to stroke patients with new clot-dissolving drugs;
pioneered the study of the first drug (Prostacyclin) approved by the FDA to treat primary pulmonary hypertension:
pioneered the study of the first two drugs -- beta interferon and copolymer 1 -- found to be effective in reducing the number of attacks in patients with mild to moderate multiple sclerosis;
performed the first laparoscopic ulcer surgery in the United States;
pioneered in the use of the Ilizarov procedure for bone lengthening and straightening;
performed the most laparoscopic kidney removals in the world from living kidney donors for transplants;
awarded $119 million in external research funding;
added more than $640 million in economic impact to the Maryland economy.

When you consider the impact of the nation's 125 allopathic medical schools, it is easy to see why America's leadership in medical technology and biomedical research is uncontested. People from around the world come to the United States to take advantage of the latest medical advances, available mainly at academic health centers. Collectively, AHCs conduct 40 percent of the nation's biomedical and health services research.

However, while the public understands what medical schools and teaching hospitals are, in general they do not understand the concept of an academic health center or the challenges facing AHCs. Two years ago, the Association of American Medical Colleges (AAMC) conducted a series of focus groups across the country to determine the public's perception of AHCs. The participants were among the most informed people in our society, earned more than $30,000 per year, graduated from college, regularly read newspapers, and participated in local and national elections. I attended two of the three sessions held in the Baltimore region. The findings from this project convinced me and others that we have a serious problem with our public relations, the clarity of our missions, our credibility and even our understanding of what the public expects of us.

The public thinks that medical education is important, but they wonder why some don't have easier access to medical care and why health care is so costly. The public overwhelmingly supports medical research, but they do not know that we are the major contributors -- they think that most of the research in the country is done by pharmaceutical companies and the National Institutes of Health.

While the focus groups held physicians in high esteem, they held scientists and nurses even higher. There was the hint that they perceived that researchers and nurses received less compensation, and therefore were more dedicated to their professions. When asked if they thought that medical schools were facing financial difficulties, they were incredulous, indicating, "how could that be, considering the high tuition that students pay?" In general, they were not kind to health maintenance organizations in most respects.

Further evidence of our "message disconnect" was obtained from the results of a 1997 survey of U. S. Senate and House staff, which also conveyed the sense that academic medicine's missions and contributions are not known. When asked who or what is most responsible for medical innovations, only 11 percent of respondents credited medical schools and only 15 percent cited teaching hospitals, while 45 percent credited private companies or the pharmaceutical industry.

Listening to these comments, it is clear that we are challenged to convince the public that we need their continued support to keep viable this enormously successful collaboration of medical schools, teaching hospitals and research institutions, and to explain that the benefits that result from this collaboration occur because these three entities are linked. The public does not understand that for most medical schools (certainly ours) the major source of revenue to fund faculty salaries and unrestricted research is the medical school clinical practice plan. They are not aware that the changing health care marketplace, which is increasingly driven primarily by low cost and an unwillingness to support education and research with health coverage premium dollars, is affecting the very vitality of past successful practices of medical schools and teaching hospitals. That is not to say that medical schools and teaching hospitals cannot improve their efficiency, and we are well-attuned to the need to change and improve our operations.

The AAMC has developed and is in the process of implementing a national communications campaign for academic health centers. Even with this effort, we still have our work cut out for us. As the University of Maryland and other academic centers face a host of critical issues impacting our financial viability, you can play a key role in helping to publicize all of the important and exciting activities that go on at the University of Maryland and other institutions. I call on each of you to serve as ambassadors without portfolios, so that we may build upon the enormously positive image we already have. All of the elements for our success are collectively in our own hands.

Donald E. Wilson, MD, MACP