The academic health center and the public agenda: whose three-legged stool?

The American academic health center has emerged from a tradition that bound research, teaching, and patient care. In recent decades major changes in its faculty array and activities have been generated by extramural funding patterns that have emphasized the research functions of the faculty and, more recently, subspecialty care by faculty members, to the detriment of teaching functions and of immersion in major health care and health promotion issues. The latter are arising more prominently in the public agenda than in the academic agenda. The academic health centers should re-examine their activities with particular attention to the opportunities afforded by this emergent public agenda in biomedicine and health.