Preventing academic medical center from becoming an oxymoron.

Many academic medical institutions are facing serious threats to their survival today as changes in the organization and financing of health care delivery and reductions in federal support create damaging pressures. In order for Americans to continue to have the best health care in the world, academic medicine and its crucial contributions of medical education, training, and research must receive adequate support. The author maintains that it is up to the Association of American Medical Colleges and associated organizations to ensure that this message is heard and recognized and to seek an all-payer approach that would support the costs associated with medical education and training and would allow teaching hospitals to compete on a level playing field with non-teaching hospitals. Academic medical institutions must face painful transformations while maintaining their academic missions; the author discusses the nature of these transformations and missions, particularly research, and outlines useful strategies to maintain these missions, such as establishing a centralized approach to curriculum and having clinical and basic science faculty form alliances to address common research problems and secure more research funding. He concludes that many of the structural and other changes that academic medicine's institutions must make may result in true improvements and help maintain the validity of the term academic medical center in the future.