In the midst of radical transformation, it is often tempting to focus on
the short-term rather than the long-term, and to neglect the lessons of
the past. We need to skate to where the proverbial puck is going to be,
but we also need to appreciate where it came from. Academic medicine
has been incredibly powerful and effective over the past century, largely
due to our faculty. Thoughtful consideration of the changing roles
and expectations for faculty can lay the foundation for success in the
continued evolution of academic health centers.
We know that faculty models from an earlier epoch are now outdated. If
roles and expectations do not evolve along with the other constructs of the
academic health center, there will be very serious and destabilizing cracks
in the foundation.
No one can know with certainty what healthcare delivery will look like
ten years from now, but we do know that those leaders and institutions
who deliberately and thoughtfully create new models for faculty
development will rise to the top—not only in terms of the quality and
effectiveness of their faculty, but also in the clinical, education, and
research missions that rest on their shoulders. We need to establish the
necessary training and support systems to prepare us for the still hazy
future. Institutional leaders must have the courage to shake off the
shackles of older models that were designed (or passively evolved) to
support a previous version of the academic health center. For example,
if we want to emphasize new strategies—such as team-based care,
population health, and translational research—then reward systems
and resource allocation criteria should be reshaped to support them.
Departmental silos must give way to multi-disciplinary approaches to
education, research, and clinical care.
Technology has changed the landscape, and this is especially apparent
in research and education. The centuries-old model of a distinguished
professor delivering a lecture to a large group of students will not meet
evolving educational needs. We should embrace new technologies for
active, collaborative, group learning. And we need to develop reward
systems that recognize “team science” and appreciate the timelines
for successful completion of meaningful interventional and outcomes
research. The current generation of students grew up with a comfort
and ease in obtaining information and data instantaneously. Educators
need to teach them how to sift and winnow, and thereby learn from the
magnitudes of information available at their fingertips.
The Affordable Care Act is just the first chapter in the ongoing narrative
of changes in healthcare delivery. The growing recognition of population
health management should encourage an integration of the fields of
medicine and public health as a key to the advancement of all missions in
the evolving academic health center.
Robert N. Golden, MD
Dean, University of Wisconsin
School of Medicine and Public Health
Vice Chancellor for Medical Affairs
University of Wisconsin – Madison