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IOWA CITY - Academic medical centers like the University of Iowa's play an oversized role in providing charity care through programs like Medicaid, treating complex pediatric and trauma patients, conducting research into vexing illnesses like cancer and training the next generation of healers.
And like the UI Hospitals and Clinics, the 154 medical schools and 400 teaching hospitals and health system members of the Association of American Medical Colleges juggle those multiple missions with a sometimes precarious balance of revenue streams - from state support, patient fees, federal reimbursements, tuition dollars and philanthropy, according to new AAMC President and Chief Executive Officer David Skorton.
As the demands of those multipronged missions continue to shift, so do the resources needed to complete them.
'Just imagine the burdens and the responsibilities that are placed on academic medical centers,” said Skorton, who spent years at the UI as a physician and professor before serving as the university's president from 2003 to 2006. 'The future of the profession is in the hands of the faculty in these schools.”
Skorton - who after Iowa spent nine years leading Cornell University before stepping in as secretary of the Smithsonian Institution from 2015 to 2019 - said in an interview with The Gazette that his roots in medicine pulled him back into the quagmire of what he perceives as the most pressing issues facing the country.
'This gives me a change to be involved in some aspect of health policy, medical education, research and patient care,” he said. 'I'm really thrilled that I came.”
In addition to training and educating doctors, nurses, dentists and other health care workers, Skorton said, academic medical centers like the UIHC provide an 'astounding” amount of patient care - particularly when it comes to complex cases.
'The percentage of trauma units, neonatal ICU, burn units, the more complicated care - we do a lot more than our numbers would suggest,” Skorton said, noting, too, the disproportionate chunk of undercompensated or uncompensated cases that walk through the doors of his members.
'And it's a very important thing in a country where, unfortunately, we still have such dramatic differences in health equity and access to medical care,” Skorton said.
As teaching hospitals and academic medical centers continue to take on sicker patients with more complex diseases, Skorton said, they're also scrambling to uncover new discoveries and develop new technologies.
But just like colleges and universities are struggling with funding cuts and changing demographics affecting their pool of prospects, competition and recruitment strategies, so are the health centers, according to Skorton.
'As the country becomes steadily, steadily, steadily more diverse, we have to make sure that we're keeping up on two aspects of things,” he said.
First, he said, are 'social determinants of health,” which have to do with those aspects of health that are not specifically tied to care but more so 'our ZIP code.”
'Whether we have access to shelter, to food, to all the basics of life,” he said. 'Unfortunately, as you know, in our great cities, and in our rural areas - and Iowa is a great example of this - there are a lot of differences in people's access to these kinds of things.”
The second issue that medical centers like the UI need to focus on has to do with the education of tomorrow's clinicians.
'They have to understand how to exist in a world of this very, very widely diverse patient population, multilingual patient populations, populations of patients from many, many cultures all over the world,” he said. 'These pressures on these institutions to do education training, patient care, research, and to keep up with the changes in the country's culture - they're really massive demands.”
UIHC Chief Executive Officer Suresh Gunasekaran recently told The Gazette of his institution's challenge in competing for top faculty and clinical talent, considering its low payer rates as the highest recipient of Medicare and Medicaid patients in Iowa.
'We absolutely are not market competitive for almost any job that we have at UIHC,” Gunasekaran said in a November interview. 'Across the board. We're not market competitive for the majority of our physicians. We're not market competitive for our nurses. And that has a lot to do with the fact that, when you look at it, we're not market competitive for how much we get paid” from reimbursements.
Skorton said that for academic medical centers, that 'is definitely not just an Iowa phenomenon.” But for now, there are no simple solutions, and it's not going to wane any time soon.
Still, Skorton hopes the nation will continue looking for a way to provide health care access for everyone living in the United States.
'I'm not talking about ‘Medicare for all.' I'm not talking about any one particular way of doing it,” he said. 'But just that we have to make sure, despite the financial pressures on the federal budget and state budgets, we have to remember that health care and good health is primary to everything else we do in our lives. And we have to prioritize it as such.”
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