Darrell G. Kirch, M.D. President and CEO, AAMC March 16, 2011

1. From Medical School Applicant to Health Reform Leader University of South Carolina School of Medicine Darrell G. Kirch, M.D. President and CEO, AAMC March 16, 2011

2. The Legacy of Abraham Flexner for Medical Education

3. The Culture of the University

4. The Legacy of James B. Wyngaarden, M.D. for Biomedical Research

5. The Culture of Biomedical Research

6. The Legacy of Lyndon B. Johnson for Health Care

7. The Culture of Health Care

8. Academia as a Major Provider of Health Care • AAMC-member teaching hospitals represent 6% of all hospitals • Their work represents: • 40% of all Medicare inpatient days • 22% of all Medicaid inpatient days • 40% of all hospital charity care They provide: • 79% of all burn center beds • 40% of neonatal intensive care beds • 83% of all ACS-verified Level 1 regional trauma centers Overall, AAMC-member teaching hospitals provide 20% of all hospital care

9. Our national political reality!

10. A Bipartisan Moment…

11. …Followed by a Partisan Statement…

12. …Followed by Conflict at the State Level

13. The State of the Union

14. Our national economic reality!

17. Source: NEJM. April 1, 2010. Vol.362(13). 1166-1168.

18. Our national health care reality!

19. “Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades” 2009 Total Health Expenditure $2.5 trillion 4% from 2008 17.6% GDP 1% from 2008 Source: Health Affairs, 30, no.1 (2011):11-22

20. Deficits in Insurance Coverage Number of Uninsured Children and Non-elderly Adults- 2004-2009 43 44.4 46.5 45 45.7 50 Millions “Uninsured Rate Soars, 50+ Million Americans Without Coverage” — Kaiser Health News 16 September 2010 Source: The Uninsured: A Primer. Kaiser Family Foundation. December 2010.

21. Deficits in Access

22. Deficits in Outcomes U.S. Comparison to Developed Nations *Only 5 nations reported data on this indicator Source: OECD Health Data 2010, June 2010

23. South Carolina Health Status Source: statehealthfacts.org

24. Government Social Spending - 2007 Percent GDP Source: Social expenditure: Aggregated data, OECD Social Expenditure Statistics (database) doi: 10.1787/20743904-2010-table1

25. In the face of these realities, have we really “reformed” health care?

26. Can We All Commit to “Fixing” Health Care? American Expectations Care Model Professional Issues Economic Model Institutional Culture

27. Can We All Commit to “Fixing” Health Care? American Expectations Care Model Professional Issues Health Insurance for All Rational Payment System Economic Model Institutional Culture

28. Can We All Commit to “Fixing” Health Care? American Expectations Care Model Professional Issues Economic Model Institutional Culture

29. Can We All Commit to “Fixing” Health Care? American Expectations Creating True Teams Confronting Workforce Shortages Care Model Professional Issues Economic Model Institutional Culture

30. Can We All Commit to “Fixing” Health Care? American Expectations Care Model Professional Issues Economic Model Institutional Culture

31. Can We All Commit to “Fixing” Health Care? American Expectations Care Model Professional Issues Creating True “Medical Homes” Changing the Focus From “Sickness” to “Wellness” Economic Model Institutional Culture

32. Can We All Commit to “Fixing” Health Care? American Expectations Care Model Professional Issues Economic Model Institutional Culture

33. An Emerging Culture for Health Care Hierarchical Collaborative Autonomous Team-based Competitive Service-based Individualistic Mutually accountable Expert-centered Patient-centered

34. Can We All Commit to “Fixing” Health Care? American Expectations Care Model Professional Issues Economic Model Institutional Culture

35. What Americans Want From Health Care I want to prolong life as long as possible! I want someone else to pay the bill! I want it now! If anything goes wrong, I want to sue someone! I want the latest in health care! Adapted from T. Gorrie

36. Can We All Commit to “Fixing” Health Care? American Expectations Care Model Professional Issues Economic Model Institutional Culture

37. Healthcare Innovation Zones Source: Patient Protection and Affordable Care Act, H.R. 3590

38. Will we have the health care professions workforce to take care of us?

39. Rising to the Challenge of Workforce Shortages With PPACA 91,500 Without PPACA 58,000 64,100 30,200 25,200 7,400 Projections prepared by the Lewin Group for the AAMC

40. First-Year Medical School Enrollment Projected to Increase 21% by 2012 Existing + New Schools Existing Schools 16,488 Source: AAMC Annual Survey of Medical School Expansion Plans

41. Will we create a true continuum of medical education?

42. Can We Rethink Our Approach to the Medical Education Continuum?

43. AAMC FSMB AHME ABMS CMSS AMA AHA Medical Schools State Boards Specialty Societies NBME Specialty Boards MCAT USMLE Cert Exams CME Recert/ MOC Subject Exams In-Training Exams Practice Premedical Medical School Residency and Fellowships LCME ACGME ACCME NCQA JCAHO

44. Creating a True Continuum of Medical Education Learning Medical School Residency and Fellowships Practice Premedical Assessment

45. In the end, is this all just a matter of politics?

46. Source: JAMA. 2009;301(14):1482-1484