Whither academic health centers? A commentary.

Academic health centers (AHCs) currently face the greatest challenge of their entire existence. Managed care, increased competition for research funding, and inefficiency all contribute to the present vulnerability of AHCs in the cost competitiveness of today's health care marketplace. The increased reliance of medical schools on clinical income to subsidize undergraduate and graduate education and biomedical research now jeopardizes the success of their missions, since clinical income is declining. While AHCs must make significant changes to adapt to the new environment, left on their own in the marketplace, many will not survive. Additionally, the biomedical research advances and high technology medical care that we have come to expect in this country will also likely suffer. A national approach designed to preserve responsive AHCs is needed.