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Advocacy for Academic Medicine


How can leaders in academic medicine engage in advocacy to help shape the policy that affects our institutions? Atul Grover, chief public policy officer for AAMC, and Liz Winter, chief of staff, University of Utah Health Sciences engage in discussion of the public policy threats and opportunities that have created "the change imperative". 

Dr. Grover: We have so many smart people working around us and we have to just learn that as we're asked to do more, we should take advantage of people and their wonderful potential.

I'm Atul Grover, Chief Public Policy Officer, the Association of American Medical Colleges.

Announcer: Asking questions, seeking perspectives, searching for answers, Algorithms for Innovation, live from Philadelphia at the AAMC 2013.

Winter: This is Liz Winter, I'm the Chief of Staff for the University of Utah Health Sciences Center. And we're here at the AAMC interviewing Dr. Grover to hear about the very serious policy issues that we're faced with academic medical centers.

The theme of the AAMC this year is the change imperative. What's the change imperative with regard to our policy stance?

Dr. Grover: Well I think the policies are changing in an iterative fashion right now. Where, standing from the Affordable Care Act, there are some major changes going on in terms of what's expected from us as major health care providers in the United States, and as people that are training the next generation of physicians and other health professionals, and as people who are looking to find new discoveries. Not only about bio medical research and how to make our lives better through science, but also how do we make the health care system better through science?

The challenge is that all of this comes at a time where we are in a world of restrained resources. Everybody wants to figure out how to take money out of the health care system and at the same time we are being asked to do more and more. And that's going to require a real fundamental shift in our business model.

Winter: When you look at some of the key policy issues, GME, the sustainable growth rate, NAH Funding, how do we work so that we are working across all of those three missions without having one cannibalize another?

Dr. Grover: It's always a challenge, I think, among academic centers. Because even though we have lots of people who are the traditional triple threat of doing research and teaching and patient care, there are folks who increasingly align with one mission to the greatest extent.

I think the challenge is really helping our family, our academic medicine family understand that we're all in this together. Neither one can succeed without the other pieces of that three-legged or increasingly four-legged stool at in-community service.

And what I mean by that is if you think about the work that's done in our institutions that's partially funded by NIH or other supporters of bio-medical research, it's not enough to get the job done. It's not enough to actually do science from bench to bedside, and we have to invest our own dollars into the research mission. And that requires clinical dollars. And so, to say we want to cannibalize the clinical dollars so that you can have more money for bio medical research, is really a false proposition. It can't be done that way.

Similarly, even from the academic side of the institution, versus the pure health system side of the institution, we'll tend to focus on margin or mission. And historically, if you talk to health system CEOs, they'll say, "Oh, the medical school across the street, all they care about is their mission." And the med school says, "All that health system cares about is the dollars. What about the mission?"

The truth is, there is no mission without margin. And even if I am, as a university hospital, saying the academic side is really pulling too much money out of the clinical enterprise. I think they need to face up to the fact that you wouldn't be going to University of Utah unless it was University of Utah. There's nothing special about the building that you're in. What makes your institution special is the faculty, the scientists, the trainees, and the clinicians that all work together.

Winter: What are some constructive ways to get faculty and staff involved in the national conversation with our policy makers?

Dr. Grover: I think the challenge is really that we're all busy. We're all trying to just keep the ship floating and slowly trying to steer these giant tankers that are academic medical centers. And so as busy people, it's always hard to figure out how do I take on one more thing? How can I try to figure out how to advocate on behalf of science and medicine and patients and education when I'm busy trying to take care of patients or to do research?

But I think it's that something that we all have to add into our daily lives as good citizens. People like AAMC need to figure out how to make the education and the information easy for our busy faculty and students to absorb. So that's why I'm absolutely thrilled that you're doing the things that you are with the radio station, with Algorithms because it just makes it that much easier to get some information into people's head.

Winter: Give us an idea, a tip if you would, about how you carve out just a few extra minutes in your day to be able to be engaged in a policy discussion nationally.

Dr. Grover: On a day-to-day, really what I try to learn to do is to delegate. We have so many smart people working around us at the AAMC and at all of our institutions. And we have to just learn that as we're asked to do more, we should take advantage of people and their wonderful potential. Whether that's in the clinic and figuring out how the clerks, and the RN's, and the pharmacists, and the social workers do more. Whether that means that I figure out how to get my faculty to do more of this work by unloading something administrative on somebody else, and by really taking opportunities to share knowledge in some of these bite size pieces and figure out how to get information in a very rapid and efficient way.

Now the challenge is we get so much information thrown at us now, now the trick is trying to figure out how to filter out things. And that is something frankly I'm still learning.

Winter:  So is it a reasonable expectation for us to ask division chiefs, and department chairs, and physicians to actually try and have a target of one a quarter or one in every other month to actually connect on that level?

Dr. Grover: Yeah, I think what's amazing about physicians and scientists in our institutions is that they love data and they are incredibly competitive. So I think if you make this a bit of a challenge to the faculty, make it fun, I think you can expect them to do it, you should.

Announcer: Impossible problems in academic medicine. Here how others are solving their impossible problems in at