Future of medicine addressed

University Health System Chief Executive Officer William Kelley and six other panelists, representing a cross section of the health care industry, gathered at the Medical School last night to discuss the challenges facing academic medical centers in the coming years. A crowd of several hundred doctors, medical students and onlookers packed Stemmler Hall's Dunlop Auditorium for the third annual Thomas Langfitt Memorial Symposium, entitled "Survival of the Fittest: Academic Medical Centers in the 21st Century." Among the issues on the table were the preparation of medical students for a health care system increasingly dependent on managed-care companies, the impact of for-profit medicine on the quality of treatment and the competition for research dollars between academic medical centers and for-profit research companies. The evening's moderator, Sanford Schwartz, director of the University's Leonard Davis Institute for Health Economics, summed up the evening's focus: "To recognize that these outside [for-profit] forces are real. If we [academic medical centers] don't do the job, they will do it for us." Panelists were quick to agree that for-profit healthcare companies, such as Columbia/HCA Healthcare Corp., became successful by improving on inefficient operations at academic medical centers. But they emphasized capabilities unique to the academic medical center setting and the increased competitiveness of the academic medical center. "What is different about for-profit [health care companies] is the fiduciary duties," said Mildred Cho, a professor at Penn's Center for Bioethics. "The balance has shifted so that stockholders have [input]." In contrast, she said, the academic medical center faces no presumption of acting for financial reasons. But Patrick Oden, a Wall Street analyst specializing in the health care industry, said the difference is not so simple. Oden explained that recent events such as the collapse of Columbia/HCA, a national chain of for-profit hospitals, have emphasized the need to focus on quality rather than constant cost reduction. Alan Miller, chairperson and chief executive officer of Universal Health Services Inc. -- one of the nation's largest chains of for-profit hospitals -- agreed that focusing on a different set of goals than those academic medical centers strive for would be foolish. He noted that the last thing any hospital would want is a reputation for valuing money over patients' lives. But Kelley, who is also dean of the Medical School, cautioned that while for-profit hospitals may not necessarily abandon quality, "the difference is really more of an issue of investor pressure" -- something which academic medical centers do not face. The panel also addressed the nationwide surplus of doctors. Panelists agreed that hospitals may train too many doctors, but cautioned against drawing conclusions about the Hospital of the University of Pennsylvania from national statistics. "These projections don't account for the fact that some residency programs are training national leaders," said Risa Lavizzo-Mourey, chairperson of HUP's Geriatric Medicine division. The annual symposium, organized by a group of Wharton and Medical School graduate students, focuses on "timely issues in medical management," according to Brian Choi, one of the organizers and a dual degree graduate student at Wharton and the Medical School. It is co-funded by the Office of the Dean for Medical Education and the Leonard Davis Institute of Health Economics.