Darrell G. Kirch, M.D.President and CEO, AAMCMarch 16, 2011From Medical School Applicant to Health Reform LeaderUniversity of South Carolina School of Medicine

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The Legacy of Abraham Flexner for Medical Education

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The Culture of the University

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

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The Culture of Biomedical Research

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The Legacy of Lyndon B. Johnson for Health Care

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The Culture of Health Care

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Academia as a Major Provider of Health CareAAMC-member teaching hospitals represent 6% of all hospitalsTheir work represents: 40% of all Medicare inpatient days22% of all Medicaid inpatient days40% of all hospital charity careThey provide:79% of all burn center beds40% of neonatal intensive care beds83% of all ACS-verified Level 1 regional trauma centers

Overall, AAMC-member teaching hospitals provide 20% of all hospital care

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Our national political reality!

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A Bipartisan Moment

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Followed by a Partisan Statement

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Followed by Conflict at the State Level

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The State of the Union

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Our national economic reality!

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2010 AAMC. May not be reproduced without permission.

2010 AAMC. May not be reproduced without permission.

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

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Our national health care reality!

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Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five DecadesSource: Health Affairs, 30, no.1 (2011):11-222009 Total Health Expenditure17.6% GDP4% from 20081% from 2008$2.5 trillion

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Deficits in Insurance Coverage4344.446.54545.7MillionsNumber of Uninsured Children and Non-elderly Adults- 2004-2009Source: The Uninsured: A Primer. Kaiser Family Foundation. December 2010.50

Chart1

35.37.7

36.38.1

37.88.7

36.98.1

38.47.3

42.57.5

Adults < 65

Children

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Adults < 65Children

200435.37.7

200536.38.1

200637.88.7

200736.98.1

200838.47.3

200942.57.5

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Deficits in Access

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

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South Carolina Health StatusSource: statehealthfacts.org

South CarolinaU.S. averageLife expectancy 75.8 years78 yearsInfant mortality rate (per 1,000 live births)96.8Heart disease rate (per 100,000)92.9190.9Diabetes rate (per 100 adults)9.3 5.5Overweight/obese adults62.8%60.8%

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Government Social Spending - 2007Source: Social expenditure: Aggregated data, OECD Social Expenditure Statistics (database) doi:10.1787/20743904-2010-table1Percent GDP

Chart1

7.21MexicoMexico

23.089HungaryHungary

20.541UKUK

21.579SpainSpain

20.799NorwayNorway

24.858ItalyItaly

27.304SwedenSweden

20.078NetherlandsNetherlands

16.856CanadaCanada

26.348BelgiumBelgium

25.161GermanyGermany

28.4FranceFrance

18.521SwitzerlandSwitzerland

16.196USUS

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MexicoHungaryUKSpainNorwayItalySwedenNetherlandsCanadaBelgiumGermanyFranceSwitzerlandUS

7.2123.08920.54121.57920.79924.85827.30420.07816.85626.34825.16128.418.52116.196

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In the face of these realities, have we really reformed health care?

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional Culture

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional CultureHealth Insurance for AllRational Payment System

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional Culture

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional CultureConfronting Workforce ShortagesCreating True Teams

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional Culture

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional CultureChanging the Focus From Sickness to WellnessCreating True Medical Homes

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional Culture

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CollaborativeHierarchicalAutonomousCompetitiveExpert-centeredMutually accountableIndividualisticTeam-basedService-basedPatient-centeredAn Emerging Culture for Health Care

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional Culture

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I want the latest in health care!

I want to prolong life as long as possible!

If anything goes wrong, I want to sue someone!I want it now!I want someone else to pay the bill!

Adapted from T. GorrieWhat Americans Want From Health Care

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Care Model Professional IssuesEconomic ModelCan We All Commit to Fixing Health Care?American ExpectationsInstitutional Culture

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Healthcare Innovation ZonesSource: Patient Protection and Affordable Care Act, H.R. 3590

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

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Rising to the Challenge of Workforce Shortages7,40025,20030,20064,10091,50058,000With PPACAWithout PPACAProjections prepared by the Lewin Group for the AAMC

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5000

10000

15000

20000

Without PPACA

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Without PPACAWith PPACASeries 3

200850002

201210000252002

201615000580003

202020000915005

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First-Year Medical School Enrollment Projected to Increase 21% by 2012Existing + New SchoolsExisting Schools16,488

Source: AAMC Annual Survey of Medical School Expansion Plans

Chart1

164882002

165412003

166482004

170032005

173702006

177592007

1810318103

1867318433

1912218680

1951118922

1990919123

2030119396

2067319669

2102119941

2129420214

2156720487

East

West

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2002200320042005200620072008200920102011201220132014201520162017

East16,48816,54116,64817,00317,3701775918,10318,67319,12219,51119,9092030120673210212129421567

West18103184331868018922191231939619669199412021420487

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Will we create a true continuum of medical education?

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Can We Rethink Our Approach to the Medical Education Continuum?

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Creating a True Continuum of Medical Education

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

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

*Institutions, from left to right:- Virginia Tech Carilion SOM (admitted first class July 26, 2010)- University of South Carolina School of Medicine - Johns Hopkins Hospital- Eclectic Medical College of the City of New York (1868)

*NIH Director from April 1982 to July 1989*President Johnson signed Medicare bill on July 30, 1965

** **Volume 362:1166-1168, April 1, 2010, Number 13**Updated Jan. 2011*Medically Underserved Areas/Populations are areas or populations designated by HRSA as having: too few primary care providers, high infant mortality, high poverty and/or high elderly population

Red: Medically underserved population designation at request of state governorGreen: Federally designated medically underserved areaYellow: Federally designated medically underserved population *Updated Jan 2011

Life expectancy: U.S. ranked 25th out of 31 developed nations Infant mortality: U.S. ranked 4th out of 31 developed nations Adult obesity: U.S. ranked first out of 5 developed nations reporting on this indicator

*SCU.S. AveragePopulation living in poverty 20% 20%Health spending per capita $5,114$5,283Uninsured population16% 17%Medicaid enrollment20% 19%Smoking adults20%18.3%Participation in physical activity45.4%50.9%

*Updated January 2011*******Loma Linda has had a 3% enrollment increase since 2002 (from 160 slots to 165)

Chart shows that first year medical school enrollment is expected to increase 21 percent by 2012 This means we are basically on track with regard to our recommended 30 percent increase in med school enrollment by 2015, but that we are more likely to achieve this goal by 2017 Note: chart is based on 2002 baseline year of 16,488 first-year enrollment******Publication date: April 8th 2009 *