American College of Physicians: Internal Medicine — Doctors for Adults ®


New effort launched to increase funding for academic centers

From the February 1997 ACP Observer, copyright 1997 by the American College of Physicians.

A group of researchers has founded an organization to find new revenue sources for academic medical centers in an effort to protect the future of medical education and research.

The group, Citizens for Public Research and Education Funding (CPR) held its first official meeting in January in Washington, D.C., to examine where revenue for academic medicine will come from in the era of managed care. A number of organizations, including the College, have expressed their support for CPR.

"The increasingly competitive environment of managed care and budgetary pressures to reduce government spending are eroding the financial foundations of academic medical institutions," said Jack Ginsburg, Senior Associate for Policy Analysis and co-author of the ACP position paper, "The Impact of Managed Care on Medical Education and Physician Workforce." The College favors establishing a funding system for graduate medical education in which all payers share equitably in the cost of medical education and research. (For a copy of the paper, call ACP's Washington office at 800-633-9400.)

According to Henry Black, FACP, "Unless we preserve the country's academic structure, we have no way to train future physicians or develop top medical research." Dr. Black, chair of preventive medicine at Rush-Presbyterian Hospital in Chicago, and James E. Muller, FACP, chief of cardiovascular medicine at the University of Kentucky, initially talked about the need for academic center funding last summer after Dr. Muller temporarily lost his position with the University of Kentucky due to downsizing.

Before managed care, academic medical centers relied largely on the revenue generated by their faculty practice income, according to David Korn, MD, a distinguished scholar in residence at the Association of American Medical Colleges and former dean of the Stanford University Medical School.

But since many faculty practices now treat mostly managed care patients rather than fee-for-service, they contribute less to academic medical center revenue. The centers are left with less working capital to put toward research and education, he said.

Since 1991, revenue from faculty clinical practices available for research and teaching has dropped 55% in areas where managed care is dominant.

"We as a society have benefited from the system in the past, and now because of changes in care delivery and financing, education and research are just hanging out there without any support," Dr. Korn said. "We must build public support for education and research."

The CPR campaign has considered legislation on tax on health care premiums as a possible solution to the revenue crisis, Dr. Black said. Last year, Sen. Daniel Moynihan (D-N.Y.) unsuccessfully proposed a bill for a 1.5% tax on premiums to raise $4 billion from the private sector to support medical centers.

CPR has formed a few state chapters and another national meeting is planned for sometime this spring. Information: or


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