Academic health centers need to reinvent themselves to meet changing societal needs, Duke University Health System CEO says.

(Left) Victor Dzau, Duke University, and Sam Hawgood, UC San Francisco

Despite academic health centers’ past success – in providing the most advanced, high-quality care, in educating future leaders in the health professions, and in making research discoveries and moving them into clinical practice – they may need to change to maintain their leadership roles in the future.

That thought was on the minds of about 150 UCSF leaders who gathered Jan. 21 for the annual UCSF School of Medicine Leadership Retreat in the Presidio of San Francisco.

Academic health centers consist of medical and other health professional schools, teaching hospitals and organized health care services. These centers need to reinvent themselves to meet changing societal needs for health care services delivered equitably and with greater cost-efficiencies, according to the morning session’s keynote speaker, Victor Dzau, MD, CEO of Duke University Health System and chancellor for health affairs at Duke University.

The title of Dzau’s presentation was “Academic Health Centers: Preparing for an Uncertain Future.”

“Academic health centers can be leaders in the transformation of medicine,” Dzau said, and society will then continue to look to and value these centers for clinical breakthroughs and paradigm shifts, for high-quality, cost-effective care, for improvements in population and community health, and as magnets for innovation and innovators.

But academic health centers must contribute to needed health care reforms, Dzau added, by helping to address problems that include rising health care costs, diminished access to health care, fragmentation of care, misplaced emphasis on late-stage disease instead of prevention, the difficulty of translating innovation to standard practice, and persistent health care inequalities at both the local and global levels.

The greatest challenge may be to make game-changing advances during an era of economic constraints.

A major concern for academic health centers is that future revenues from clinical services are expected to exceed the costs of providing those services by a smaller percentage, thereby greatly limiting funds that can be used to help subsidize the costs of education and research.

“Clinical revenues remain flat in aggregate, and margins are declining despite increasing volumes” of services provided, Dzau said. “With declining clinical reimbursement, a weak economy and reduced NIH [National Institutes of Health] funding, this gap is likely to increase.”

While UCSF and other academic health centers have successfully expanded their research portfolios, on the whole, research grants do not completely pay for the indirect costs of research – such as bricks and mortar, salaries, and administrative costs. The shortfall is growing, according to Dzau.

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