Academic health center or academic medical center? Does it make a difference?

American Journal of Pharmaceutical Education, Summer 1999 by Cohen, Jordan L

Approximately 35 of our 81 Colleges and Schools of Pharmacy are physically located on campuses designated as Academic Health Centers (AHC's). While the organization and structure of AHC's varies, every center contains an allopathic or osteopathic medical school, at least one other health professional school or program, and one or more owned or affiliated teaching hospital. Many of these campuses also have other health science colleges including Dentistry, Nursing, Public Health, Allied Health, etc. Many other Academic Health Centers exist, but do not have Colleges of Pharmacy, and certainly many of our Colleges realize similar collaborative opportunities despite not being on one of these designated campuses.

In examining the current state of the (AHC) one of the most often mentioned frustrations among pharmacy deans and faculty is the lack of inclusion of Pharmacy and other "smaller" colleges in the planning and reengineering that is taking place constantly. Thus, although in theory there is synergy by being on a multidisciplinary health science campus, our input is generally not sought and our impact is perceived to be minimal by many Medical School Deans, Vice Presidents for Health, Hospital Directors and other university administrators, based mainly upon the sheer relative magnitude of budget. As these centers continue to respond to the massive effects of Managed Care, the focus has shifted to enhanced partnerships between Hospitals and Medical Schools and often includes the creation of new integrated delivery systems designed to position the center to retain patients and the much needed revenue from patient care to enable teaching and research to thrive. Ironically at a time when team delivery of health care is expanding all over the country, less team thinking is occurring on our nations leading academic health centers. Rather they are acting like, and even being renamed in some cases, Academic Medical Centers or Health Care Systems. Also in several centers the senior academic leader, which in many cases was a Chancellor of VP for Health, is reverting back to the model of the Medical School Dean assuming these roles either by title or de facto.

While generalizations are always dangerous, from my experience it is clear that Colleges of Pharmacy are not having the impact that we should in helping these Centers respond to the changing external and internal environments based upon market pressures and changing state and federal policies. While collaboration in research continues as a result of faculty to faculty interactions, few examples exist of true multidisciplinary teaching outside of the clerkship experience in many acute care hospitals and pharmaceutical care is not generally considered a vital component of the delivery system. This is exacerbated by the fact that the cost of pharmaceuticals continues to increase and the focus is on reduction of direct drug costs and pharmacy personnel in most centers.

Deans, Pharmacy Practice Department Chairs and faculty alike must continue to try documenting the added value of Pharmacy in terms of service, research and teaching in these centers if we are to be successful. This will require carefully developed strategies individualized at each of these centers to "make the case" for Pharmacy. Areas that appear to offer major opportunities for making this case include (but are not limited to) pharmacoeconomic/outcome studies documenting (overall) cost savings and quality of care - especially in capitated environments; linkages with health economics and health policy groups in either Colleges of Medicine and/or Public Health; major faculty involvement in newly emerging clinical research organizations within the AHC's; and major participation by faculty in major Research Centers such as Heart, Cancer, Aging/Neuroscience, drug and alcohol. Given the strong reliance on extramural support, peerreviewed funding on the part of pharmacy faculty is critical in this "shared risk" environment that all AHC's and Colleges of Medicine find themselves in.

Appropriate involvement in multidisciplinary teaching programs is also important and will vary depending upon the local strengths. Multidisciplinary rural clinics, family practice programs and in some cases faculty involvement in therapeutics teaching to students in other colleges such as Medicine and Nursing, also offer strong evidence of value added by pharmacy.

Clearly the era of benefiting from the AHC environment just by virtue of being physically present is over. Accountability for revenue or cost savings is essential and all of us need to include these initiatives as major components of our strategic plans. Especially given the financial duress these centers are under this very challenging time should be turned into a great opportunity to secure pharmacy's future.

Jordan L. Cohen

College of Pharmacy, The University of Iowa, Iowa City IA 52242