The Future of Academic Medicine: More Doctors, More Dollars

During the second annual Houston Shock Symposium, Guiseppe N. Colasurdo, MD, president, University of Texas Health Science Center at Houston, and CEO, UT Physicians, discussed insight into the past, present, and future of academic medicine, notably in Texas.

He noted how, over the last century, the Texas Medical Center grew from an idea—nothing but land—to a reality, where it now exists as a large, busy, institution.

“You always start with nothing,” he said, before you decide what you want to be. As academic medicine grows, so does the need for revenue.

“We like to live in this very expensive place,” he said, referring to the United States. “We like to teach, we like to do research, but who’s going to pay for all that?”

“It’s not as much fun as understanding the mechanism of shock and how we approach it,” Dr. Colasurdo, a native of Italy, said. He talked about the new reality for academic health centers and discussed how, as the field has grown, funding sources for academic health centers have drastically changed. From 1960–1961, clinical service and tuition/fees accounted for the smallest percentage of revenue—each coming in at 6%. Funding primarily came in the forms of federal research funding (31%), state or local funding (17%), and other federal funding (10%). The remaining 30% was all other income sources.

Over the next 50 years, this sharply changed. By 2008–2009, more than half (52%) of the funding came from clinical services, and the remaining sources provided significantly smaller amounts of revenue (federal research funding, 19%; state or local funding, 8%; tuition/fees, 3%; and other federal funding, 3%). The remaining 15% came from all other income sources.

Universities with their own hospitals depend even more heavily on direct patient care.

“If you go into universities, where they have their own hospitals today, you are close to 80%. About 80% of an academic health science center [budget] today is dependent on us seeing patients,” Dr. Colasurdo said.

The presence of academic health has also grown substantially during that time. From 1960–1961, there were 86 medical schools nationwide; by 2008–2009, this number had nearly doubled to 126. The number of medical students also increased—from 30,288 to 76,202—as did the presence of residents/fellows (14,417 to 108,176) and full-time faculty (11,224 to 128,683). The most significant difference was in expenditures: $437,000,000 to $78,856,000,000.

Despite the surge in medical students, the doctor role is evolving as well, as the medical field makes advances in artificial intelligence.

For 2010–2020, Dr. Colasurdo said strategy and priorities in academic medicine focused on facets such as discovery and customer experience. Looking at 2020 and beyond, he emphasized cost structure, informatics, artificial intelligence, and population health/precision medicine/health disparities.