1. Darrell G. Kirch, M.D. President and CEO, AAMC March 16, 2011 From Medical School Applicant to Health Reform Leader University of South Carolina School of Medicine

2. © 2010 AAMC. May not be reproduced without permission. The Legacy of Abraham Flexner for Medical Education

3. © 2010 AAMC. May not be reproduced without permission. The Culture of the University

4. © 2010 AAMC. May not be reproduced without permission. The Legacy of James B. Wyngaarden, M.D. for Biomedical Research

5. © 2010 AAMC. May not be reproduced without permission. The Culture of Biomedical Research

6. © 2010 AAMC. May not be reproduced without permission. The Legacy of Lyndon B. Johnson for Health Care

7. © 2010 AAMC. May not be reproduced without permission. The Culture of Health Care

8. © 2010 AAMC. May not be reproduced without permission. Academia as a Major Provider of Health Care AAMC-member teaching hospitals represent 6% of all hospitals Their work represents: 40% of all Medicare inpatient days 22% of all Medicaid inpatient days 40% of all hospital charity care They provide: 79% of all burn center beds 40% of neonatal intensive care beds 83% of all ACS-verified Level 1 regional trauma centers Overall, AAMC-member teaching hospitals provide 20% of all hospital care

9. © 2010 AAMC. May not be reproduced without permission. Our national political reality!

10. © 2010 AAMC. May not be reproduced without permission. A Bipartisan Moment…

11. © 2010 AAMC. May not be reproduced without permission. …Followed by a Partisan Statement…

12. © 2010 AAMC. May not be reproduced without permission. …Followed by Conflict at the State Level

13. © 2010 AAMC. May not be reproduced without permission. The State of the Union

14. © 2010 AAMC. May not be reproduced without permission. Our national economic reality!

15. © 2010 AAMC. May not be reproduced without permission.

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

18. © 2010 AAMC. May not be reproduced without permission. Our national health care reality!

19. © 2010 AAMC. May not be reproduced without permission. “Recession Contributes To Slowest Annual Rate Of Increase In Health Spending In Five Decades” Source: Health Affairs, 30, no.1 (2011):11-22 2009 Total Health Expenditure 17.6% GDP 4% from 2008 1% from 2008 $2.5 trillion

20. © 2010 AAMC. May not be reproduced without permission. Deficits in Insurance Coverage 4344.446.54545.7 Millions Number of Uninsured Children and Non-elderly Adults- 2004-2009 Source: The Uninsured: A Primer. Kaiser Family Foundation. December 2010. “Uninsured Rate Soars, 50+ Million Americans Without Coverage” — Kaiser Health News 16 September 2010 50

21. © 2010 AAMC. May not be reproduced without permission. Deficits in Access

22. © 2010 AAMC. May not be reproduced without permission. Source: OECD Health Data 2010, June 2010 Deficits in Outcomes Bottom third (77.9 yrs compared to Japan at 82.6) 2007 Life Expectancy 4 th Highest (6.7% compared to average 5.1%) 2006 Infant Mortality 1 st (Over 1/3 of U.S. population) 2006 Adult Obesity* U.S. Comparison to Developed Nations *Only 5 nations reported data on this indicator

23. © 2010 AAMC. May not be reproduced without permission. South Carolina Health Status South Carolina U.S. average Life expectancy 75.8 years78 years Infant mortality rate (per 1,000 live births) 96.8 Heart disease rate (per 100,000) 92.9190.9 Diabetes rate (per 100 adults) 9.35.5 Overweight/obese adults62.8%60.8% Source: statehealthfacts.org

24. © 2010 AAMC. May not be reproduced without permission. Government Social Spending - 2007 Source: Social expenditure: Aggregated data, OECD Social Expenditure Statistics (database) doi: 10.1787/20743904-2010-table110.1787/20743904-2010-table1 Percent GDP

25. © 2010 AAMC. May not be reproduced without permission. In the face of these realities, have we really “reformed” health care?

26. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture

27. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture Health Insurance for All Rational Payment System

28. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture

29. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture Confronting Workforce Shortages Creating True Teams

30. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture

31. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture Changing the Focus From “Sickness” to “Wellness” Creating True “Medical Homes”

32. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture

33. © 2010 AAMC. May not be reproduced without permission. Collaborative Hierarchical Autonomous Competitive Expert-centered Mutually accountable Individualistic Team-based Service-based Patient-centered An Emerging Culture for Health Care

34. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture

35. © 2010 AAMC. May not be reproduced without permission. 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. Gorrie What Americans Want From Health Care

36. © 2010 AAMC. May not be reproduced without permission. Care Model Professional Issues Economic Model Can We All Commit to “Fixing” Health Care? American Expectations Institutional Culture

37. © 2010 AAMC. May not be reproduced without permission. Healthcare Innovation Zones Source: Patient Protection and Affordable Care Act, H.R. 3590

38. © 2010 AAMC. May not be reproduced without permission. Will we have the health care professions workforce to take care of us?

39. © 2010 AAMC. May not be reproduced without permission. Rising to the Challenge of Workforce Shortages 7,400 25,200 30,200 64,100 91,500 58,000 With PPACA Without PPACA Projections prepared by the Lewin Group for the AAMC

40. © 2010 AAMC. May not be reproduced without permission. First-Year Medical School Enrollment Projected to Increase 21% by 2012 Existing + New Schools Existing Schools 16,488 Source: AAMC Annual Survey of Medical School Expansion Plans

41. © 2010 AAMC. May not be reproduced without permission. Will we create a true continuum of medical education?

42. © 2010 AAMC. May not be reproduced without permission. Can We Rethink Our Approach to the Medical Education Continuum? Premedical Medical School Residency and Fellowships Practice

43. © 2010 AAMC. May not be reproduced without permission. AAMCFSMBAHMEABMSCMSSAMAAHA Medical Schools State Boards NBME Specialty Boards Specialty Societies MCATUSMLE Cert Exams CME Recert/ MOC Subject Exams In-Training Exams Premedical Medical School Residency and Fellowships LCMEACGMEACCMENCQAJCAHO Practice

44. © 2010 AAMC. May not be reproduced without permission. Creating a True Continuum of Medical Education Learning Assessment Premedical Medical School Residency and Fellowships Practice

45. © 2010 AAMC. May not be reproduced without permission. In the end, is this all just a matter of politics?

46. © 2010 AAMC. May not be reproduced without permission. Source: JAMA. 2009;301(14):1482-1484