Presidential address: doing our part to ensure the future of academic medicine.

Peggy and I thank you for the privilege of serving in the Presidency of the American Clinical and Climatological Association (ACCA). The ACCA is unique among professional societies because of the special emphasis it places on fostering great friendships among families even as we gather to share our scholarship. To be entrusted with the reins of this special organization has been a singular honor, one that we will count among the highlights of our careers. For the most part, service as ACCA President has been a pleasurable experience, one marred only by the requirement to deliver the Presidential Address like that you are about to hear. Deciding what to say and how to say it has been arduous because, like many of you, I am far more comfortable with a reportorial rather than a discursive style of discourse. On the other hand, this address is a chance to speak off-the-cuff about things that matter to me, and to do so before this august audience of treasured colleagues, friends, and mentors. In that spirit, I thank you in advance for the gift of your presence and your attention. What I have to offer today in return for the next 20 or 30 minutes of your time are my personal, highly subjective, and completely qualitative musings about the future of academic medicine. This is the ecosystem in which we have been so lucky to thrive throughout our careers. As all ecosystems inevitably do, ours is struggling to adjust to a rapidly changing environment that is disrupting the niches in which we have built our comfort zone. Some would even have us believe that our surroundings are being altered as profoundly as the earth was by the meteor that killed the dinosaurs. In this scenario, of course, we get to be the dinosaurs! I do not happen to believe that the changes already occurring are that catastrophic, but they do pose a significant threat to academic medicine nonetheless. My topic today is about preserving the essence of what academic medicine can contribute to society in these disruptive times, and some things we must do to ensure that we preserve sustainable niches for our successors. We are members of this Association because we have thrived in this ecosystem, excelling as scholars, teachers, mentors, clinicians, or leaders. We have, individually and collectively, received a great deal in return. The rewards for our many years of education, training, and contributions to our fields have been substantial. We enjoy an interesting and fulfilling professional lifestyle, academic tenure, a reasonably high level of compensation (most of us fall within the now infamous 2%), and broad networks of friendships, even among those we regard as our competitors. We have been the beneficiaries of several decades of unprecedented expansion in public and private support for our endeavors. Indeed, the past seven decades have blessed us with perhaps the greatest expansion of any scholarly enterprise since the Renaissance. That era of largesse is over now. We, the beneficiaries of this phenomenon, owe academic medicine our best efforts to ensure that the enterprise will continue to thrive and make its contributions to society despite a much tougher environment. We owe this to our successors, our patients, and to the society that supported us so generously. If we are to do our part to guide our endeavor through these perilous times, we must first understand the essence of what it is we are trying to protect and preserve. Each of us would likely articulate what that is in individual ways. My version of what we must preserve is a national enterprise supported by institutions that are dedicated to fostering discovery, innovation, scholarship, education, and career development in all disciplines needed to enhance our understanding of human health and disease, and which will accelerate application of that understanding in ways that improve human health and well-being. These institutions must also nurture the development of the next generations of scholars and professionals who will continue the pursuit and ultimate accomplishment of those daunting goals. We need to protect the core missions of discovery, translation, education, application, and service. We need not protect the existing way that we go about our business. Indeed, maybe we should do the opposite. This is not about our titles, our compensation, our reputations, our personal legacies, nor is it ultimately about budgets, programs, buildings or balance sheets. It is about the impact of what we do for others that merits the gift that we are given in return—the way that we get to live our professional lives. In what other profession can you care for the sick, teach and mentor the best and brightest, work in an environment populated by brilliant and committed people, all while pursuing our strongest intellectual interests? And in what other endeavor can you do all of that with a rather comfortable lifestyle and job security that most other professions envy. Most importantly, in what other endeavor can we, individually and collectively, have such a positive impact on the health and well-being of individuals, their families and loved ones, and society in general? We have been able to wake up each morning knowing that our efforts would in one way or another contribute to those lofty goals. We all expect that the future is going to be far more daunting and uncertain for those following in our footsteps. Those succeeding us must perforce be even brighter, more creative, more committed, more dedicated, and more forceful than we have been in advancing academic medicine and what it has to offer. The majority of us are in the latter stages of our career. The finest legacy we can leave is a vibrant 21st century version of Academic Medicine, an ecosystem robust enough to attract the most exceptional people to become our next generation, and to extract from them all of the societal benefits of their creativity, energy, brilliance, and talent. What follows is not a comprehensive manifesto or prescription for “fixing” academic medicine. Indeed, many things that academic medicine must accomplish to survive are not even on my list. For example, I have not attempted to delve into the extraordinarily complicated business issues, many of them local, that each academic medical center faces in this era of healthcare reform and declining federal funding. I am also not going to dwell on our need to work harder than ever to influence public policy and the public itself about the importance of what we do to this nation's future. Those are givens. They have been discussed extensively by many individuals who are more qualified than I to opine about these matters. Rather, I will focus on some things that, while hardly sufficient, are absolutely necessary if we are to emerge from this highly disruptive period as a thriving enterprise. These are things that do not get discussed quite as often or loudly, but are essential if we are to deliver on the promise that science will create better health for everyone. Here are five things that I believe to be essential to that future: We need to get over it and stop the whining. We need actually to embrace change not merely to react to it. We must save our young. We must do a better job of understanding our customers in all of their dimensions. We must master the convergence of research and care that our own discoveries are creating.