Finding the silver lining without the golden eggs.

Abstract

Despite the failure of Congress to enact comprehensive health care reform legislation, including the hard-won proposals on behalf of academic medicine, there is much reason for hope for the future. Academic medicine won major victories in having its proposals for a broad-based all-payer system of explicit supports for its various missions included in major reform bills. If the members of the academic medicine community can strengthen further the unity they achieved during the long debate, they will be well positioned to succeed if another opportunity arises in time to rescue academic medicine from a buyer's market that is indifferent to their needs. But prudence dictates that they not depend on being rescued and instead consider the faltering of legislative reform as a wake-up call, summoning them to focus on difficult issues within their own control as they engage the rapidly changing health-care marketplace. Academic medicine has grown phenomenally over the past few decades because its missions have been strongly supported by the public. Continued growth is unlikely, given society's numerous unmet needs and limited resources. Therefore, academic medicine not only must face squarely the challenge of restructuring its work to be more efficient and more productive, but must use the many opportunities that lie ahead to sustain and strengthen its public support by embracing public accountability and rededicating its efforts to meet public expectations.(ABSTRACT TRUNCATED AT 250 WORDS)