American College of Cardiology

PROCEEDINGS OF THE 30TH BETHESDA CONFERENCE. THE FUTURE OF ACADEMIC CARDIOLOGY. BETHESDA, MARYLAND, OCTOBER 26-27, 1998.
JACC Vol. 33, No. 5, April 1999:1091-1135

30th Bethesda Conference:
The Future of Academic Cardiology (1998)*

Kenneth Lee Baughman, MD, FACC, Conference Co-Chair
Michael H. Crawford, MD, FACC, Conference Co-Chair

Contents

List of Conference Participants

Introduction

Task Force 1: Clinical Care

Purpose of Clinical Care in the Academic Medical Center
Current Challenges
General Considerations
Challenges to the Academic Cardiovascular Program
Shifting Resources
Separation from the Community
Noncompetitive Structure
Cardiology Divisions at Risk
Changing Environment
Primare Care Emphasis
Internal Structure
Performance Measures
Teaching Models/Mission
Faculty Expectations
Reimbursement/Documentation
Advantages of Academic Medical Centers
Expertise
Application of Basic Research to Clinical Practice
Organizational Structure
Administrative Structure
Brand Equity
Information Systems

Potential Solutions/Opportunities
External Relationships
Acquire Primary Care Practices
Develop Primary Care Networks
Subspecialty Care Clinics/Outreach Programs
Subspecialty Carve Outs
Leasing Arrangements
Purchase of Cardiology Practices
Internal Restructuring
Broad Clinical Strength
Align Incentives
Become Cost-Competitive
Minimize Variation in Practice Patterns
Define Training/Workforce
Nonphysician Extenders
Advocate Change in Payment Policies of the Health Care Financing Administration
Relationship between the Academic Cardiovascular Division and the Departments of Medicine/Pediatrics
Operational Changes
Hospitalists
Advantages of a Product Line Structure
Product Standardization
Clinical Pathways
Redesign Teaching Models
Disease Management
Disease Management and Medical Management Services: Rationale
Vying for the Delivery of Disease Management Services
Marketing Strategies of Academic Medical Centers
Telemedicine
Conclusions
Recommendations
References

Task Force 2: Research

Effect of Current National Priorities and Reimbursement Strategies ...
Scope of the Problem
The Value of Academic Cardiological Research
Current Research Funding for Academic Cardiology and its Limitations
The Current Status of Research in Academic Cardiology
The Researchers
Factors Affecting Research Performance
Limitations of Current Research Training
Recommendations and Conclusions

Recommendation #1
Recommendation #2
Recommendation #3
Recommendation #4
Recommendation #5
Recommendation #6
Recommendation #7
Summary Recommendations
Reference List
Table List

Task Force 3: Teaching

Cardiology Teaching and the Changing Health Care Scene
Comparing Teaching in 1998 and 1978
The Leadership View
The View of the Teachers
Factors Affecting Teaching
Corrective Measures
Better Transition to an Outpation Model
Enhanced Prestige of Teaching
Innovations in Teaching Methods and Evaluation Techniques
Financial Support
Conclusions
Recommendations
Reference List
Table List

Task Force 4: Faculty

The Faculty of the Academic Cardiology Divisions in the 21st Century
Threats to Salary Stability, Job Security and Morale
The Appropriate Number of Cardiology Faculty for the Future
Challenges to Promotion and Tenure
New Promotion Tracks

Investigator Track
Clinician-Scholar (Clinician-Investigator) Track
Clinician-Educator Track
Affiliated Clinical Faculty Challenges to Meeting Promotional Requirement for Fully Affiliated Faculty
Requisites to be a Successful Academic Cardiologist
Research Requirements
Clinical Demands
Faculty Assessment and Performance Improvement
Forces Acting on faculty
Faculty Development and Counseling
Aligning Faculty Incentives With Mission and Goals
Supplemental Funding of Teaching and Research
Academic Pediatric Cardiac Centers
Women in Academic Cardiology
Minorities in Academic Cardiology
Recommendations
Reference List
Table and Figure List

Address for reprints: American College of Cardiology, 9111 Old Georgetown Road, Bethesda, Maryland 20814. Attention: Educational Services Department (800-253-4636 ext. 694).

© 1999 by The American College of Cardiology