Forward

This report is one of three similar and simultaneous publications about current challenges to and alternative futures for academic medicine. The authors, members of the International Campaign to Revitalise Academic Medicine (ICRAM), want to stimulate discussion among colleagues who work in academic medicine, as well as practitioners and students of medicine and other health professions. They also hope to reach the men and women who set priorities for academic medicine and allocate resources to and within it.

The three publications—articles in BMJ* and PLoS Medicine* and this Milbank Report—differ in the extent to which the authors compress and document their discussion of what they call current “instabilities in academic medicine.” For this report, the authors expanded their discussion and documentation of these instabilities in order to provide additional context for readers who do not spend their professional lives in academic medicine.

The authors define academic medicine as the “capacity” of the health sector to “think, study, research, discover, evaluate, innovate, teach, learn, and improve.” Each country allocates responsibility for these tasks differently. In all countries, however, schools of medicine and other health professions and the hospitals, ambulatory care settings, and research units associated with them are central in carrying them out.

Since the second half of the nineteenth century, the institutions of academic medicine have contributed to improving and maintaining health, to national and regional economic development, and to upward socioeconomic mobility for millions of people—students, trainees and employees. Governments and, in some countries, philanthropies generously subsidized the people and institutions of academic medicine for most of the past century because their leaders valued these contributions.

The scenarios in this report suggest that some of the current instabilities in academic medicine could stimulate changes in the priority accorded to it by the public and, as a result, by policymakers— in some countries at least. ICRAM devised these scenarios in order to promote discussion about the instabilities and how they can be addressed in ways that strengthen the contribution of academic medicine to the public good.

Daniel M. Fox
President

Samuel L. Milbank
Chairman

*You may access the BMJ article at http://bmj.bmjjournals.com/cgi/data/331/7507/DC2/1 and the PLoS Medicine article at http://www.plos.org/press/plme-02-07-clark.pdf.