Advocating for Health


What’s so special about teaching hospitals? Emory Dean Tom Lawley and the Association of American Medical Colleges want you to know. 

By Thomas Lawley

Not surprisingly, the biggest issues facing the Association of American Medical Colleges (AAMC) today are economic ones, above all, proposed cuts to federal support for research and teaching hospitals.

As AAMC president Darrell Kirch recently wrote in a letter to President Obama, cuts to funds for teaching hospitals would have serious adverse and lasting effects on patient care, jobs, medical research, and hopes of ever mitigating our country’s growing physician shortage. 

Teaching hospitals account for only 6% of U.S. hospitals, so how can they have such an impact? And why is the federal government supporting them in the first place?

The importance of government funding—specifically Medicare—to teaching hospitals is not well understood. Serving as a source of information for elected officials and citizens alike is one of the AAMC’s ongoing responsibilities, so here goes.

The nation’s 400 teaching hospitals—including Emory’s own five hospitals and its affiliates (Grady, Children’s Healthcare of Atlanta, and the Atlanta VA Medical Center)—are by definition hospitals associated with a medical school. Teaching hospitals serve as educational sites for more than 100,000 residents nationwide. These young physicians are medical school graduates who are receiving postgraduate specialty training to become family medicine doctors, surgeons, gynecologists, internists, or practitioners in another of the 130 clinical specialties recognized by the Accreditation Council for Graduate Medical Education (GME). Such training can take three to 11 years, depending on the specialty.

The cost for hospitals to train a resident averages $100,000 each year, including a stipend and a percentage of supervision costs and hospital overhead. While that figure may sound high, in actuality graduate medical education is a bargain for hospitals, communities, and the nation, considering that each resident provides up to 80 hours of complex patient care each week while being taught and supervised by medical faculty. The highest paid resident, a physician in the 10th year of training after medical school, receives roughly $60,000 a year (and often has more than $100,000 in student loans to repay at the completion of the residency).

On average, Medicare, through its GME payment system, reimburses teaching hospitals about $40,000 per resident over and above their salary. The payments are partial compensation for the fact that teaching hospitals end up treating a sicker, more medically complicated patient population than other hospitals, that they provide essential but costly services unavailable elsewhere in the community, and that they treat a disproportionate share of poor patients.  

For example, teaching hospitals provide the country with 75% of burn units, 62% of pediatric ICUs, 61% of level I regional trauma centers, 50% of surgical transplant services, and the list goes on.

Furthermore, teaching hospitals provide more than 40% of all hospital charity care and 25% of all Medicaid hospitalizations. (Like Medicare for seniors, Medicaid for individuals and families with low income pays less than the costs incurred in providing patient care.)

No one can argue with the need for fiscal responsibility, but our country can’t afford to target teaching hospitals to achieve it. The phrase throwing out the baby with the bathwater never rang truer. The AAMC has expressed concern that funding cuts would almost immediately cause serious damage, threatening services that all of us want to be in place if we need them. For the poor or those with devastating medical bills, an already tenuous safety net would be torn to shreds.

Then there is the future.

Further declines in Medicare support to teaching hospitals (support has effectively been frozen since 1997) would not only threaten access to services for all of us but also worsen the current physician shortage. By 2020, the proportion of the population over 65 will have increased by 35% at a time when one-third of current physicians are expected to retire. The AAMC projects a shortage of 45,000 primary care physicians and 46,000 surgeons and medical specialists. The passage of health care reform would add 32 million Americans to the rolls of insured people, further intensifying the demand for physician care. While a critical shortfall will affect everyone, those most affected will be vulnerable and underserved populations. 

Little wonder that support for medical schools and teaching hospitals is such an important issue to the AAMC, but there are plenty of other irons in the fire too. One is advocating for support of the National Institutes of Health, our nation’s health research engine, which supports thousands of jobs. Another is creating the best possible physicians. For example, the MCAT exam, which is part of the selection process for medical schools, is being revised to balance its current focus on natural sciences with more emphasis on critical analysis, reasoning skills, and behavioral and social sciences. Another AAMC effort involves tailoring medical school curricula to prepare future physicians, nurses, allied health, and other health care professionals to work together in teams rather than as lone rangers.

Despite the challenges we face today, the excellence of American academic medicine, research, and patient care has never been greater. And the AAMC wants to make certain that they keep getting better. That’s not just advocating for academic medicine. It’s advocating for the American people. EH


Web Connection: To learn more about the AAMC’s advocacy for teaching hospitals, visit



The man for the job

Dean Tom Lawley
Dean Tom Lawley

Last year, Emory medical dean Tom Lawley took office as chair of the board of the AAMC, the highest office of the most powerful organization that supports medical education.

The AAMC represents America’s 134 medical schools (and 17 Canadian ones); approximately 400 major teaching hospitals and health systems, including 62 Veterans Affairs medical centers; and nearly 90 academic and scientific societies that are concerned with biomedical and behavioral research, medical education, and patient care.

Lawley knows this turf well. One of the longest-serving medical deans in America, he led Emory into the nation’s top medical schools, with research awards expanding five times over since he took the deanship in 1996. Before joining Emory as chair of dermatology, he was a senior investigator at the National Cancer Institute. He has never stopped seeing patients as his administrative duties have increased.

Now, as head of the 17-member AAMC board that he helped create and on which he has always served, Lawley is front and center in dealing with the critical issues that face medical education—and the country—in an era of economic pressure, health care reform, and spiraling achievements of modern medicine.

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