This chapter takes on a big topic: the interaction between the Foundation and the nation's academic health centers. These centers, which train most of the clinicians who deliver health care in America, have been the engines of innovation, specialization and technological change in the health sector. As a dominant force in the health care world—perhaps the dominant force during the 1970s and 1980s—it is not surprising that academic health centers would be an important focus of the Foundation's grantmaking.
This chapter by Lewis Sandy, the Foundation's executive vice president at the time this chapter was prepared, and Richard Reynolds, the executive vice president between 1987 and 1996, traces the interaction between the Foundation and the nation's academic health centers over the past three decades. In their assessment, the authors observe that the Foundation's strategies have not always converged with those of academic health centers. In particular, the Foundation has long promoted the importance of educating generalist physicians; academic health centers—often responding to large amounts of money coming from clinical practice and the National Institutes of Health—have tended to concentrate on training specialists and subspecialists. This chapter explains that early grantmaking pursued an "augmentation strategy" in an attempt to persuade academic health centers to add generalist training to the medical school curriculum, whereas more recent grants tried to get academic centers to make fundamental changes in their educational approach. Regardless of the prevailing strategy to influence medical education, Sandy and Reynolds note the Foundation's consistent investment in individuals within academic health centers. Such support reflects the value placed on individual leadership to effect institutional change.
This analysis of the Foundation's efforts to influence academic health centers complements the chapter written by Stephen L. Isaacs, Lewis G. Sandy, and Steven A. Schroeder, "Improving the Health Care Workforce: Perspectives from Twenty-Four Years' Experience," that appeared in last year's Anthology. It can also be read in conjunction with Terrance Keenan's review of the Foundation's experience in promoting the fields of nurse practitioners and physician assistants—some of which took place in academic health centers—that appears as Chapter 11 of this year's Anthology.