Going global: Academic medical centers innovate to maintain an international presence
Dr. Gilbert Mudge
American academic medical centers have played a pivotal role in the evolution of global healthcare by training international clinicians and researchers and providing advanced clinical care. International patient referrals became an important component of their business planning. But globalization of capabilities and political realities after Sept. 11 have created a new paradigm.
Dr. Thomas Aretz
Accordingly, academic medical centers have developed new initiatives to maintain a global presence and an international revenue stream. The purpose of this review is to describe the new and evolving role of these organizations in global healthcare, pointing out emerging strategies and potential complications or consequences.
Traditionally, global outreach of academic medical centers has been reminiscent of historical missionary efforts. Most compelling are the numerous initiatives directed toward specific disease entities such as HIV and drug-resistant tuberculosis programs, and must be lauded for their commitment and mission.
Academic medical centers also have maintained their commitment to their educational mission, driven by the global healthcare interests of those in graduate medical education programs. Student electives and resident rotations are readily available, many directed toward humanitarian or disaster relief missions.
The past five years have witnessed a transformation in the nature of global initiatives at these organizations, driven by the economic pressures and challenges at home coupled with the interest in academic medical center-based healthcare and education, technology, quality, standards and knowledge, and fueled by the growth of new hospitals and education systems in emerging economies. So academic medical centers are now entering into more complex relationships with public and private organizations to advance their mission, enhance their reputation, garner economic benefits, and attract overseas patients for specialized medical care.
Broadly, these relationships fall into the following areas:
- Clinical providers: Owner or joint venture relationships to provide highly specialized care, e.g. transplantation and oncology care (University of Pittsburgh/Palermo, Italy; MD Anderson Cancer Center/Spain).
- Team management or support: Long-term contracts with resident teams to build, operate and/or manage facilities, or provide support to local overseas hospitals. (Cleveland Clinic/Abu Dhabi, United Arab Emirates; Johns Hopkins Hospital/Al Ain, United Arab Emirates).
- Degree granting: Affiliating with other educational institutes to grant joint degrees (Duke University Medical School/National University of Singapore) or building and operating medical schools, conferring their own degrees (Weill Cornell Medical School/Qatar)
- Advisory, knowledge transfer and training: This includes long-term agreements around advising, knowledge transfer, training in quality assurance, management, specific clinical domains, patient safety, information technology, education and health sciences school curricula (Partners International, Boston; Methodist Hospital, Houston).
International groups are often interested in academic medical centers for commercial reasons, brand utilization, etc., while the medical centers are typically driven by a broader mission. Protecting the brand while delivering what the name truly represents is very challenging, especially when academic medical centers try to reconcile the mismatch between commercial and academic imperatives.
Some groups also see the relationships with academic medical centers as a financial investment, using purely commercial metrics and models to support these projects. They may place less importance on the noncommercial contributions of an academic medical center, such as teaching, research and unprofitable, but much needed, clinical services. Such fundamental mismatches often lead to significant misalignment between academic medical centers and the project sponsors requiring frank discussions and novel approaches and solutions.
Many international relationships also expect direct on-the-ground, long-term participation of the leaders and faculty from the academic medical centers, but long-term positions may not be desirable for either party.
Establishing a school or hospital abroad requires: the willingness of academic medical center faculty to move long term to a foreign location, affecting their academic and professional career trajectory; dealing with the economic disparities between the medical center and local faculty; attracting and retaining high quality faculty and creating a seamless interface between the overseas faculty and the home-based faculty.
The domestic campuses of academic medical centers strive to create a balance between academic mission, social responsibility and financial imperatives. In a developing country, this balance may be more difficult to achieve, requiring academic medical centers to adjust their missions to the new circumstances and “campus.”
Academic medical centers are expensive institutions, with cost structures incompatible with many evolving global healthcare systems. Their sources of funding are complicated and multifaceted. Transferring an academic medical center model to developing nations is therefore difficult and requires acknowledged and calculated compromises by both parties.
Dr. Mehul Mehta, Edwin McCarthy and Dr. Frederick Van Pelt contributed to this article.
Dr. Thomas Aretz is vice president of global programs at Partners Harvard Medical International, and Dr. Gilbert Mudge is vice president of international programs at Partners HealthCare System