Academic medical centers and underserved communities: Modern complexities of an enduring relationship

Background: Most private academic medical centers are located in underserved areas, yet fiscal pressures have led many to struggle with balancing their commitment to surrounding communities with other missions. Objective: To explore stakeholders' views regarding the ethical, legal, and financial obligations of private academic medical centers to their surrounding neighborhoods. Design, Participants, and Measures: Qualitative analysis of key informant interviews during 2008 with medical students, faculty and community physicians, administrators, and community health leaders at a large urban academic medical center. Grounded theory was used to iteratively review, code, and revise a taxonomy of themes, with abstraction of illustrative quotes. Results: Nineteen in-depth interviews were conducted. All respondents believed academic medical centers have an obligation to their surrounding communities but characterized the extent of this obligation in a variety of ways. Respondents disagreed about how the core mission of an academic center should be defined, although many recognized the tripartite mission, conflict centered on the balance that should be sought between research and clinical care. A majority of interviewees expressed frustration with the nation's current health care system. Many provided unprompted recommendations regarding how academic medical centers might engage their underserved communities, including conducting formal needs analyses, promoting ongoing dialogue, and using information technology to bridge the provision of clnical care in community and academic settings. Conclusions: These data provide enriching perspectives from stakeholders regarding this enduring yet evolving relationship. The diversity of views illustrates one of the challenges that will accompany health care reform impacting academic medical centers and their surrounding, often underserved, communities.