A familiar ding echoes from blue scrub pants. My conditioned frontal cortex reflexively shoots my hand to the back pocket. Fingers encircle a black smartphone. A ricochet of notification vibration still tickles my right buttock. Several semi-autonomous thumb swipes ensue. The joy of Microsoft Outlook’s blue glow reveals a new email—one of nearly a hundred emails jostling for self-importance that day. But this one is different. The ominous phrase “Effective Immediately” hooks my gaze, and I proceed to read a lengthy rationalization of government action, directly decreasing funding for academic medical centers.
Academic institutions serve massive roles in their communities. They are bastions of education for the next generation of medical students, residents, and fellows—training grounds for the legion of doctors across America. These centers further create the atmosphere to conduct critical biomedical research, answer real questions, and create real science. Medicine is pushed forward slowly by curious minds laboring over nuance and hypothesis—not bureaucrats with empty promises. Clinically, academic institutions remain last lines of defense—tertiary or quaternary referral hubs for patients who cannot find care elsewhere. Those too sick and riddled with comorbidities, conditions too chronic and complex, or, frankly, those who cannot pay. Academic institutions differ sharply in these three facets from the massive private equity-driven health care consolidation metastasizing across the United States.
But how is this sustained? How do universities and medical schools maintain advantage and ability to accomplish the above? Funding. Grants. Donations. Academic institutions rarely share the lucrative commoditization of medicine that tempted the drooling mouth of private equity. Caring for complex patients—often uninsured or underinsured—requires more time and more resources, yet without the crutch of competitive pay from powerful payer mixes. How is this financial loss sustainable? Funding. Grants. Donations. A strong reliance on government.
Academic medical centers rely on giant research grants to push the envelope of science, educate the next generation, and simultaneously augment the clinical patient care enterprise. Just billing for clinic visits and surgeries doesn’t cut it. This academic engine only works if the government regime understands and appreciates the value of medical education, scientific advancement, and tertiary complex patient care. It fails when government policy is ruled by Twitter slogans—some concepts require more than 280 characters to communicate.
My fingers grip my smartphone (perhaps too aggressively). I glare at Microsoft Outlook, aghast at the shortsightedness of government cuts. Political allegiance is irrelevant. Supporting science and education should be pan-partisan. Yet decreased funding for the National Institutes of Health (NIH), Health and Human Services (HHS), and Centers for Disease Control and Prevention (CDC) is dangerous and damaging today and for generations of Americans tomorrow.
As economics allegedly trickles down, so does the weaponization of withholding the wallet. Our medical students, residents, and fellows will see shrinking educational opportunities. The doctors of America’s future, expected to provide ever-improving care … albeit with curtailed resources. The effects are more than just verbose musings on a page. They are direct. Funding cadaver labs for surgical residents to directly see, feel, and apply anatomy and prepare for real surgery—cut. Funding for institutional research support to investigate new drugs, delivery methods, and treatment modalities—cut. Funding for trainees and faculty physicians to travel for research, extramural collaboration, and networking—cut. Funding for faculty educational development, learning new surgical techniques to maintain a competitive edge and expand the ability to care for patients—cut. Funding for more doctors and ancillary providers to meet the needs of a growing American public—cut.
Efficiency can be a beautiful habit, mindset, and series of actions. But it can also be a dangerous ruse, disguising malintent. When fake government agencies pop into existence—etymology derived from canine internet memes and a floundering cryptocurrency—one must question whether this is just another affluent elite club existing at the expense of the populace. Sweeping statements, social media campaigns, and the bravado of braggadocio—a recipe for a rabble-rouser. But I fear the trickle-down effects: funding cuts for academic medical centers, research, and education. I fear the challenge to rouse ourselves from the rubble of faux efficiency. Perhaps some things should not trickle down?
The views and opinions expressed in this essay are solely those of the author and do not represent those of any employer or affiliated institution.
Adil S. Ahmed is an orthopedic surgeon.
