Changing Landscapes in Academic Medicine: What do we do now????

Barry R. DeYoung, MDActing Chair/DEOFrederic Stamler Professor of PathologyUniversity of Iowa

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Barry R. DeYoung, MD

Philosophy According to Yoda"Difficult to see. Always in motion is the

future."

What we know……

• Volume of tests (specimens) is going to continue to increase

- Directly related to aging population as well as increased access to screening procedures such as mammography and colonoscopy

- Considered a good thing????• Reimbursement will be decreasing

- Possibly in real terms (radiology); for sure in terms of growth

What we know II …….

• We have obligation to provide our junior faculty/next generation the opportunity to have an academic career in all phases of the tripartite mission

• How do we procure the appropriate resources in a world of constricting resources???

• The Chair/DEO conundrum……- Where to procure resources to meet all

demands and maintain balance across missions????

Possible Ways to Enhance/Provide Resources for Academic Development• Surtax/Sequester on/of small percentage

of highest salaried individuals- Can lead to a pool of money to be utilized solely

for the purpose of junior faculty academic development

• Small percentages of salary on various grants

- Even though small, and even though very difficult in current funding situation, small amounts add up

Possible Ways to Enhance/Provide Resources for Academic Development II• Credit for services provided– At Cancer Center initiative, have procured funding support

for activities related to patient care and research within the CC

• Two levels of support– Basic oncology patient care activities– Support of specific research and/or investigative

related activities (support of tumor repository)– 8 faculty X 7500 per (60K)

• Additional support for faculty involved in Molecular Pathology (10K per faculty)

– These funds help defray salary, freeing up other departmental funds for academic development

Possible Ways to Enhance/Provide Resources for Academic Development III• Outreach activities

– Many different forms and shapes ranging from consultative AP services to “full shop”

– Difficult to compete with large labs for any number of reasons– Many different business models which tend to be institution

specific– Depending on agreement with institution, can range from

profitable to exceptionally profitable– Projects to remain so, at least short and intermediate term

• Especially true for “niche” markets such as Renal, Nerve/Muscle where volumes are increasing and the complexity of the testing makes even technical cuts difficult

– Under threat when population reimbursement (capitation) or outpatient DRG’s come into play

University of Iowa Diagnostic Labs (UIDL)• Predominantly AP driven; much activity related

to niche markets• Annual growth in billed and collected charges

for last decade• Purchases technical services from hospital;

professional charges subject to Dean’s tax (6.5%); some payout to faculty involved as incentive

• Allows for significant underwriting of faculty development as well as deposits to reserve funds

UIDL Charges and Revenues

Conclusions• Current environment is threat to academic department’s

ability to foster appropriate faculty development• Departments must “diversify” as best they can to insure

consistent revenue streams • As a “hospital based” practice exist limited ways exist to

achieve diversification• Partnering with other stake holders within the institution or

enriching outreach activities may have some traction in achieving consistent or increased revenue

• Long term, even greater threats on horizon with population based care and outpatient DRG’s

• Need to be highly vigilant, creative, and entrepreneurial to meet the challenges successfully

Discussion????