Over the course of the last century and a half, academic medicine has evolved from the local, charitable care of alms houses into a global marketplace of competing ideas, resources and interests. During the 25th Annual Ben Park Lecture on March 16, visiting lecturer Dr. Michael Zinner placed the current state of academic medicine within this context and forecast a future in which surgical medicine is evaluated by a "new metrics for quality" that will provide patients with more information and control over health-care decisions as insurance coverage continues to decrease for most Americans. Dr. Zinner is the Moseley Professor of Surgery at Harvard Medical School and surgeon-in-chief and chairman of the department of surgery at Brigham and Women's Hospital in Boston.
The lecture, titled "Milestones in American Medicine: History, Cost and Quality (Gauguin to the Red Sox)," outlined different eras in medicineĀamong them charitable, educational, insurance, government, managed health care, and the current era, consumerĀand how the competing interests of insurance companies, government administrations, physicians and (to a lesser degree) patients have driven the evolution from one era to another.
From a business perspective, Dr. Zinner consents that the health-care business model is broken, signaled by rapidly rising costs despite decreases in insurance coverage and access to care. Over the last decade, health-care partnerships and mergers have challenged the role of managed health-care organizations, redefining the relationship between physician and insurer and forcing patients to play a greater role in the health-care decision-making process.
"At the end of the '90s things changed," Dr. Zinner said. "Partnerships and mergers have given hospitals and institutions the opportunity to push back against insurance companies. As we move into the era of consumerism, patients are asserting their rights and resisting the limitations of HMOs."
Access to information has catalyzed this resistance, and as patients become more critical of both individual doctors and managed-care organizations at large, Dr. Zinner sees the emergence of a new system of measuring physician performance.
"The new metrics of quality will introduce the concept of values" to evaluating doctors and will consider elements such as a doctor's volume of surgical cases and the risk-adjusted outcomes of those cases, said Dr. Zinner. Ultimately, he believes these figures may be used to create report cards that consumers can access and utilize in a pay-for-performance health-care system where insurance coverage is increasingly limited.
The Annual Benjamin S. Park Jr. Lecture is the pinnacle of the Department of Surgery's academic year. The program provides lectureships to the most outstanding surgeons in the field as a reminder of the importance of surgical education.
The program is named for Captain Ben Park Jr., M.D., a physician and surgeon of unusual talent who trained in the General Surgery Residency Program at The New York Hospital. Following his residency in 1968, Dr. Park entered the Medical Corps of the U.S. Army and, one year later, joined the Twenty-First Evacuation Hospital in Korea. One week after his arrival, Dr. Park died in a helicopter crash during a rescue mission in the demilitarized zone. The Department of Surgery at Weill Cornell established the Visiting Professor Lectureship in 1982 as a memorial to Dr. Park's life and as a reminder of the tragedy of war.