Autumn 2009: Letter from the President

President James Wagner

James W. Wagner, President, Emory University

Ann Borden

Is there a doctor in the University?

By James W. Wagner

Over the past several months our nation’s attention has been drawn to the debates focused on health care reform. As I travel the country to speak with alumni and others, I am repeatedly asked where Emory stands on this issue. After all, the training of health care professionals and the providing of health care itself have been central to the mission of Emory since 1915, when the Atlanta Medical College and Wesley Hospital merged with the newly chartered university that grew from Emory College.

That was also the year that Emory began its long association with Grady Memorial Hospital, which had been founded to care for Atlanta’s indigent patients; Emory’s partnership with Grady has provided training for a large proportion of Georgia’s physicians as well as doctors now scattered throughout the world. Since those early days, Emory also has added schools of nursing and public health to our array of health education.

Of course much has changed in the nearly one hundred years since Emory began its health care enterprise. It is still the case, however, that academic health centers in metropolitan areas give a disproportionate share of medical care to our nation’s uninsured population, largely through hospitals like Grady.

Beyond health care, the last half-century has also witnessed a complete transformation of funding and direction for research in basic and clinical health sciences, as the federal government and industry have developed effective ways to collaborate with universities to advance discovery, manage clinical trials, and transfer inventions from the lab to the bedside. (Emory, along with a number of other universities, has recently examined our policies, practices, and culture in this area to make certain that we are managing potential conflicts of interest appropriately and effectively.) Last year, funding awarded to Emory for sponsored research reached a new high of $484 million, largely in health sciences.

Academic health centers like Emory thus play a unique and vital role both in caring for America’s health today and in anticipating America’s health care needs of the future. In addition to providing primary and highly specialized clinical care for millions of Americans, the 120 or so academic health centers train tomorrow’s health practitioners, develop the next generation of life-saving treatments, therapies, and technologies, and provide more than 40 percent of the care for the nation’s uninsured and underinsured, despite representing only 6 percent of all hospitals in the country. Often the hospitals at academic health centers treat the sickest and most complex patient cases.

Emory’s priorities in health care reform focus on ensuring that these critical facets of our health care system do not wither and die. We seek to safeguard our nation’s health through wise stewardship of federal support for medical education. Without that federal support, teaching hospitals could not bear the greater costs they incur than other hospitals do. We hope, then, that Congress will protect graduate medical education at the very least; ideally we would also see expanded federal funding for residencies in states which, like Georgia, have a low ratio of medical residents per capita.

What will become of the health care system in America remains a critical question. A big part of that question is how a university like Emory can continue to serve the health care enterprise.

I would argue that our success as a university and as an academic medical center will not necessarily lie in treating greater numbers of sick patients. It will come from meeting—and exceeding—the standards of other great academic medical and health centers, thus developing new approaches and modalities that can be adopted by others around the world. In this way we will have a role in improving the health of millions who never even set foot in one of Emory’s hospitals or clinics. While we’re at it, we might imagine a role for academic health centers to develop and test new models for delivering health care and new models for providing insurance here in America.

So my response to where Emory stands on this issue is simple: Emory seeks to continue educating the best health professionals for the sake of a healthier country and a healthier world. Whatever new legislation ultimately is adopted, it will be short-sighted if it does not enable universities, the hubs of intellectual enterprise in America, to invest their most valuable resource—brain power—in solving some of our nation’s most intractable health problems.

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