Big changes are taking place in academic medical practice as the line between academic and private practice begins to blur. Today, more and more academic practices are being run by for-profit groups and community practices are being run by academic institutions.

So say speakers for a panel discussion Monday devoted to the “Academic/Private Hybrid Model of Perioperative Care.”

“Traditional academic practices are generally in large tertiary centers, often in an urban setting, with a Level I trauma service,” said panel moderator Zachary Deutch, M.D., Assistant Professor of Anesthesiology at the University of Florida, Jacksonville.

“They are closely associated with big-name universities and conduct teaching programs throughout the hospital. Research is important, and the bottom line is less important,” Dr. Deutch said.

He defined traditional private practices as taking place in small to mid-size communities with less emphasis on teaching and research and greater emphasis on efficiency and profitability.

Mark E. Hudson, M.D., M.B.A., Executive Director of Anesthesia Services at the University of Pittsburgh Medical Center, commented, “The current health care economic and regulatory environment is driving consolidation of academic and private anesthesiology practices. Academic anesthesiology departments must evolve in this new environment to maintain their academic mission by developing private practice ideals.”

Dr. Hudson said there is growing interdependence among hospitals, health care systems, physicians and other health care providers. All are obligated to meet regulatory requirements and quality metrics.

“Few purely academic practices are surviving. Increasingly, large health care organizations are acquiring anesthesia practices and anesthesia practices are merging, leading to a decline in traditional private practice, although it is still the most prevalent type of practice,” he said.

Academic anesthesiology practices face declining funding for research and declining revenue from clinical practice along with higher expenses for labor, forcing academic practices to focus on increasing revenue from clinical care and paying more attention to recruiting clinical talent, managing resources efficiently and optimizing productivity.

Aman Mahajan, M.D., Ph.D., M.B.A., described what he called the academic/private hybrid model of care. He is the Ronald L. Katz Professor and Chair of Anesthesiology, Professor of Anesthesiology and Bioengineering and Co-Director of the UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center at the University of California, Los Angeles.

“Hybrids have always existed in our folklore, in our culture and in our practice. They are usually created to solve a perceived unmet need. At UCLA, clinical care is at the center of our mission. Teaching and research are equally important. We also have a strong culture of community service. The evolution of our health care system has been and continues to be in line with supporting these missions,” Dr. Mahajan said.

Health systems are integrating and consolidating across the nation and changing the delivery of health care. At UCLA, anesthesiology is partnering with other departments in providing primary and secondary care with private practice groups to achieve economies of scale.

UCLA’s hybrid model has resulted in a 50 percent increase in revenue and expansion of services, productivity and innovation. The university is among the top five in the nation for grant funding from the National Institutes of Health.

“For academic medicine to survive, our missions need to be aligned, integrated and consolidated with private practice, realizing that there might be some conflict between physicians. Ultimately, health care can be improved for our patients,” Dr. Mahajan said.

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