AAMC Reporter: June 2008

Retiring AAMC Leaders Ponder the Past, the Present, and the Future

Related Resources A Word from the President: Standing on Their Shoulders AAMC Leadership Team AAMC at a Glance

This summer, AAMC Chief Health Care Officer Robert M. Dickler; Chief Legal Officer Joseph A. Keyes, J.D.; and Executive Vice President and Chief Advocacy Officer Richard M. Knapp, Ph.D., are all retiring after more than 90 years of combined service to the association and its members. They leave behind an organization and a health care environment that have both changed dramatically since their arrivals. They recently took time to reflect on the changes they have seen during their time at the AAMC—and what they feel the future may hold for medical education and health care as a whole.

Reporter: When you first arrived at the AAMC, what were some of the major issues and challenges facing medical schools and teaching hospitals?

Keyes: The first was that the AAMC had recently been reorganized. What had previously been a deans' club was now growing into a major umbrella organization that also included teaching hospitals and academic societies. There were also issues in play that were similar to what we are facing in the current period: the need for substantial growth in the number of medical students we train, a recognition of the need for more diversity, and a sense of unsustainability in our financial situation. Obviously, we've had substantial institutional growth over the years, but with the societal expectations on our members, we almost always feel that we are in a period of constrained resources. So I think the issue carousel is coming around again.

Reporter: How has academic medicine changed since your arrival?

Knapp: Back in 1968, you could easily find the medical school. Now you have giant academic health sciences centers, where the massive clinical and research operations have dwarfed the medical education mission. That is why I think some schools are reinventing the academy to reestablish the commitment to undergraduate medical education.

I think it has changed in very significant other ways as well. When you look at the schools, there was not a single female dean when I started here in 1968, and now there are 15. The same general point holds true for minority participation. Some people would say we still have a long way to go, and that's true. But it will happen.

Furthermore, a lot of people smoked back in those days. And there was a lot more drinking, a lot more alcohol around. It was everywhere. And now, if you smoke, you have to do it in a special place. And that's a huge difference. I think these kinds of prevention issues certainly get more attention now than they used to.

Reporter: How has the AAMC changed during your tenure?

Dickler: We are much bigger. And some of us are older! But overall, the whole network of mechanisms by which we support, serve, and communicate with our members has undergone a radical change. The range and quality of our service enterprise has expanded considerably. We have shifted from paper-based to computer-based applications for services like the MCAT exam. Our IT infrastructure has become the backbone of the organization in terms of day-to-day operations. We used to have a face-to-face meeting every time there was a new proposal in Washington. Basically those have disappeared. Now we interface through the Web, which did not really exist when I got here, and we do teleconferences all the time. We have also continuously expanded the various facets of our membership support functions. We have more professional groups and interest groups than when I first arrived. Internally, we have a much stronger focus on diversity, which complements our ongoing external focus.

Reporter: What do you foresee to be the major issues and challenges in the coming years for medical schools and teaching hospitals?

Knapp: I think one of the challenges is how the medical care system is going to be organized to provide primary care, and what the physician's role will be in the provision of that care. In that context, we have to show more leadership in the areas of health services research and what might be called patient care redesign. Physicians are going to need experiences and role models that help them become more team-oriented people.

Reporter: How do you think the AAMC should be involved in responding to future challenges?

Dickler: We are currently a superb resource for information, data, and reports. In many ways, we are an information organization. There is no doubt that we need to continue that. One of the questions before us is how we can help our members use this information more effectively back home. We need to figure out how to make our intellectual capacity more useful and available. We have an incredibly talented staff, and our members utilize us. But how can we take this intellectual capacity and offer it in a more focused way over a range of areas, from leadership development to bridging gaps between mission areas and providing greater organizational alignment? I think this is an incredibly exciting time. Our ability to help our community and the broader health care society is not diminishing, but expanding.

Reporter: What do you think was the AAMC or academic medicine's greatest accomplishment during your tenure?

Keyes: Our members are enormously important members of our society, and they take on a variety of socially desirable missions. They have willingly accepted the burden of being the safety net for the less fortunate in our society. But I think the safety net is becoming increasingly frayed. Caring for our communities has been a big accomplishment, but it's still unfinished business. We also have made major strides in science, and the result of that has been remarkable progress in curing and treating disease. There is a whole list of problems like polio and tuberculosis that used to be major threats, but which our community helped to improve.

The AAMC's contribution is in helping our members do things that are better done collectively than individually. Our contributions have been enormous in evaluating applicants, accepting students, and making services simpler and much more cost-effective.

Reporter: How do you hope your career is remembered by those at medical schools and teaching hospitals, and what advice might you have for them as you depart?

Dickler: I guess the question to ask yourself is whether the organization is as good as or hopefully better than when you came. Have I made a contribution to the whole? I hope and like to believe that I have made contributions that we've been able to build on. I have been blessed with a brilliant group of colleagues.

Our collaboration with members and with other sectors of the organization has increased. I would like to think we have helped a good organization stay good, helped in some ways to make it better, and positioned it to continue to get better in the future.

Keyes: I would like people to remember that I played a role in helping our members do their work better. As for advice, I think we capture it in our tagline: Learn, Serve, and Lead. We have to view ourselves as learning persons and learning organizations whose role is to serve our society and step up to the moral obligations of leadership when appropriate.

Knapp: I have a sign in my office. It says 'The main thing is to keep the main thing the main thing.' It's very easy to get distracted. When you keep the focus on the main thing, that's when you start to make progress.

As for me personally, I would want people to say, 'He listened.' Listening is becoming a lost art these days. The AAMC has been a wonderful place to work. I always felt like I belonged here.

—By Scott Harris