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Letters |
a Address correspondence to this author at: Department of Laboratory Medicine, University of Connecticut Health Center, MC-2235, 263 Farmington Ave., Farmington, CT 06030-2235. Fax 860-679-2154; e-mail makowski{at}nso1.uchc.edu
1
Department of Laboratory Medicine, University of Connecticut, School of Medicine, Farmington, CT 06030
2
Department of Pathology, and Laboratory Medicine, Hartford Hospital, Hartford, CT 06102
To the Editor:
A recent report from the Council of Scientific Affairs of the
American Medical Association indicated that the introduction of managed
healthcare had a substantially negative influence on the academic
productivity of clinical faculty in academic health centers (1). Consistent with this finding is the observed change in
the number of scientific abstracts presented during the Annual Meeting
of the AACC (2). As can be seen, over the last 4
years there has been a substantial 30% decrease in the number of
abstracts received and accepted from all sources, including academia
and industry (Fig. 1
, A and B). This decline does not correlate to a change in the
abstract rejection rate, which has remained relatively constant
(~20%) since 1992 (Fig. 1C
).
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To more closely examine this finding, we undertook a retrospective study to determine whether the percentage of abstracts presented at the AACC Annual Meeting from academic institutions was disproportionately decreased relative to the total number of abstracts (including those from industry). Abstracts were assigned on the basis of authors’ affiliation. In the case of multiple affiliations, abstracts were assigned on the basis of the first author’s affiliation. Surprisingly, we found that the percentage of abstracts presented from academia increased from 58.4% in 1992 to 63.0% in 1999. This unexpected change may, however, reflect a more recent policy (1997) of the AACC Annual Meeting Organizing Committee to eliminate duplicate and triplicate abstracts on industry-sponsored instrument evaluations in which the only difference between submitted abstracts was the analyte; this policy may initially artifactually increase the percentage of contributions from academic institutions. However, relatively few abstracts were affected by this policy (~25 per year). Thus, the large observed decrease in abstract volume cannot be attributed solely to implementation of this policy.
Although the percentage of academic abstracts increased from 1992 to
1999, the number decreased ~12% (from 426 to 379). The number of
students presenting their work at the annual student poster contest has
also decreased, most dramatically in recent years (Fig. 1D
). The reason
for the decline in student participation is not known, but it probably
is related to a decreased number of funded fellows in clinical
chemistry training programs (A.H.B. Wu, personal
communication) and a decreased number of programs approved by the
Commission on Accreditation in Clinical Chemistry (COMACC;
Fig. 1E
). Decreased student involvement may also reflect decreased
funding for academically related activities, including travel to the
national meeting.
In sharp contrast to the changes above, total AACC
membership has remained relatively steady over this period (1995–1999;
Fig. 1F
) (3). Despite this success, it can be anticipated
that the decline in junior faculty participation and training programs
will negatively impact long-term membership goals and subsequent
clinical laboratory research and development. It is well known
that decreased clinical revenue streams substantially limit
the flexibility of traditional cross-subsidization mechanisms in
academic health centers, including the funding of graduate medical
education programs, i.e., postdoctoral fellowships, residency training,
and the research activities thereof (1)(4)(5). In an effort to stabilize
existing revenue sources and prevent further anticipated erosion,
performance-based compensation for clinical faculty has
been introduced (1)(4). This
strategy rewards clinical productivity at the expense of other
"nonproductive", i.e., non-revenue-generating activities. The
establishment of a service-based compensation system within an academic
medical center dissuades academic productivity, especially
among junior clinical faculty (1)(4)(5), i.e., faculty likely to
publish preliminary research results in abstract form and participate
in poster sessions.
Although most laboratorians are aware that the diagnostic services they provide are now viewed as "cost centers", these data should compel us to evaluate the long-term implications of these findings. The growth of managed care, the increasing influence of health maintenance organizations, and the changes instituted by the Balanced Budget Act of 1997 will exacerbate an already tenuous situation in the provision of healthcare. Academic health centers will be particularly disadvantaged because of their need to balance increased clinical activity with their primary roles of teaching, research, and education.
Are the above data an indication that academic productivity is decreasing? Whether these observations provide early indicators of future constraint on academic commitment to clinical laboratory research and development missions remains to be determined.
Acknowledgments
We thank Christine Donnell, Marian Vallely, Erika Witherspoon, Kimberly Thompson, and other staff members of the AACC National Office for their cooperation. Dr. Tsongalis was Abstracts Coordinator for the 1999 AACC Annual Meeting and Clinical Laboratory Exposition; Dr. Wu is President, Commission on Accreditation in Clinical Chemistry.
References
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