Abstract
The medical marketplace and various forms of contracted care place academic medical centers at a potential disadvantage. Recruitment of patients and maintenance of the academic mission may at times have disparate agendas. The university surgeon traditionally has embraced patient care, education, research, and administration with relative ease. Major price constraints and new forms of market competition now threaten the centralization of technology, the creativity, and the educational mission of university surgical practices. The university must deal with this new order by being proactive and flexible in negotiation. Faculty should conduct their business among themselves and with outside entities under a practice plan. Business management and physicians must try vigorously to understand each other. Finally, universities should use their expertise to lead in clinical outcomes research. The ideal university practice must show leadership in technological advances, retain the scientific method, and produce useful precise outcomes analysis. The academic surgeon must help solve problems involving excessive costs, assaults on creativity, and the business-medical interface. Time management will be essential.
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