The affiliation between The Methodist Hospital, Weill Medical College of Cornell University and New York-Presbyterian Hospital is, to our knowledge, the first transcontinental affiliation between major nonprofit academic health centers (AHCs) in the United States. The rationale for the affiliation was clear to those involved in the discussions. The institutions share the same mission of fostering progress in clinical care, education and research; and because of their geographic separation, Methodist, Weill Cornell and New York-Presbyterian do not compete with each other in providing clinical care to their regional populations. While academic and potential competition for international referrals do exist, it was judged that these potential areas of competition could easily transform into collaborations. Most importantly, this situation ottered an opportunity to explore new models for AHCs, which many feel must change to better meet society's needs.1 Also, it seemed that this could have importance beyond the collective interests of the three institutions. A spirit of optimism and possibility, respect and trust between the key individuals, the support of senior board leadership, and recognition of the need to conclude the negotiations promptly served as the key enablers of agreement. The affiliation agreement's straightforward basic terms facilitate collaboration in patient care, teaching, research and operational performance. The affiliation is primary and reciprocally exclusive in New York and Texas (e.g., Methodist is Weill Cornell's only affiliate in Texas, and Weill Cornell is both The Methodist Hospital's primary academic affiliate and its only affiliate in New York, but both may have other affiliations). Members of Methodist's medical staff are eligible for faculty appointments at Weill Cornell, but appointments are neither automatic nor required. The primary academic appointment for chairs will be at Weill Cornell. Mutual efforts to improve clinical care include coordination between department chairs and sharing best practices, quality methods and clinical databases. The affiliates intend to collaborate extensively in education - including graduate medical education (GME), medical student education and research training at the graduate and postgraduate levels - and foster joint research, particularly clinical and translational research. Finally, administrative staff explore opportunities for sharing processes and progress in operational performance.
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