This chapter discusses the ability of the academic physician to respond appropriately to demands to document and improve the quality of medical care. Such quality care issues may represent a more formidable challenge to academic medical centers (AMCs) and to their clinicians. The systems approach can be used to understand the relationships of the AMC and its academic physicians to their internal and external environments. Academic physicians are less well prepared through training, experience, or mindset to accept or respond to the new environmental and societal pressures relative to the issue of quality of care, than they are to economic restructuring. Lack of preparedness makes a negative impact on the education of future physicians. The chapter provides specific means by which AMCs can respond successfully to the issues. But there are no facile modifications of reward systems that can prepare AMCs and their physicians to meet the challenge of their environments, particularly relative to financial and quality challenges. Modifications in rewards must be accompanied by changes in the medical education process so that the physicians of the future are prepared to embrace the requisite new managerial and CQI skills as a part of their medical armamentarium.
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