Academic medical centers and the fallacy of misplaced concreteness

Academic medical centers (AMCs) are a familiar target of critics who charge the US health care system with indifference to the most pressing needs of the public. AMCs are frequently faulted, for example, for promoting specialization instead of primary care, for favoring high-tech services rather than the promotion of health and prevention of illness, and for failing to adequately meet the needs of the disadvantaged. An organizational perspective, with particular attention to the structure, mission, and environment of this institutional form, suggests that these critiques may misplace onto AMCs responsibility for solving problems with deep roots in the larger political economy of health care policy in the United States. By the same token, however, the pressures of that political economy (i.e., environment) on AMCs progressively strain their structure, mission, and (arguably) their capacity to serve the public interest.