Academic Dermatology in a Changing Health Care Environment

Abstract

NO ONE in his or her right mind should presume to understand what is happening in terms of the changing American health care environment. Certainly I make no claim to understanding it myself but I would like to offer some personal views that take a somewhat different perspective to the usual discussions that are held about the subject. My interest in doing so is based on 2 considerations. First, over the last 15 years I have served as the section head, or chair, of dermatology in 3 different settings: Tucson, Ariz; Minneapolis, Minn; and Sacramento, Calif. These 3 geographical sites are widely acknowledged to be among those most severely affected by what is euphemistically termed health care system reform. Second, having served as hospital director for ambulatory care at the University of Minnesota, Minneapolis, I have experienced the changing health care environment from the hospital side as well as from