The federal government should give more money to medical schools and teaching hospitals, two recent reports recommend. But managers of academic health centers shouldn't expect such a windfall, says one administrator.

"I would not risk the viability of my own institution by waiting for federal funds," comments Ralph Snyderman, chancellor for health, executive dean, and president and CEO, Duke University Health Systems Inc., at Duke University Medical Center. Snyderman agrees with two recent reports showing that academic health centers in competitive markets have less money for internally funded research than those in less competitive markets. However, instead of anticipating a federal fix, researchers at medical schools who find their research budgets squeezed by managed care should start planning. Managers at Duke reevaluated their business in 1991. "We had a market share of only 3 percent in one of the wealthiest, fastest growing counties in the country," Snyderman recalls. They...

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