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"Educators are probably more na than physicians in private practice, according to Amundson. "You can't not include discussion of finance because it's so on the mind of patients today."

Robbins keeps reinforcing the message of collaboration at TMC, even though collaboration takes place more easily on an academic medical center campus. Community hospitals tend to use more physician extenders such as nurse practitioners and physician assistants, whereas teaching hospitals also employ researchers. "Researchers are by nature collaborative," Robbins says.

Dzau agrees that academic medicine needs to evolve. "Certain dynamics of medical education haven't been taught well," he says. In Nike Zoom Uptempo V Premium Camo his opinion, schools need to focus on subjects like preventive practices and social factors that affect health.

says. The statement at Duke specifically mentions evidence based medicine, reducing health disparities between socioeconomic strata and improving the health of the communities it serves. Dzau also has stressed transparency with the public so it is easier to explain important decisions such as service cuts.

"We are moving from a traditional center that has a connotation of four walls to a system," says Nike Air More Uptempo 2016 Price

All three areas are under stress right now, from ongoing funding cuts and the pains of trying to reform a broken health care industry, including a shift away from traditional hospital and clinic care to remote and home based monitoring. And yet academic medical centers still struggle with the Nike Uptempo V Premium

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At the University of South Dakota's Sanford School of Medicine, doctors in training work with students in other disciplines as well, such as pharmacy, nursing and physician assistant programs. "Early on in their education, they're learning to work together as a team," says faculty member Dr. E. Paul Amundson.

Still, medical education often is slow to adapt to the times. Amundson says he has been "bugging the medical school for a couple of years" to let him lecture about health care economics, a key part of private practice that med students just aren't taught. This school year, Sanford's administration gave him an hour.

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Academic Health Care Systems Facing Additional Complications

Dr. Victor J. News and World Report Hospital of Tomorrow conference last November, Duke reworked its mission statement in 2006 before undertaking other changes.

"Many mission statements are very bland," he Nike Vis Zoom Uptempo For Sale

On the other hand, teaching hospitals have some world renowned names on their faculty who often bring egos to match their expertise and are many of the same people who write national practice guidelines. "Some are resistant to following others' pathways," Robbins says.

In reality, research and education usually are cost centers in academic medicine, not revenue producers, according to Dr. Robert C. Robbins, president and CEO of Texas Medical Center in Houston, who also spoke at the Hospital of Tomorrow conference. At that event, he suggested that this might actually give academic medical centers an advantage over community hospitals in a new era of health care that emphasizes collaboration.

However, Robbins says that medical schools, particularly those considered "top tier" schools, are incorporating collaboration into their curriculum. In Houston, Baylor College of Medicine and the University of Texas both TMC affiliates are doing so.

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"On the care delivery side, we've done a lot, but if you look at statistics, I think we've had a minor impact," Dzau says. Innovations coming into common use in academic health centers include telehealth, remote patient monitoring and geospatial mapping to help with disease prevention.

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[READ: Abandoning Insurance to Improve Care?]

"Everything is second guessed," Dzau says. "People think we have lots of money."

same issues facing all health care organizations.

These are uncertain, trying times for health care providers of all stripes, but nowhere may things be more complicated than at academic health systems. Unlike community hospitals and independent medical practices, which can focus on patient care, academic medical centers also have education and research components.

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