Our identity is fundamental to how we see the world, approach problems and develop relationships. The exploration of identity was the underlying concept between last year’s question of the year, “What is a doctor? What is a nurse?” And identity development has become an integral part of our current conception of professionalism in medicine. It is with this perspective that I began to read the articles in our February issue of Academic Medicine that focus on mergers, because mergers involve challenges to the identities of the involved individuals and organizations.
As I read the articles by Thier and colleagues and Handel and colleagues that describe the mergers in Boston, Philadelphia, New York and Indianapolis I found myself thinking about them through a personal identity lens. How would I feel if I had to alter my own identity that I had developed over many years to conform to a new organizational ethic? What would I lose in the process and what would be the potential gains? Did I risk losing a sense of what was most important to me? The leaders of the mergers in our issue described the important challenges of bridging cultures as they attempted to join together different organizations. This is such a wrenching process I wondered why anyone would put themselves through it.
Thier and colleagues describe market and clinical reimbursement pressures and the need to accelerate clinical growth to protect the academic mission. Handel and colleagues describe similar concerns about the need to grow and avoid becoming a “Switzerland,” which I assumed referred to the traditional neutrality of Switzerland that had helped that country to survive without choosing sides during times of political conflict. The descriptions of the mergers is instructive to anyone at an institution that is considering this option or going through it. The articles provide guidance about the ways to merge different organizations without destroying the unique identities that characterize the organizations.
There are other options to maintain competitiveness in a changing market. Edwards and colleagues describe the aggressive growth and expansion efforts at University of Kentucky and how they addressed clinical and educational imperatives related to regionalization of medical services. Certain specialized clinical services require a large population and for a rural-based hospital this may require the development of networks that extend over a large geographic area. Azziz supplies a commentary that discusses mergers and expansions and also considers the value of merging of academic medical centers with non medical universities for improved research and educational opportunities that bring benefits to both organizations. He describes the recent experience at the Georgia Regional University as an example of the synergies that can be realized with such new relationships.
Although the lessons of Boston, New York, Philadelphia, Indianapolis or Georgia should be viewed through local perspectives, they stress the importance of reexamining our values and priorities as we forge new identities, so that we do not lose what we most value in our attempt to grow and survive.