"Insufficient funds." A startling and sobering, not to mention embarrassing, message. No one wants to face it or even contemplate its possibility. But "insufficient funds" are the reality in American health care. At the Woodruff Health Sciences Center (WHSC), we not only provide care, but we must also find the funds to create the future of health care through cutting-edge programs of discovery, professional education, and clinical research. Therefore, the sobering prospect of "insufficient funds" weighs even more heavily on those of us in academic than nonacademic settings.

Don't misunderstand. The WHSC is not going to run out of money or bounce any checks. But the reality today is that our brilliant faculty, health professionals, scientists, and educators increasingly work under uncomfortable, often discouraging and frustrating fiscal constraints. Our physicians, nurses, and other care providers must work longer hours for less pay. Those who also have a passion for research have less time and fewer resources to devote to innovation and discovery. Our educators and mentors find that the time for inspiration is at increasing odds with the time required for perspiration devoted to administration, funding, or other imperatives. More at risk than our fiscal health is the risk of wasting the genius that a better health care future requires.

Why the difficult reality? Over the past five years alone, hundreds of billions of dollars have been stripped out of the health care system by both private- and public-sector policies. The Balanced Budget Act of 1997 alone, designed to cut $200 billion in health care payments, is actually on track to cut more than $1 trillion over 10 years. And private-sector managed care organizations have cut provider reimbursements to the bone. Overall, at Emory we have seen a reduction of an estimated $100 million in reimbursements in five years. Every year, increases in related costs, like drugs, medical devices, malpractice insurance, administration, and regulatory compliance, add millions of dollars in new costs to our work and programs.

Michael Johns, Director,
Woodruff Health Sciences Center

As the articles in this issue of Momentum make clear, funding our way through this difficult era has been possible only through the extraordinary work of faculty, staff, administrators, board members, and friends. The WHSC has eliminated more than $53 million in operating costs over five years. Our faculty scientists and scholars have almost doubled the amount of sponsored research funding during that time. Friends, grateful patients, and philanthropic organizations have given generously to fund everything from promising new research programs to desperately needed new facilities.

But even more will be required over the next few years. We will grow and further streamline our patient care capabilities. We will aggressively make our case that there is no better philanthropic investment than in making people healthy. We will do what is necessary to ensure that we have the resources to empower the dedication, hard work, and genius it takes to make a better future.

Michael M. E. Johns

From the Director  /  Letters

Banking on benevolence

Healing the bottom line

Moving forward  /  Noteworthy

On point: Tell Congress what's at stake

Stopping the AIDS cycle