The healthcare industry in general has continued to grow, even during the recession, but the roll out of the Affordable Care Act presents challenges, especially for academic medical centers like Upstate, Dr. Joanne Conroy, MD said Thursday during a presentation on the Syracuse campus.

Academic medical centers are the most expensive places to receive healthcare because of their dual mission of providing healthcare and education, said Conroy, the chief healthcare officer for the Association of American Medical Colleges. Teaching hospitals provide care that is not available at all hospitals, such as trauma care and stem cell transplants and lots of other services that people don't know they need until they do.

"Probably only one in 1,000 people will need our services, but they really need our services," she said.

Among the audience were key representatives of the New York State legislature participating in "Project Medical Education," an intensive two-day program held periodically at Upstate to educate lawmakers about academic medicine.

“'Project Medical Education' allows us to pull back the curtain and share the excitement, complexity and compelling missions of academic medicine,” said Dan Hurley, Upstate‘s assistant vice president for government and community relations.  “This program gives elected officials and key legislative staff first-hand access to our campus and people, which helps to deepen their understanding of the work that happens here. That understanding puts them in a better position to make informed decisions related to our policy and financial needs in the years ahead.”

Other parts of the program are designed to teach participants about medical school admissions, financial aid and curriculum, allow them to interact with current Upstate students, tour clinical areas and meet top-level caregivers across multiple service lines. They also learn what it‘s like to be a biomedical researcher or resident and gather insight on what it means to be a teaching hospital.

Conroy offered some sobering statistics:

* Reductions of 8 percent in Medicare payments could place hospitals that are operating in the black into the red, depending on what percentage of the hospital's patients are on Medicare.

* 32 million additional Americans will enter the healthcare system with health insurance through the Affordable Care Act. It remains to be determined whether academic medical centers -- which have traditionally been the "safety net" for the uninsured and underinsured, but which are expensive -- will be included in the network of providers through the Affordable Care Act.

* For the next 19 years, 10,000 people per day will turn 65. (And older people, as a whole, use more medical services than young people.)

Conroy said that applications to both allopathic and osteopathic medical schools are increasing. But even as medical schools accept more students, those students cannot practice until they graduate and complete at least a three-year residency program. And the number of residency spots available has not increased. "Our supply is flat, and demand is increasing," she said.

In the future, hospitals and doctors will work closely together. They are likely to be reimbursed based on patient outcomes. For example, the outcome measure for a patient who has a hip replacement might be getting that patient back to work. Hospitals and doctors would have to determine the most efficient way to accomplish that. It might mean surgeons handle the operation, while internal medicine doctors oversee post-operative care.

"I don't think healthcare is broken," Conroy said, "but I think we're struggling very hard with change." She expects that America's healthcare system won't change much by 2015, but 10 years from now, it will likely be very different from today.

Medicine is still a great career choice, Conroy said. "Physicians, nurses and PAs walk into hospitals every day and save people's lives."