Historically focused on tertiary and quaternary care, AMCs have often deprioritized primary and preventive services due to financial constraints, institutional rigidity, and reimbursement models favoring high-margin procedures. However, as health care systems evolve, AMCs must extend their reach into community health to sustain their mission and uphold their ethical obligations. Strengthening their role in addressing social determinants of health and expanding access to specialty services across all communities will allow them to bridge long-standing disparities in care. Strategies such as community-based participatory research and community-engaged research provide frameworks for AMCs to collaborate with local populations, ensuring that academic expertise translates into tangible improvements in public health.

Despite the clear need for AMCs to extend their reach, they face significant barriers-particularly due to the growing financialization of outpatient specialty care. In procedural fields such as gastroenterology, ophthalmology, and others, PE-backed groups have aggressively acquired independent physician practices, prioritizing high-volume procedures over broader, continuity-based care models. As a result, access to specialty services is increasingly shaped by financial incentives rather than community health needs. These corporate models, which emphasize efficiency and profitability, threaten to erode AMCs’ ability to engage meaningfully with communities and deliver comprehensive care.

Moreover, PE acquisitions have disrupted health care delivery by destabilizing workforce continuity. A study of 200 PE-acquired ophthalmology practices (2014–21) revealed a 46.8 percent increase in total clinicians within three years- but also a 265.0 percent rise in physician turnover, with annual departures 13 percentage points higher than in non- PE-acquired practices. These trends raise concerns about the stability and consistency of care and underscore the importance of the organizations shaping how health services are delivered. The differences between AMCs and PE- backed groups go beyond finances-they affect how care is structured, accessed, and experienced. Understanding who owns and governs these entities is essential to evaluating their impact on communities.

Alternative Models For AMC-Led Community- Based Care

To remain competitive and mission-driven in an increasingly commercialized health care landscape, AMCs must explore alternative care models that extend their reach beyond hospital walls. While many AMCs already operate outpatient procedural centers, these facilities often lack an advantage over PE-backed competitors due to high facility fees and administrative overhead. To differentiate themselves, AMCs must adopt a model that provides greater accessibility, cost- effectiveness, and unique value beyond what PE groups offer. A recent study of the National Breast and Cervical Cancer Early Detection Program highlights how partnerships among academic institutions, hospital systems, and community organizations can significantly improve access to cancer screening and help reduce disparities in high-risk populations. This reinforces the importance of AMC-led care models that extend into communities while maintaining high clinical standards.

One such approach is the academic outpatient procedure center model, which significantly reduces facility fees, making procedural care more financially accessible while maintaining academic quality and patient safety standards-a counterpoint to concerns raised about rising costs and variable quality in PE-owned procedural services. Unlike existing university-operated outpatient facilities, which often mirror hospital-based structures in pricing and administration, these centers aim to streamline operations, reduce non-essential costs, and prioritize accessibility for a broader patient population, including the uninsured as well as those covered by Medicare and Medicaid. To make these centers viable against well-financed PE-owned outpatient clinics, AMCs must introduce distinct advantages beyond cost reduction. Patients could have access to cutting-edge clinical trials, advanced diagnostics, and novel therapeutics that are unavailable in commercial PE-backed settings, integrating research opportunities directly into clinical care. Unlike traditional university-affiliated outpatient departments, these centers would prioritize procedural efficiency while embedding research and innovation into routine care, allowing patients to benefit from early adoption of emerging technologies and treatments.