Academic medical centers find it increasingly necessary to pursue economies of scale by merging, partnering with, acquiring, or being acquired by nonacademic hospital networks and health systems. These arrangements may provide greater purchasing power, leverage with payers, and a reduction in the size of clinical and ancillary staff for services that are deemed to be redundant. In this environment, a new set of challenges confront the ability of academic medical centers to fulfill the mission to create new medical knowledge. Clinical research is encountering a “hyper-level of scientific and operating complexity”1 and pressures to generate clinical volume and revenue leave many academic researchers with limited ability to focus on investigative work. New partners involved in mergers and acquisitions of academic medical centers, such as community hospitals and large specialty practices, may lack the infrastructure, institutional experience, and the knowledge base required to ensure that research occurs in an efficient and compliant manner. Conversely, the potential inclusion of new patient populations in clinical research studies and opportunities for advancing delivery science from and to a broader base holds enormous promise. As a consequence, clinical research faces new challenges and, at the same time, unprecedented opportunities. In this Viewpoint, mergers and acquisitions are broadly defined to cover a range of transactions including affiliations involving an academic medical center with or by a nonacademic health system. Although academic medical centers may merge (eg, Partners Healthcare in Boston) or purchase smaller community hospitals, the primary focus involves ownership by nonacademic partners. Suggestions are provided to mitigate the risks to the research mission that accompany these mergers and capture the prospect for transformative change in ways that can enhance research and benefit medical school faculty, health systems, and most importantly patients.

中文翻译：

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在并购时代推进研究使命

学术医疗中心发现越来越有必要通过合并、合作、收购或被非学术医院网络和卫生系统收购来追求规模经济。这些安排可以提供更大的购买力、与付款人的杠杆作用，并减少被认为是多余的服务的临床和辅助人员的规模。在这种环境下，学术医学中心履行创造新医学知识的使命的能力面临着一系列新的挑战。临床研究正面临“科学和操作的高度复杂性”1，产生临床量和收入的压力使许多学术研究人员无法专注于调查工作。参与学术医疗中心并购的新合作伙伴，例如社区医院和大型专科诊所，可能缺乏确保研究以高效和合规方式进行所需的基础设施、机构经验和知识库。相反，将新的患者群体纳入临床研究的潜在可能性以及在更广泛的基础上推进递送科学的机会具有巨大的前景。因此，临床研究面临着新的挑战，同时也面临着前所未有的机遇。在这个观点中，并购被广义地定义为涵盖一系列交易，包括涉及学术医疗中心与非学术卫生系统的附属关系。尽管学术医疗中心可能会合并（例如波士顿的 Partners Healthcare）或购买较小的社区医院，主要关注点涉及非学术合作伙伴的所有权。提供了一些建议，以减轻伴随这些合并而来的研究任务的风险，并以可以加强研究并使医学院教职员工、卫生系统和最重要的患者受益的方式捕捉变革的前景。