Louise Gunning-Schepers
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Within the last 10 years, eight University Medical Centers (UMCs) were created in the Netherlands. In a UMC, the faculty of
medicine, with its responsibility for the initial training of physicians and for scientific research, is merged with the academic
hospital, with its responsibility for tertiary care and clinical research and innovation. All medical faculties and academic
hospitals in the Netherlands are now a UMC.
Each UMC is a private, nonprofit enterprise with strong links to the University and with an executive board, including a dean
of medicine. The finances come from the Department of Education and Science and the Department of Health, as well as health
insurance companies that operate the mandatory health insurance in the country. The eight UMCs have a special position in
the health care system, because although they are legally private entities, they have a distinct public mission. This mission
can be divided into three core responsibilities: teaching and training, basic and clinical research, and (tertiary) patient
care.
Bridging three worlds
The added value of UMCs is that they integrate these three core functions—patient care, biomedical research, and biomedical
education. Medical students are exposed to patients as well as to basic research from day one of their curriculum and they
become part of the UMC community. Many of them will participate in research projects during their studies and many will opt for a MD/PhD program. Almost every
doctor and nurse is involved in the teaching process. And as students enter their clinical rotations they will be an important
driver for quality of care, as their supervision requires doctors and nurses to provide a good role model. Increasingly the
modern curriculum will include a mix of clinical and basic science around a specific disease, and so both clinicians and scientists
often lecture together.
As the science labs are often located within the same building as the hospital, interaction between clinicians and scientists
is frequent, but also many doctors continue to work in a lab as well. Good clinical epidemiology in most UMCs has supported
many clinical researchers (doctors and nurses) and the close vicinity of patients has proven immensely important in the recent
developments in the area of genomics, proteomics, and other fields of translational medicine. This is visible in the position
of Dutch biomedical research in the international scientific community.
Increasingly, results of research are taken further, either as direct innovations in patient care after thorough evaluation
studies or through patents, spin out companies, or other forms of "valorization" of science. Innovation in clinical therapeutics
and diagnostics has always been important in academic hospitals.
UMCs also are becoming more responsible for innovations in the process of care delivery, not only in the hospital setting
but also for their departments of family practice in primary care or nursing home care. Innovations can be thoroughly evaluated
before becoming standard practice and their value in improving outcomes for patients or in reducing costs can be critically
assessed. In that way the whole health care system profits from academic medicine.
UMCs in The Netherlands
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Finally, UMCs have an important responsibility in tertiary care. Patients with rare diseases, difficult to manage complications,
or who are in need of very complex interventions are often referred to a UMC. Transplantations, neonatal intensive care, genetic
diseases, rare metabolic disorders, and complex cancers are examples of patient groups that are concentrated in some or all
UMCs so that sufficient volume guarantees expertise. However, despite the unique responsibility for tertiary care, all of
the UMCs provide a certain amount of regular hospital care, if only for training purposes. For those patient services, the
UMCs compete in the health care market just as general hospitals do.
Teaching and training
Since 1992, the Netherlands has increased the number of first year medical students from 1485 to 2850 a year. Each UMC has
an average of 315 to 410 new first year students.
After six years of training, two of which on average are spent in clinical rotations (50% in a UMC and 50% in another health
care institution), physicians can enter specialty training. UMCs offer all specialties including family practice and public
health; but during most specialty training the physician will spend approximately 50% of his training in a general hospital.
Around 60% of the Dutch hospitals participate in specialty training in regional networks around each UMC. The UMC plays an
important role in providing courses and lab skills for students and teachers.
All UMCs also have at least one degree program in biomedical sciences (around 500 students a year) and all participate actively
in the training of nurses and nurse specialists.
