Contributor: Rethinking Academic–Community Partnerships in Oncology: Never the Twain Shall Meet?

Like most physicians trained in the US, I was “raised” in an academic environment and, later, had to make decisions about the best practice setting in which to work. With the exception of the past 5 years, I have trained or worked in large academic medical centers that served as referral hubs for patients from the surrounding community. The perception of community physicians from the ivory tower of academia was mixed.

Some of my senior colleagues proactively encouraged the referrals and appreciated their community counterparts as equal partners in comanagement, while others made elitist remarks implying that the community physician was, in some way, lacking or providing a lower quality of care. I was not immune to that mindset myself, despite knowing almost nothing about what a busy community practice actually demanded. Now, flip the script. Over the past 5 years, I have been working in a community practice and have gained a very different perspective—both of academia and of the unique structure and expectations placed on community physicians.

In recent years, there has been an ever-growing urgency to reshape the way academic and community physicians perceive and interact with one another.

The "Ivory Tower" vs the "Local Doc"

Community physicians, particularly general oncologists, are tasked with knowing “a lot about a lot,” especially since the field changes on what seems like a daily basis. There is little, if any, administrative time and generally fewer resources—the very resources that had enabled me to be more productive in academia while I was still there. David Fleming, MD, MA, FACP, similarly describes the limiting philosophies that can exist between physicians in these 2 practice settings, noting the tension between the “ivory tower” and the “local doc.”¹

Community physicians are often viewed as more patient-centric and efficient, while academic physicians tend to have a career focus oriented around research and teaching. Yet between 2006 and 2017, academic medical centers and National Cancer Institute–designated cancer centers saw a greater increase in the number of oncology patients initiating treatment than their community counterparts.²

Why Patients Want Care Closer to Home

In recent years, there has been an ever-growing urgency to reshape the way academic and community physicians perceive and interact with one another. Much of this stems from the fact that, as the oncology patient population ages, it is becoming increasingly preferable for patients with cancer to remain closer to home, particularly for patients who reside in remote rural communities.³

To accommodate such preferences and expand their reach, many large academic medical centers are now expanding to include community practices as part of their broader networks.⁴ In an interesting study by Stamy and colleagues, 107 deans of large allopathic US medical schools were interviewed about their experiences with academic expansion into community practices. The study yielded many notable findings. A few that particularly resonated include the following⁵:

• Most academic medical centers have expanded into the community and will continue to do so in the coming years
• Integration can be successful, but is often slow and may be hampered by geographical distance, logistical challenges, salary expectations, and hierarchical attitudes from the main academic center toward the community sites

Advanced Therapies Are Moving Into the Community

Today, there is a growing dependence on community physicians, especially in oncology, where many treatments, including chimeric antigen receptor (CAR) T-cell therapy and bispecific antibody therapies, that were traditionally limited to tertiary care centers can now be administered in the community setting. In addition, the general shift away from high-risk cytotoxic chemotherapies that required intensive monitoring in specialized academic settings is also contributing to patients with conditions like acute leukemia being managed in the community. Community practices also offer meaningful cost savings.

Burke and colleagues similarly describe a “spillover effect,” relating to improved 30- and 90-day mortality following hospitalization in nonacademic hospitals located near academic medical centers.⁶ Patient experiences at satellite hospitals of major academic medical centers have also been rated higher than at the main academic site.⁷

The Role of Payers in Bridging the Gap

The concept of academic-community partnerships is not a novel one. This has been explored since the early 1990s.⁸ However, communication and relationship-building barriers have been reported as major limitations to successful partnerships.⁹ Another important consideration that has rendered this relationship somewhat slow to gain traction is its reliance on multiple stakeholders to attain widespread success. In addition to institutional and organizational buy-in to develop academic-community partnerships, support from payers is also integral.

Payers have immense power to support or enhance these partnerships through several mechanisms: providing financial support for community-based organizations to conduct impactful research that is particularly well suited for the patient population it serves¹⁰; covering services that help provide equitable care for patients facing barriers related to social determinants of health, including transportation services and case management, to offset some of the financial barriers that hamper academic-community integration; and supporting the development and maintenance of accessible registries that allow for relevant data mining and identification of emerging practice gaps that could be bridged between an academic and community site (eg, care coordination for patients receiving immunotherapy including CAR T-cell therapy or patients on clinical trials).

A Necessity, Not a Choice

There is no denying that oncology care is at a critical juncture and that Kipling’s famous quote cannot continue to ring true. Building genuine partnerships between academic and community oncology practices, with the ever-changing face of medical care, is now more of a necessity than a choice and can create “win-wins” for patients and for physicians who practice in either setting.

References

1. Fleming DA. Community practice to academe: a road less traveled. Mo Med. 2023;120(5):338-340.

2. Frosch ZAK, Illenberger N, Mitra N, et al. Trends in patient volume by hospital type and the association of these trends with time to cancer treatment initiation. JAMA Netw Open. 2021;4(7):e2115675. doi:10.1001/jamanetworkopen.2021.15675

3. Pace E, Dennison S, Morris J, Barton A, Pritchard C, Rule SAJ. Chemotherapy in the community: what do patients want? Eur J Cancer Care (Engl). 2009;18(2):209-215. doi:10.1111/j.1365-2354.2008.01051.x

4. Bosserman LD, Cianfrocca M, Yuh B, et al. Integrating academic and community cancer care and research through multidisciplinary oncology pathways for value-based care: a review and the City of Hope experience. J Clin Med. 2021;10(2):188. doi:10.3390/jcm10020188

5. Stamy CD, Schwartz CC, Han LP, Schwinn DA. Community and academic physicians working together in integrated health care systems. Mayo Clin Proc Innov Qual Outcomes. 2021;5(5):951-960. doi:10.1016/j.mayocpiqo.2021.06.008

6. Burke LG, Burke RC, Orav EJ, Duggan CE, Figueroa JF, Jha AK. Association of academic medical center presence with clinical outcomes at neighboring community hospitals among Medicare beneficiaries. JAMA Netw Open. 2023;6(2):e2254559. doi:10.1001/jamanetworkopen.2022.54559

7. Ma DC, Singh A, Bloom B, et al. Patient experience performance at a primary cancer center versus affiliated community facilities. Adv Radiat Oncol. 2023;8(5):101240. doi:10.1016/j.adro.2023.101240

8. Maurana CA, Goldenberg K. A successful academic-community partnership to improve the public’s health. Acad Med. 1996;71(5):425-31. doi: 10.1097/00001888-199605000-00009

9. Woolford SJ, Buyuktur AG, Piechowski P, Doshi A, Marsh EE. 3573 critical barriers to effective community-academic research partnerships and potential solutions. J Clin Transl Sci. 2019;3(suppl 1):86-87. doi:10.1017/cts.2019.199

10. Anderson Y, Artis R, AuYoung M, et al. . Developing strategic and collaborative community-academic partnerships to improve community health, from moving upstream to getting at the root. Am J Public Health. 2025;115(suppl 2):S152-S163. doi:10.2105/AJPH.2025.308092