AACP Newsletter, Volume 10,
Number 3, Summer 1996
Editor's Column:
Managed Care and the Crisis of Over Capacity:
The View From the Bloomfield Bridge
St. Francis Medical Center
as seen from the Bloomfield Bridge
There is a spot in Pittsburgh - the Bloomfield Bridge - where it is possible to see six medical centers, all congregated within a two-mile radius. At one point in time, not long ago, this concentration of health care facilities was viewed as evidence of the vitality of health care as an engine of the local economy. In fact, health care was touted as the “next” industry, picking up where steel left off.
Now it appears that the connection of the health care system to the fate of the steel industry was deeper than it was first appreciated to be. We are now facing the fact that, as with steel, we have built up a health care infrastructure that is grossly inefficient and inflexible - a veritable sink for dollars with little evidence of the value created.
Here in Pittsburgh, as in other parts of the country where a major industry has died, we know what “downsizing/ rightsizing” means. It means the Mon Valley - the long stretch of now almost deserted towns along the Monongahela River. It means the vast Pittsburgh diaspora, with born and bred Steelers and Pirates fans scattered to the four corners of the country looking for work. In short, it means the deterioration and even demise of families and communities.
Now we face the same with the health care industry. In the days of the demise of steel, the forces that brought the factories down were foreign competition and highly efficient “mini mills.” In health care, it’s managed care, created to squeeze the “excess” out of the health care industry, all for a handsome profit to those willing to take the heat and do it.
So hospitals are closing here and people are being laid off, including doctors. We are familiar with the general phenomenon here, but it’s a lot different when it’s your industry. Unfortunately, as goes Pittsburgh, so goes the rest of the country. The Pew Health Professions Commission recently reported that it is reasonable to anticipate
- the closure of as many as half of the nation’s hospitals and elimination of up to 60% of hospital beds;
- a surplus of 100,000 to 150,000 physicians; and
- a surplus of 200,000 to 300,000 nurses
Clearly, hard times are upon us. How are we going to cope? It should be obvious to all of us that we are not going to be able to hold back change. Nostalgia is not the way forward. It might be useful to consider how Pittsburgh dealt with the change.
Since all the devastation when the mills closed, the communities in the Mon Valley organized themselves, developed an aggressive entrepreneurial spirit and have worked to focus on job development in their communities. These efforts are now beginning to bear some fruit, but it has been a long struggle. Meanwhile, the United Steel Workers Union has worked to preserve as many jobs as possible while accepting that the steel industry has changed. What does this tell us?
To me it suggests that we have to realize that we are contending with forces that are much greater than just changes in health care. The entire economy is in flux. We are just one small part. If we are to survive we must recognize that we will be different than we are today. If we are to have any control of what our destiny will be we must organize and we must seek allies. But even that will not be enough. We will have to be entrepreneurial - in the sense of being flexible and aggressive in seeking out opportunities, not in the sense of selling ourselves to the market. The latter is a great danger. We could end up selling ourselves to the highest bidder and give up on the ideals that define our mission.
To make sure we do not do that, it is my belief that we have to engage in a public discourse about the importance of public service and the need to provide care to those who are in need and can not pay for it. The media and the public needs to hear from us. We must struggle against the fear that we may all be hung together or be assured that we will be hung separately. If there ever was a time to get active in the AACP, this is it!
Ken Thompson, MD
Associate Editor
March 30, 2003 - Web Editor's Note: The six hospitals Ken Thompson could see from the Bloomfield Bridge back in Summer 1996 were St. Francis (very close by), West Penn (also quite close), Shadyside Hospital, (about a mile away), Allegheny General, Children's Hospital, and the UPMC hospitals in the Oakland neighborhood of Pittsburgh (this includes Western Psych).
At 8:00 am, Friday, September 6, 2002, St. Francis Hospital, closed its doors forever. This saddens me, the person working on this webpage, because I was born at St. Francis. St. Francis was run by the Sisters of St. Francis of Millvale, focused on providing care to the poor and was very big on Psychiatry. Its buildings will be razed and the new Children's Hospital building will be built in its place. Children's had recently joined with UPMC.
Another one of those six hospitals, Shadyside Hospital - founded as a homeopathic hospital but later went allopathic - has been taken over by UMPC. Shadyside Hospital also expanded - especially in regards to cancer research and treatment. Allegheny General was taken over by West Penn and together they are now the West Penn Allegheny General Health System (WPAHS). UPMC in Oakland is unchanged except that Children's will move to the Bloomfield-Lawrenceville neighborhood a few years from now, and a contruction has recently begun for a new center for the research of neurodegenerative diseases.
And where I now sit as I type, I am only a few blocks form the Bloomfield Bridge. - Cecelia Clancy
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