Monday, September 25, 2006

Will DMC Run From Wayne State?

No, this isn't about rap music... but this story does typify the clash between physicians' professional and academic values, and the business culture now dominating health care.

The Detroit News recounted the serious rift that has developed between Detroit Medical Center (DMC), a large, up to know academic medical center that also served many poor people in Detroit, and Wayne State University's medical school.

A bitter contract dispute between Wayne State University and the Detroit Medical Center is coming to a head, threatening the survival of medical programs that care for the region's needy and serve as a crucial training ground for Michigan doctors.

The nation's largest medical school and the eight-hospital system are entrenched in a years-long battle over terms of contracts that bind the institutions as a medical school and teaching hospital.

The national body that accredits graduate medical programs, effectively deciding whether they can operate, has caught wind of the troubles in Detroit and is giving the two sides until Oct. 1 to report on where they stand.

Without approval from the Accreditation Council for Graduate Medical Education, Wayne State and the DMC face losing nearly 1,000 medical residents and hundreds of faculty physicians who make up the core of programs that treat the city's poor and uninsured and train hundreds of doctors a year.
Why are these two partners at odds?

Wayne State says the DMC's increasing focus on the bottom line conflicts with the medical school's focus on research and community care. The DMC says the medical school is abandoning Detroit by looking to set up operations in the suburbs and forming alliances with hospitals that compete with the DMC.

Already, the fight has cost the region an orthopedic residency program, forcing 24 DMC residents to find new hospitals in which to finish their education. The accreditation council has asked for the voluntary withdrawal of the cardiothoracic surgery residency, because of similar squabbling. WSU wanted to team with Oakwood Health System because it performs more surgeries in that field; the DMC objected.

[Wayne State School of Medicine Dean Robert] Mentzer said the DMC, in its efforts to remain profitable, is moving away from programs that cater to community and research needs.

The medical school, for example, wants an emphasis on family medicine, urology and dermatology. The DMC, meanwhile, is looking to carve out a niche as a heart hospital, of which there are several in the area, he said.

'When a hospital system develops a business strategy that is no longer consistent with our mission, we have to re-evaluate,' Mentzer said.

He said WSU has looked to partner with other hospitals to help meet the medical school's needs.

That has irritated Duggan and the DMC and resulted in disputes over contracts. Mentzer said he has submitted a proposal to Duggan that would include no pay increase to Wayne State despite higher operating costs at the medical school.

[Detroit Medical Center CEO Mike] Duggan has said Wayne State's efforts to pair with other hospitals threaten to create competition with the DMC for business, compromising the health system's ability to stay in the black. The DMC has just begun to make money under Duggan after years of multimillion-dollar losses and a $50 million bailout by the state.
There is other evidence that underlying this dispute the discordance between the medical school's professional and academic mission and the business orientation of the hospital's new leadership.

The dispute over the orthopedics residency program, which seemed to touch off the larger conflict, ensued when DMC canceled the program (see this article in Crain's Detroit Business) after (see this April 1, 2006 Detroit Free Press article) the medical school would not accede to DMC CEO Duggan's wish to redirect the clinical focus of the program.

Duggan wanted to build a stronger sports medicine component within the program, but some doctors feared it would be at the expense of care for poor people.
And what made Mike Duggan an expert on the need for specific kinds of orthopedic services? That's a good question.

It turns out that Duggan came to his job as CEO of DMC with no direct health care experience, and no experience managing a health care organization. He is the former Prosecutor for Wayne County (Michigan). In a profile in Modern Health Care we see the thinking that lead to his appointment.
In December 2003, as Duggan was preparing to run for re-election as county prosecutor, DMC Board Chairman Chuck O'Brien asked him to interview with the board's search committee....

O'Brien, president and owner of Emerald Steel Processing, says Duggan has proved he's able to lead large, complex organizations.

'He has excellent skills and a superb understanding of where the bottom line is.'

Duggan conceded that just because he's never operated a hospital before or studied healthcare administration, it doesn't mean he doesn't know healthcare.

'I helped start Wayne County's HealthChoice program, an award-winning health plan that we built from scratch. So it wasn't like the terminology was a great mystery to me. And I've dealt extensively in my other jobs with all of the major local (healthcare) players.'

Roger Quick, a partner in the executive search firm Quick Leonard Kieffer, who led the search for Porter's replacement, characterizes Duggan as an unconventional candidate. 'I won't pretend that Mike's lack of hospital administrative experience didn't come up. People thought and talked about it. But ultimately the board saw it as a plus that he came from outside of the industry. If you're smart, creative and hard-working, you can learn the industry.'
I guess I should no longer be amazed that business people and lawyers think that they can pick up all they need to know about health care by developing a quick understanding of "the terminology" and by being "smart, creative, and hard-working." To think of all those years I wasted in medical school, internship, residency, and fellowship.

How much a lawyer learning about health care on the job really understands about health care is one question. How much such a person internalizes health care's values is another.

The incipient split between two once-proud health care institutions, to the apparent detriment of both, is more evidence that health care is too important not to be put back into the hands of health care professionals.
If the split occurs, the lawyers and businesspeople will quickly find new pursuits. But who will take care of the patients if the medical center suddenly loses most of its doctors?


Richard said...

As an RRC member I can confirm that this conflict has reached our radar and will, at a minimum, involve much work to ensure the adequacy of clinical training whatever changes may occur.

As a generalist I appreciate WSU's overt focus on community. Hospital bottom line isn't always the same thing as community bottom line.

313_doc said...

I hope that the RRC remembers that the DMC did not allow the transfer of the CMS funds with the ortho residents to help them with finding new spots. This made the transfer a whole lot harder and begs the question of what is the DMC doing with this ~$6 million dollars in funding? The DMC only cares about a workforce and not education. Simply put.

313_doc said...

Also, I hope that the RRC doesn't fall into the trap of the "social issues" card that is being played by both sides right now during this fight. Remember, it is not the responsibility of the ACGME/RRC to stock residents in underserved areas simply to treat the poor in the face of a terrible educational environment.

Anonymous said...

Before you endlessly blather on about a situation that you do not all the details I ask you these questions:

1)If the Medical School and WSU Medical Group is so concerned about the community and medical services for the poor why did they go behind the DMC's back and buy a 200,000 square foot building Troy for $20M that will serve that poor Oakland Co. Troy population? Outside of that they decided to joint develop it with Oakwood? Doesn't sound like WSU or the Medical Group evert had any interest in staying in is about physician component reimbursent and the WSU docs seeking more money period....they don't care about the residencies.

2) Why would the DMC pay WSU physicians a top quartile payment for teaching services and call coverage while the UPG physicians are going to cherry pick the insured patients out of the DMC and send them to Troy and Oakwood. If you going to pay someone to teach and train and then they steal your resource base? Why....

3) The DMC did not dismantle the orthopedic program...the Residents and Orto physicians chose to leave because they violated their contract committment. The DMC offered to take on ALL of the Ortho residents and provided full replacement Ortho MD's to train...most better than the defecting staff. The Residents chose to leave - period.

4) WSU is totally abandoning downtown detroit make no doubt about it.

Anonymous said...

Mr.Duggan only cares about money, is a lawyer used to win, he does not care about patients, he does not care about medical education and he does not care about the approx. 1000 residents he is jeopardizing with his arbitrary decisions. He thinks he knows about healthcare/medical education, he doesn't even know the basic principle of residency programs. History will judge him and of course the consequences of his acts.

Anonymous said...

In response to anonymous. Clearly you are prepared to swallow any line cast in your end of the pond.

The DMC has built many hospitals and outpatient clinics outside the city including Huron Valley and Berry Outpatient Surgery Center both in Oakland County. Using your logic the DMC must also be preparing to leave Detroit. The reality is to remain competetive all health care organizations have felt the need to expand.

Second, in this competetive market patients go where they damn well please. The hospitals surrounding the DMC have the same or superior capabilities in terms of technology and infrastructure. The argument that the physicians will cherry pick insured patients and wisk them away is absurd. There is no finacial incentive for them to do this. They will get the same amount of pay if it is done at the DMC or elsewhere.

Again, your third point smacks of partially digested propaganda. The residents had NO interest in leaving the DMC. Most residents are strapped with medical school loans and the thought of adding another year to relocate and complete there training makes no sense. It is truely a burden and barely managable by most residents. Secondly, the residents are here because the interviewed and selected the DMC as a place they wanted to train. To now be thrown into a situation where they need to search for a spot open in some other program anywhere in the country is absolutely inferior in terms of training. This will affect there careers.

Lastly, you have clearly not walked around the WSU campus. The university is looking to the future in Detroit. The medical college is a valuable component to the university. If it is forced to leave it will only be due to the inability of the DMC to provide the hospital structure for the School of Medicine to remain competetive.

Anonymous said...

To the anonymous writer who says that ortho residents chose to leave: of course they chose to leave. The alternative was to stay at DMC and be trained at the less than prestigious, newly minted, "Mike Duggan orthopedic surgery residency program".

But of course, this is too hard to grasp for a lawyer like Mike. That's his main problem, he doesn't understand physicians and he treats them the same way he treats the cafeteria staff. Duggan has no clue what goes into a medical career, let alone one in orthopedic surgery.