MHOP Closure

Word arrived that the hospital where I concluded my career, Mercy Philadelphia Hospital, would be abandoning their inpatient services in the forseeable future.  No precise word on when.  During my years there I was treated well, had challenging patients, admirable colleagues, and residents deriving great benefit from the experience they were receiving.  My own activity was about 2/3 office, 1/3 hospital.  I liked the challenge and flexibility of the hospital better. 

We served a poor community, Medicare and Medicaid for those with insurance at all plus a subsidy from the City of Philadelphia for those uninsured patients who received care from the City Clinics.  We had the nominal support of the Archdiocese.  What we did not have was economic viability that could take in more than we spent. 

It's hard to cite villains but I think medicine is heading in the direction that agriculture moved a hundred years ago.   Farms are bigger and hospitals are bigger.  During my active time, I saw the number of doctors remaining constant while the number of employees who could not bill for what they did mushroom.  Not that what the various managers did was unimportant.  Safety is much better than it once was, doctors are more accountable for decisions, investment in electronics required geeks to maintain everything.  But only the doctors brought in more money.  To support all these people, you need more doctors bringing more money into the system.  The number of outcome monitors, accountants, or DRG ladies could be kept under control.  A large network had the same departments as a smaller network with the same number of chiefs and not that much difference in Indians.  But if you had a fixed number of doctors, which we did, and more staff for them to subsidize, the system would collapse.  I think that's what's happening.

It expansion of scale a good thing or not?  Hard to say.  At MHOP I knew all the senior physicians and senior managers.  I doubt if the people at the mega-centers can say that.  I was treated well.  The physicians at the large institutions were more likely to be guppies in the big pond.  We probably take care of the same number of patients individually as our capacity really does not change when there are more of us. 

People that I hold in very high personal and professional regard can expect some displacement.  But they are still employable for the same reasons my esteem for my colleagues remains unshaken.  Unfortunately, I have no realistic input to make their professional resettlement less traumatic.