Interesting US NEWS & World Report article that I dug up in response to another member's request. Details the finanical woes at Stanford, Mount Sinai, Georgetown, MCP, and others. Thought everyone should read it even if they aren't considering these schools. I'll try to dig up more when I have time. Meanwhile, please feel free to post any other articles regarding this topic. <a href="http://www.usnews.com/usnews/edu/beyond/grad/gbhosp.htm" target="_blank">http://www.usnews.com/usnews/edu/beyond/grad/gbhosp.htm</a> Money woes in academia The health of your medical school may be shakier than you think By Avery Comarow For more than 15 years, the medical center ignored students' complaints about the sad state of the instructional facilities. The library's computer system was hopelessly obsolete, and the library itself had no bathrooms or air conditioning. Informal gathering spots where medical students could meet with faculty and researchers were nonexistent. Rather than learn using the latest computer technologies, students used "wet labs" from a previous era in which staining and centrifuging were done at the bench. Fed up, students circulated a petition in late 1998 demanding action. "We got involved because we love the place," says fourth-year medical student Michael Ennen. The "place" is hardly some second-rate institution. It is Stanford University Medical Center, long one of the nation's premier teaching facilities. The issue–limited dollars–should be of great interest to anyone considering a career in medicine, because Stanford is only one example of how questionable priorities and financial pressures are harming the health of some medical schools and their affiliated teaching hospitals. Premedical students certainly won't spot the warning signs by reading a school's handouts. But checking the Web and asking the right questions of the right people will elicit a surprising amount of information. Coming toll. Some institutions seem destined to vanish, and soon. Robert McDonald, partner in charge of national health care strategy for consultants PricewaterhouseCoopers, believes that as many as a fourth of the country's academic medical centers will merge or declare bankruptcy within the next five years. Events of the last two years foreshadow this new reality. In March 1999, Mount Sinai Medical Center in Cleveland cut medical students adrift from their clinical rotations when the hospital's ownership filed for bankruptcy and recast Mount Sinai as a nonteaching facility. This January, Georgetown University Medical Center in Washington, D.C., announced $83.7 million in losses in fiscal 1999. Its teaching hospital is slated for takeover this summer by a regional health system, with yet-unknown consequences for medical students and residents. And in 1998, MCP Hahnemann School of Medicine in Philadelphia faced near-certain shutdown after its parent health system folded. A $50 million last-ditch rescue by Drexel University was worked out, but meanwhile the students had only faculty assurances that they would be placed elsewhere. Such stories, and others still to be written, are a consequence of giant changes in the U.S. health care system. As managed-care plans have aggressively negotiated reimbursement levels downward, hospitals have collected less and less for patient care. Cheaper outpatient treatment has replaced inpatient care, eroding profits and leaving beds empty. And teaching hospitals were particularly hard hit by the Balanced Budget Act of 1997, which slashed Medicare reimbursements and lowered payments from the government for physician training. By 2002, according to a study by the Association of American Medical Colleges (AAMC), the cuts will cost the average teaching hospital a total of about $43 million and could drive up to 40 percent of them into the red. Shortsightedness and miscalculations have made matters worse. When managed care forced cost-cutting measures and imposed limits on reimbursements, many institutions bought up local physicians' practices at unrealistically high prices to keep referrals flowing. And because teaching produces no income while high-profile research lures eminent scientists, generates good publicity, and attracts funding, many academic centers emphasized the latter. That's what Stanford did. "We were putting resources into new and improved research facilities," says Michael Hindery, senior associate dean. "Educational facilities were not getting as much." Michael Ennen and the 225 other students who petitioned for change were not the only ones to have noticed. Deficiencies echoing the student complaints had been noted in 1983, 1991, and 1997 by the Liaison Committee on Medical Education (LCME), which accredits medical schools. Several months after the accrediting body received the students' petition, a blistering response arrived at Stanford. The LCME called the library conditions "deplorable"and went on from there. The LCME advised the medical center that its school had avoided by a single vote having its accreditation lowered to probationary status. Says Hindery: "It clearly was a difficult letter for us to receive." In less than a year, a four-year, $75 million plan for a new building and other education-related improvements were approved. "I see a real renaissance of medical education here," says a pleased Ennen, for whom the changes will come too late. Besides a new, up-to-date library and far more space, future students will see "new approaches to educational technology," promises Hindery. "We're not sure what that means as yet," but laptop facilities at each desk and computer-simulated patients with different conditions are a certainty. No leaves. Shaking the money tree won't work when the tree is bare. Medical schools do shut down. The last time was in September 1989, when the Rev. Oral Roberts announced that he would close the City of Faith Hospital and Oral Roberts University Medical School because of $25 million in debts run up by the underused hospital. Just into the academic year, the 120 first-, second-, and third-year students had to scramble to find other schools to take them in. Less than 10 years later, a similar disaster nearly played out at MCP Hahnemann School of Medicine. In July 1998, Hahnemann's parent–Allegheny Health, Education, and Research Foundation, a Pennsylvania health system that owned 14 hospitals, hundreds of physicians' practices, and Hahnemann–filed for bankruptcy, with debts totaling $1.3 billion. The state's largest medical school, with more than 1,000 students, seemed doomed. In October 1998, prodded by politicians and medical interests, Tenet Healthcare, a national health system, purchased Allegheny's Philadelphia holdings and reluctantly forged an agreement with Drexel University to run the medical school. But it had been a near thing. "This is something no medical student should ever have to go through," says John Po, 28, who had just completed his second year at Hahnemann when the bankruptcy news hit. Numerous faculty members fled, disrupting the teaching process. The patient population fell as physicians and their patients steered clear of the ailing system, leaving fewer cases from which each student could learn. "The students want stability," Po says, and under Drexel's management, "that seems to be happening." Recruiting for new teaching, clinical, and research faculty is in full swing, says new medical school dean Warren Ross. "We've moved on," he says. "We're building a new medical school." When Mount Sinai in Cleveland became a nonteaching hospital, 60 to 70 medical students from Case Western Reserve School of Medicine lost their clinical rotations. Case Western had to find room for them at its other affiliated hospitals–a particular problem in obstetrics-gynecology, says Jay Wish, a professor of medicine who had to sort out the chaos. The displaced ob-gyn students had to join existing teams, so each medical student participated in fewer deliveries, Caesarean sections, and other procedures. Homeless residents. Finding new places for residents is even more difficult. Each teaching hospital takes a carefully limited number, to make sure residents will be able to treat enough patients–and the hospital receives federal funds only for that many slots. In April 1999, when the board of Manhattan Eye, Ear, and Throat Hospital announced that the renowned teaching hospital would close, Pete Bouvier, 38, was one of 54 residents left scrambling to find a new home. After serving five years in the Air Force as a flight surgeon, Bouvier had cut his separation papers. He flew back with his pregnant wife from their home in Germany into a firestorm of outrage from the hospital's staff physicians, who were frantically pulling strings to find places for the residents, including 12 "first-years" like Bouvier. Several discouraged residents abandoned the practice of medicine. Others changed specialties to get in elsewhere. Bouvier was fortunate. He ended up, along with two other first-year ophthalmology residents, at New York Presbyterian Hospital–Cornell University Medical College. The doctors of Manhattan Eye and Ear went to court to keep the hospital open, and earlier this year they prevailed. It was too late for most of the residents. "I'm locked into the Cornell program," says Bouvier. "I feel loyal to them, and they've treated me great. But it's not where I had hoped and planned to go." In a report sent last year to medical centers, the Accreditation Council for Graduate Medical Education–the LCME's counterpart for residency programs–worried about "the specter of program closures on a larger scale." Like a man headed for a heart attack unless he changes his habits, teaching institutions have to adopt a leaner lifestyle. Many have gotten the message, and most premeds and their school of choice will flourish together. But they will be entrusting the next four years of their lives to one medical school. They need to know what they're getting into.