Adieu, Fairview

The arrival of managed health care at the University of Minnesota's medical clinics may mean research opportunities will dry up. As a result, many doctors are leaving the university for private practice.

IN THE WAKE of the merger between the University Hospital and Fairview Health Systems, doctors are reportedly leaving the institution for private practice and physicians who've stayed are warning that more will leave should the institution implement a plan designed to attract business from managed care to the institution. Similarly, the doctors say the new policy will put the University Medical School's groundbreaking research in peril.

Last year, university physicians voted to implement a "unified practice plan," giving all UM doctors the same employer, University of Minnesota Physicians, which would take over their billing and administrative functions. Not only do many doctors stand to earn less under the new plan, the former teaching hospital is now part of a private conglomerate that's competing in the managed care marketplace.

Some physicians are unhappy with the new arrangement, however, and are leaving the U in protest and selling their services back to the Fairview University Medical Center. State and federal research dollars are dwindling, managed care is pushing lucrative clinical practice, and doctors are realizing that if all they're going to do is take care of patients, they can make more money in private practice.

The ultimate goal of the new unified practice plan is to increase the University's performance in the managed care marketplace, says Roby Thompson, vice president for clinical affairs in the university's Academic Health Center. Thompson admits he's dealing with "small islands of discontent" but says he has made every effort to deal with the concerns of the disaffected physicians. And although he says he's not aware of any doctors that have left yet, "I wouldn't be surprised if some will."

One of those "islands," it appears, is the entire Anesthesiology Department, which is in negotiations with Fairview over the provision of its doctors' services at the Fairview University Medical Center. Doctors are leaving to set up their own practices, according to Dr. Jay Cohen. He says his colleagues also attribute their departures to the hospital's new emphasis on seeing patients, a mantra of the cost-conscious managed-care market. The system leaves little or no time to do the kind of research that has been the incentive for many UM doctors to continue working on a professor's salary.

A recent study by the Association of American Medical Colleges has demonstrated that medical schools and teaching hospitals in areas with widespread managed care coverage are having trouble competing for research dollars with similar institutions in areas where managed care isn't yet the rule. The study found that increasing interference by health management companies into how services are charged has hit teaching hospitals and medical research institutions hard. The greater the number of managed care patients in a region, the less successfully its medical schools compete for National Institute of Health Research Grants and the fewer papers doctors at those institutions publish. The problem isn't just local, it's national with medical research institutions in Massachusetts, northern California, and northern New York as well as Minneapolis reporting decreases in the number of National Institute of Health grants and papers published.

The bottom line, says Cohen, is that if doctors are running to take care of patients, they aren't writing research grants, which in turn means they aren't doing the groundbreaking research that the U is famous for. Furthermore, if grants aren't being awarded, then laboratories sit empty. Possibly worst of all, because doctors who leave the employ of the UM to set up their own shop are no longer compelled to teach at the University Medical School, graduate and medical students lose educational opportunities.

Cohen and other concerned university physicians warn that Minnesota's next generation of doctors could end up knowing how to treat patients most cheaply, but have no interest or time to do the kind of research that may someday bring about cures. "The community doesn't know what it's losing," says Cohen. Without the grants and the hardworking lab technicians and researchers "our place at the forefront of medical research crumbles."

 
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