July 29, 2016
If you happened to be one of the 50 or so sitting in a recent Up North hospital volunteer fundraising presentation, you’d have thought you were listening to Gen. George Patton laying out a battle plan during WWII.
Using a PowerPoint, the hospital president talked in terms of strategies to protect the hospital’s existing market and then how to capture more territory. For those who remember the friendly Dr. Markus Welby television-era, those days are long gone. The politics behind healthcare today hardly resemble passionate care once offered several decades ago as healthcare decisions now are based on government regulations, numbers and revenue, which forces them to often abandon unprofitable procedures and services, such as drug rehabilitation and psychiatric services, where services are costly.
The foundation fundraising presentation was not much different than what has been shown not only in northern Michigan, but also across the state as one scans headlines of hospital mergers and closures, physician and other healthcare worker shortages, and higher healthcare costs with lower insurance reimbursements.
Those attending this particular event were given small pocket-size laminated cards with key talking points to be used in conversations with friends, neighbors and co-workers. The card revealed its 2016 Funding Priority: Physician Recruitment & Retention with a $3 million price tag with $2 million to be raised this year. Another $1.6 million for physician retention and physician burnout prevention.
This is no news to anyone involved or looking for healthcare services—medicine is headed for a collapse in the level and type of service once familiar to those as recent as a decade ago. While healthcare appears to be more available to service the poor and lower income, it’s not the same with higher insurance costs and larger deductibles for the already financially strapped middle income earners and small business owners. Even the purpose of health insurance has changed from at a onetime safety net to cover major health expenses from pregnancies, heart attacks or diseases to now with the expectation that insurance should cover prescriptions, routine physician visits and minor sniffles instead of being paid out of pocket.
Northwest Michigan’s healthcare systems have historically enjoyed revered reputations with the now defunct 110 multi-specialty physician practice, Petoskey-based Burns Clinic, nicked named the “little Mayo of the North”. The clinic attracted patients from a 100-mile radius – year-round residents, affluent retirees and vacationers alike. It even brought high-level thoracic surgeons to perform the first open heart surgeries in northern Michigan. For years, the Burns Clinic thrived, providing Petoskey and 23 surrounding rural counties with such specialized services as open-heart surgery, neonatal intensive care, and radiation oncology. Top specialists were willing to practice there for a third less pay than they might get elsewhere, because of the easy lifestyle, pleasant climate, and stunning scenery. Those golden years are over.
“We had wonderful physicians, a very low divorce rate, kids on the ski team. This was almost Camelot,” said Dave Thomas, the clinic’s former executive director.
“But just as Camelot crumbled because of a betrayal of trust and an inability to bridle base desires, so too did the Burns Clinic. Disputes over money, a failed partnership with PhyCor (a private Tennessee-based healthcare management company) and an every-doctor-for-himself attitude destroyed the clinic after 68 years in 1999. And now the battle-weary physicians, splintered into 30 single-specialty groups, were left to rebuild their professional lives with many leaving the area.”
Perched high on a hill overlooking the blue waters of Lake Michigan’s Little Traverse Bay, is the physically connected, but not owned by the Clinic, non-profit 202-bed Northern Michigan Regional Hospital with its roots dating back to the late 1890s. The facility enjoyed a similar reputation and history receiving national designations and honors, including some presented by the late President Gerald Ford.
Not much later in 2002, the adjacent regional hospital (later acquired by Flint-based McLaren Healthcare Care Corporation in 2012) was hit by one of the largest nursing strikes in U.S. history. Represented by the Teamsters Local 406, the hospital’s nearly 500 nurses sought improved wages, working hours, a better work environment and an improved pension plan along with benefits.
The failed strike was a black eye for the Teamsters, whose international president James Hoffa, made it his personal cause to unionize the hospital. The strike drained the hospital and its foundation, which cost it millions of dollars to remain union free. Hoffa was son of the late president of the International Brotherhood of Teamsters (IBT) union from 1958 until 1971 and vanished in late July 1975 having last been seen outside the Machus Red Fox, a suburban Detroit restaurant. He was declared legally dead in 1982.
Those two institutions caused a collapse of Petoskey healthcare services never fully regained, as it now battles the neighboring Munson Medical Center to protect and grow their service area. Munson has a similar history and was organized in 1915, as the hospital division of the State Psychiatric Hospital. The facility has grown from 21 to 391 licensed beds, and is the largest hospital in the region. The Munson Healthcare System now includes Munson Medical Center, Kalkaska Memorial Health Center, Munson Healthcare Cadillac Hospital, Munson Healthcare Charlevoix Hospital, Munson Healthcare Grayling Hospital, Otsego Memorial Hospital (Gaylord), Paul Oliver Memorial Hospital (Frankfort), and West Shore Medical Center (Manistee). Munson Healthcare employs more than 7,000 people, and as a regional, non-profit system, it offers a continuum of health care services for communities across 24 counties.
Both healthcare systems had been quietly encroaching on what were once unwritten defined services areas in an attempt to capture more market share. Traverse City threw the gauntlet when it officially acquired Charlevoix Community Area Hospital, the 22-bed critical care access facility, last year after previously providing some contractual clinical and organizational services. The hospital rests in the shadows of McLaren, only 17 miles south on U.S. 31 along the shores of Lake Michigan. The hospital provides access to most of the same healthcare specialists and services found in Petoskey.
The agreements and real politics behind healthcare and their providers rarely make the local press other than the official announcement of a new affiliation or healthcare facility acquisition. The Munson and McLaren systems work hard to acquire existing physician practices and services. The affiliations and acquisitions protect each other’s market area and provide a patient flow to either one’s healthcare system. For example, McLaren snapped up a Gaylord-based physician practice where Otsego (Gaylord) Memorial Hospital operates independently to ensure referrals to them, while an independent Traverse-based ophthalmology practice opened offices in Petoskey, but can only perform surgeries at Munson and not McLaren. Petoskey now has only one ophthalmologist that does surgery at Northern Michigan when at one time the community had five or six when the Burns Clinic existed.
Both healthcare systems do face some of the same issues with physician recruitment and retention because younger physicians do not want to work in rural northern Michigan, where earnings are less with outside cultural activities and few jobs for spouses. The area is also viewed as remote and isolated.
Generation X and Millennial physicians place more value on personal time and don’t want to work the hours characterized by the Baby Boomer, which is harder to achieve in rural areas with smaller organizations
From research, provided by the McLaren Northern Michigan Hospital Foundation, it takes more than one Millennial or Generation X physician to replace one Baby Boomer doctor.
“Unlike their elders, younger physicians are much less willing to put their lives on hold to work 80-hour weeks that include weekends, nights and on-call duty,” McLaren reports. “Many newly trained physicians are putting a premium on a ‘controllable lifestyle’ including set hours, vacations and part-time practice.” McLaren Northern Michigan services an area where 23% of the population is currently 65 or older.
The shrinking supply of physicians is also caused by early retirement of physicians not wishing to deal with the healthcare reforms and now have the money to retire.
Some 40 physicians are expected to retire by 2019. McLaren says it hopes to hire new primary care and specialty physicians over the next five years to ensure healthcare access northern Michigan will need. McLaren healthcare administrators say they are investing in innovative recruitment and retention programs to successfully pursue physician candidates.
The physician and healthcare worker shortage is not just in northern Michigan. A 2015 study conducted for the Association of American Colleges predicts that by 2025, the United States will face a shortage of between 46,000 and 90,000 physicians. This includes 12,500-31,100 too few primary physicians and 28,200-63,700 too few surgeons and specialists.
Healthcare experts report the story is not much different for experienced nurses, who are in short supply. They find the stream of new nursing graduates is good, but many hospitals want more experienced nurses too.
How northern Michigan and the national healthcare system develop will rest likely on who dominates and controls the politics of healthcare. As one 62-year-old northern Michigan internist lamented, “Medical practices no longer allow doctors to spend time with their patients and talk about their lives and families. I miss those days and know they will never return.”
Ken Winter, former editor and publisher of the Petoskey News-Review and member of the Michigan Journalism Hall of Fame, teaches political science and journalism at North in Petoskey and Michigan State University.