Sunday, November 21, 1999
Where will the doctors go?
Bethesda closing may spur exodus
BY TIM BONFIELD
The Cincinnati Enquirer
The biggest loss from closing Bethesda Oak Hospital may not be the loss of the hospital itself. It may be the exodus of doctors that results.
When it comes to medical care, especially in this era of outpatient medicine, people visit their doctors far more often than they use a hospital. For practical reasons, many doctors prefer to have their offices directly connected to or located very close to their favorite hospitals.
This trend has been a huge benefit to the moderate-income and low-income neighborhoods of central Cincinnati. Thanks to the concentration of hospitals known as Pill Hill, hundreds of doctors from all sorts of specialties have been located within an easy bus or cab ride.
Until now, it has been suburban people with the means to travel who had to drive the farthest to see a specialist. But that's starting to change.
The TriHealth hospital group announced this week that it would close Bethesda Oak, effective March 31. The move was necessary, officials said, because operating losses had reached $19 million a year and the average patient count dropped from more than 250 a day in 1989 to just 42 a day this year.
The closing will be the second to occur on Pill Hill in a little more than two years. Jewish Hospital closed its Avondale campus in 1997.
That leaves University, Good Samaritan, Christ, and Deaconess hospitals along with Children's Hospital Medical Center, Veterans Affairs Medical Center and the Shriners Burns Institute occupying a few square miles near the University of Cincinnati.
While it remains too early to tell exactly how many doctors with offices near Bethesda Oak will end up moving out to Bethesda North in Montgomery, the closing of Jewish Hospital may provide a glimpse of the future.
When Jewish Hospital closed, there were 46 doctors leasing space in two office buildings connected to the
main hospital.
Now, there are 11. And three of them are planning to move to a new office building under construction near the expanded Jewish Hospital in Kenwood, said Gail Myers, spokeswoman for the Health Alliance of Greater Cincinnati.
Alicia Reece, newly elected Cincinnati city council member, said earlier this week that the announced closing of Bethesda Oak was a “sad day for Cincinnati.”
But one of her first questions was: “Where will those doctors go? Will they continue to have an office in the heart of Cincinnati?”
Sense of abandonment
Even before the closing announcement, some doctors had urged Avondale residents to have their babies at Bethesda North instead of Bethesda Oak. When that happened recently to a family friend, Ms. Reece said she wound up providing rides for several relatives without cars who wanted to see the new baby.
The closing of Jewish Hospital was a blow to Avondale that will get that much worse when Bethesda Oak closes, said Bernadette Watson, president of the Avondale Community Council.
“There is a sense of abandonment,” Mrs. Watson said. “I can't believe the suburbs have more of a need than the people in the city.”
TriHealth officials said they intend to honor their mission of providing care to the needy. It plans to maintain, possibly even expand, services for low-income patients now located at Bethesda Oak.
Room at other hospitals
But just like the Health Alliance of Greater Cincinnati (which controls Jewish Hospital), TriHealth's influence over doctors is limited. Most doctors do not work directly for hospitals.
John Prout, TriHealth's chief executive officer, said the other members of the hospital group — Good Samaritan and Bethesda North — have the capacity to pick up all the Bethesda Oak business.
TriHealth predicts it will retain at least two-thirds of the doctors affiliated with Bethesda Oak and their patients, Mr. Prout said.
Some will move closer to Bethesda North; some might shift to space near Good Samaritan. The rest will scatter to other hospitals, most with extra capacity as well.
However, some doctors have questioned how well the other hospitals around town will do at picking up the services once offered by Bethesda Oak.
This year, Bethesda Oak projects it will have logged more than 22,000 emergency visits, 4,000 inpatient stays and nearly 2,000 ba bies born there.
During last winter's flu season, several area hospitals filled to capacity. Intensive care units were jammed. Patients who needed hospital admissions were backed up in the hallways of emergency departments.
From December to late February last year, at least six hospitals were forced to divert patients to other hospitals more than 20 times. The hardest hit were Jewish Kenwood and Bethesda North.
Bethesda Oak will be open this winter, but not next.
Next year, other hospitals will have to deliver the estimated 2,000 babies that would have been born at Bethesda Oak, along with the more than 900 that would have been born at Jewish Kenwood (which recently announced it would close its maternity unit).
Longer waits, crowds
That's about 10 percent of the 30,000 babies born a year in Greater Cincinnati. On average days, the increase will be more of a boon to the other hospitals than a problem. But the traffic jams on busy days will be worse and possibly more frequent.
“You're going to see longer waits at the ER and more crowded OB units,” said Dr. Bruce Allen, an obstetrician who delivers about a third of his patients at Bethesda Oak and many of the rest at Christ Hospital.
“Sometimes now at Christ you can't find a bed; other times there's no problem,” Dr. Allen said. “I've had women ready to be induced only to be told, "We can't do it that day, take them to a different hospital.' I've never had to re-route a woman in active labor, but I could see that happening.”
Capacity in question
The question is, how many traffic jams are acceptable? How much hospital capacity are people willing to pay for?
“It's an age-old question,” said Lynn Olman, president of the Greater Cincinnati Health Council. “Do you build enough capacity for the busiest day or for what you need on an average day? To me, it isn't whether we have enough beds, but whether they are located in the right places.”
Even with the closing of Jewish and Bethesda Oak, the remaining Pill Hill hospitals still haven't reached their maximum capacity, Mrs. Olman said. If another big one closed, though, the picture could change drastically.
“If Good Samaritan, Christ or University were to close, that would be huge,” she said.
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