by Thomas H. Fine and Dr. Daniel Rapport
Note: this essay was published in the March 7, 2020 edition of the Toledo Blade.
The University of Toledo and its medical center are experiencing troubled times. At its February meeting, the board of trustees’ president made the statement that the current financial performance of the medical center is “not sustainable” and something must be done. Employees of the medical center and the college of medicine have been told by the administration that all options are on the table. This current state of affairs has created a climate of uncertainty that the medical center has never before experienced.
There are two questions facing the University of Toledo and the taxpayers of the state of Ohio. The first is: Does the university need to own and operate a hospital for its medical school? The answer for many universities has been no, though that is not necessarily the correct answer for the University of Toledo. The College of Medicine is quite unique, designed with the hospital as an integral part of the campus. This facilitates the integration of teaching and research with the provision of health care, the core mission of the school. Maintaining ownership ensures that the hospital continues to support this core mission. It may actually be wise for the university to own and operate UTMC, the former Medical College of Ohio Hospital.
The question then becomes: In whose best interest is it for such a hospital to continue to operate? All of the medical students and students in the college of pharmacy, nursing, public health, clinical nurse practitioner, and physician-assistant programs benefit when placed in an academic medicine environment. Doctors in academic medical centers practice differently. They practice at a slower pace than regular doctors in community hospitals, which is important for teaching. Physicians make these choices early on in their careers to practice one way or the other. Attempting to force either to practice differently inevitably is frustrating and disappointing for all. An academic medical center owned and operated by the university benefits the citizens of northwest Ohio and generally the taxpayers of the state who opened this institution with a very specific purpose.
As a result of the affiliation agreement with ProMedica, the vast majority of doctors and resident physicians have transferred from UTMC to the ProMedica Toledo Hospital main campus. This put UTMC in a precarious financial situation. While there was a need for more teaching slots for residents and medical students, this wholesale transfer of physicians, residents, and patients may not have been necessary. There is no advantage in our community or to the taxpayers of Ohio for a single hospital to monopolize the education of our medical students or any of the allied health-care providers. Somehow the idea that both hospitals could serve as training sites has not been able to gain traction.
The financial failure of the UTMC medical center has placed the University of Toledo board of trustees, the president of the university, and the dean of the College of Medicine in a difficult position. On the one hand, they are constrained by the affiliation agreement that requires ProMedica to be the exclusive training site for the residents and medical students.
On the other hand they are responsible for the success or failure of the medical center. Conflicts are inherent in this arrangement, and both the administration and members of the board of trustees have a difficult job making decisions that satisfy all the parties involved, while promoting the mission of the university and the medical center.
It serves the needs of the community, the students, and the employees of the medical center to remain operating. It serves no one’s needs for it to close.
The simple solution is to bring physicians back to the hospital. In fact, a mixture of community and academic providers would create an ideal learning environment. Saving UTMC as an academic medical center, making it financially viable again, is possible, but will require both creative management and financial will.
Who should be making this decision, a conflicted university administration and board of trustees or the General Assembly and governor?
To us the answer is clear. It is time that we as citizens ask our state lawmakers and Gov. Mike DeWine to do the right thing for our community, our students, and for the state of Ohio.
Thomas H. Fine is an associate professor and Dr. Daniel Rapport a professor in the Department of Psychiatry at the University of Toledo College of Medicine. Their views are their own and do not necessarily reflect those of the university.