Note: this letter was published in the June 19, 2020 edition of the Toledo Blade.
On June 10, ProMedica delivered a response to the University of Toledo’s Request for Proposals to purchase, lease, or co-manage its financially burdened medical center: University of Toledo Medical Center, the former Medical College of Ohio hospital.
The announcement of the proposal, while brief, appears to have several attractive features. It allows retention of some specialty-care programs including cardiology, neurology, oncology, psychiatry, and orthopedics as well as emergency care and primary care.
Thus, these services will continue to be available to South Toledo residents. In addition, the proposal allows UTMC employees to retain their status within the state retirement system. Furthermore, it endorses support of research infrastructure at UTMC. Moreover, it promises that the UT College of Medicine and Life Sciences will continue to have “a home of its own” for educating future generations of physicians and other health-care professionals given that UT will retain ownership and ultimate control. On the other hand, the proposal at this time is incomplete, and there are several aspects that raise concerns. As is often said “The devil is in the details.”
First, the extent and comprehensiveness of the specialty services to remain at or restored to UTMC are unclear. Will the services be comprehensive as they were before they were moved to ProMedica Toledo Hospital or will they be at a “skeletal” level? UTMC’s remunerative services must restored in order for it to be financially stable.
The proposal does not mention the future of the Trauma Center, which was downgraded last year from Level One to Level Three. This decision should be reversed so that the Trauma Center is upgraded to Level Two at a minimum, preferably a Level One.
Also unclear is UTMC’s future identity. Will UTMC remain identified as the University of Toledo’s medical center or will it be “wrapped in the green and white banner of ProMedica” as suggested by a recent article in The Blade?
Also important is the question of the management structure: Who will be charge of and responsible for what? As several commentators have noted the UT’s Board of Trustees, the group ultimately responsible for UTMC’s management, has lacked medical and health-care expertise. Accordingly, an independent board with medical and health-care expertise for the UT Health Science Campus, including UTMC, has been suggested by many.
Likewise, ProMedica, as a financially oriented health-care organization, lacks expertise and experience in managing an academic enterprise, in which education and research are paramount. As noted by UT Psychiatry faculty members Daniel Rapport and Thomas Fine in a recent Blade essay, the nature of medical education requires that clinician faculty members spend sufficient time with students to explain the reasons behind the diagnosis and treatment of the patients they see.
This educational necessity may not be compatible with a business-oriented approach to health care which requires maximizing the number of reimbursable patient encounters in a given period of time. How will this potential incompatibility be resolved? Medical research represents a second academic mission that requires a set of expertise, resources, and infrastructure that are not routinely found among ProMedica’s resources.
Whatever management structure is envisioned it should be kept in mind that UTMC is a public asset responsible to the people of Ohio. This requires transparency that has been sorely lacking in the actions of the UT Board of Trustees and Administration, as well as in the UT-ProMedica Academic Affiliation Operating Group. This must change.
A final question is where will this collaboration lead? Will the goal be to assist UT to eventually become financially and structurally independent or will it lead to a UTMC becoming chronically dependent on ProMedica such that it is absorbed into the ProMedica organization?
Quo vadis?
In summary, as a 39-year faculty member at the Medical College of Ohio and the University of Toledo, as well as a member of the MCOH/UTMC Medical staff, I believe the ProMedica proposal has the potential to provide benefits to UTMC’s missions of health care, education, and medical research if it is implemented in manner that addresses UTMC’s academic and public health-care missions and leads to it once again becoming a true university medical center. Of course, if wrongly implemented it could be the death knell for UTMC as an academic medical center.
On balance the proposal merits further analysis and discussion. I think I can speak for my colleagues when I write that I look forward to details and trust that all interested parties, including faculty members, employees, and members of the Toledo community, will be involved in the planning of this joint enterprise should it be the proposal chosen by the UT Board of Trustees.
A. John McSweeny is a professor in the Department of Psychology at the University of Toledo.
No one really will tell how many graduating med students stay here since the affiliation. Usually most places will retain 25-30%. After 5 years, that number should be improving. If not, someone is not doing their job especially with all the resources available.UTMC has an M.D. on their side to work on clinical matters.Promedica does not to my knowledge.Odd. Worth a look.