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Published: Friday, 12/29/2006

New peril to medical care

A BLUNTLY worded report by a panel of doctors reviewing the state of graduate medical education in Toledo and northwest Ohio should serve to jolt community leaders, physicians, and the citizenry from their complacency about the ruinous competition between the two largest hospital groups in the region.

When the turf war between the ProMedica and Mercy Health systems comes up for discussion, often the criticism that arises is that the competition has led to unending wasteful expansion projects as the two giants try to outpace each other with new facilities. That may be a valid criticism, but the situation is potentially far worse and cannot be shrugged off, as it all too frequently has been by community leaders whose social ties with the highly compensated brass hats running the medical giants apparently have blinded them to issues of quality of graduate medical education.

The community owes Dr. Lloyd Jacobs, president of the merged University of Toledo and Medical College of Ohio, a debt of gratitude for his warning that specialized programs such as obstetrical training are jeopardized by a policy of drift. Dr. Jacobs was quoted as saying that unless improvements are made before an April, 2007, evaluation by accreditors, he would close the 12- to 16-person obstetrics residency before allowing it to lose its accreditation.

Graduate medical education is subject to two other trends that are distinctly worrisome.

One is that only 10 percent of UT medical school graduates stay in this region for their residencies, as compared with 30 percent just a year ago. The other is that Toledo has "an aging physician work force," in the words of the panel of doctors asked by Dr. Jacobs to examine the graduate medical program in this region. As many as 25 percent of the doctors in this region are expected to retire in the next five to seven years.

Thus the situation is compounded by this region's failure to retain and attract new doctors as well as skilled persons in other fields. The two hospital bureaucracies, though ostensibly at war with each other, sounded too much alike in their alibis or their seeming nonchalance. The only answer, in light of the hospital systems' commanding role in graduate medical education, is for them to cooperate in all aspects of training beyond undergraduate medical education, in which the University of Toledo medical school has shown steady improvement.

It's a tall order. But it can be done if political and civic leaders get off their duffs, along with business leaders who should want the best medical care for their employees at reasonable cost and citizens who have failed to raise their voices over the costly rivalry between the two major hospital complexes in the region.

As in other areas of economic life, Toledo and much of northwest Ohio have been coasting along on past accomplishments. That simply cannot be continued in a region vexed, like other older industrial areas, with a leadership mind-set among policy-makers of drift and muddling through.



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