Providence can't compete with Boston's baseball team or baked beans, but Brown-affiliated teaching hospitals are fighting to make Rhode Island competitive with Longwood Medical Center and Partners HealthCare in Boston.
Plans are moving forward to consolidate Rhode Island Hospital and the Miriam Hospital into a 1,000-bed facility — about the same size as the Massachusetts General Hospital — with shared open-heart surgery and orthopedic programs. A more ambitious proposal to combine Lifespan and Care New England — two hospital chains in Providence that together provide about 70 percent of hospital services in the state — fell through this summer.
Hospital mergers and consolidations have been popular since the '90s, when the advent of managed care forced hospitals to reduce administrative costs and increase efficiency. But when teaching hospitals like the Miriam or RIH are involved, there's more at stake than profit margins and national rankings. Medical education is also on the line.
‘We have to be competitive'
"We need to have a strong, unified medical center," said Edward Wing, dean of medicine and biological sciences at the Alpert Medical School. Construction in the Jewelry District is currently underway to create that medical center, with plans for a permanent Medical Education Building, surrounded by other medical facilities and life science research centers.
Combining RIH and the Miriam is "very important in terms of being able to have the best clinical services," Wing said, because it will reduce competition and inefficiency.
"Any kind of fractionalization is usually not good for education," Wing said, because it means duplicate services end up competing with each other both clinically and academically, instead of working to improve education or patient care.
Instead, that competitive energy will be redirected outside Providence.
Orthopedics will be one of the first programs to consolidate at RIH and the Miriam. Staci Fischer, director of graduate medical education, said she hopes that will mean fewer Rhode Islanders will travel to Brigham and Women's Hospital's new outpatient clinic in Foxborough, Mass.
The 93,000-square-foot facility next to Gillette Stadium — home to the New England Patriots — offers primary care and specialty services. Many in Providence have expressed worry that it will take away patients who would otherwise have gone to Providence hospitals, where they would have interacted with Brown medical students and residents.
"We have to make sure we have enough patients to give them a good, broad base," Fischer said of the Brown residents and medical students she oversees. "We have to be competitive in order to be a good educational system."
If too many patients are drawn away from Brown's teaching hospitals, then physicians in training will not have as diverse a patient load, Fischer said. Fewer patients mean "less opportunity to learn," she said.
Furthermore, some officials in Providence worry that patients who choose the Foxborough clinic will be wealthier and better insured. Patriot Place is not generally accessible by public transportation, and it is filled with high-end shops and restaurants.
"Ultimately, we depend on the financial health of the hospitals," said Phil Gruppuso, associate dean of medical education. And while Providence hospitals would have to swallow a significant income loss before Brown's medical education would be affected, the two are not unrelated.
Even if the merger has long-term effects on the Providence hospitals and the Med School, it probably will not make much difference in day-to-day operations for most students, residents and physicians.
"We've done things together for a very long time," said Fischer, explaining that for residents, RIH and the Miriam have been essentially one institution for years. The two are both part of the Lifespan network, and they collaborate on patient care and share departments.
Even if some specialized departments exist only at one hospital or the other, thus changing the potential locations for some fourth-year medical students' electives, Fischer said students will not notice any difference. Virtually all medical students spend time at both hospitals during their third-year rotations, she said, and they would already be familiar with both facilities.
John Kastor, professor of medicine at the University of Maryland School of Medicine, said he did not see any major changes in medical education when he was completing research for a book on mergers among teaching hospitals.
"It didn't seem to have much effect on medical students," he said.
Similarly, Mathew Maurer, an assistant professor of clinical medicine at Columbia, said he did not notice any major differences in medical education in New York when the Presbyterian and New York hospitals merged in the '90s. The two became a single facility and a major partner for both Cornell and Columbia medical schools, but Maurer said he thought the students were largely unaffected.
But he said the hospital itself has improved since the merger and that it has become a "much more efficient organization" with "improved patient care."
"If the quality of everything around you is improving, it makes you a more engaged citizen," Maurer said.
Fischer and Wing said they hope Providence hospitals and the Med School will see a similar lift after the RIH-Miriam merger.
"The educational experience, if anything happens, will actually be enhanced for those programs that do consolidate," Fischer said.