Monday, February 16, 2009

The University of Chicago's Health Care Desertification Project

posted by chicago pop

47th Street Clinic to Close by Early Spring 2009 -- University Shafts Neighborhood Middle Class

Since we posted on the prospect of Hyde Park's Impending Health Care Desert in June 2008, the situation has evolved considerably. It is now safe to say that, as a result of the subprime blowout, consequent credit crisis, and related global recession, the recently announced budget cuts at the University of Chicago Medical Center will leave Hyde Park without easily accessible primary care for everyone.

In particular, the 47th Street, University-run clinic will be closed entirely in March or April, instead of being sold to a private, federally subsidized medical group as originally planned. The tax-exempt Medical Center is transforming itself into a science colony inconveniently located among an underinsured population, with access to its basic services increasingly restricted to the original colonists.

While the issue of Chicago's ER sending l0w-priority patients to surrounding clinics or hospitals has been in the news recently, ("University of Chicago ER Sends Kid Mauled by Pitt Bull Home," Chicago Tribune, February 13, 2009) other changes strike closer to the heart of preventive, family primary care for Hyde Park residents.

If you have a doctor at 47th Street, they will be moving to DCAM.

If you want to get a doctor there, too bad, no new adult patients are being taken.

And from the word on the street I understand that it will be extremely difficult for newcomers to the neighborhood, even those with insurance that allows the University of Chicago and don't mind fighting their way into the heart of the massive Duchossois Center for Advanced Medecine, to get anything other than walk-in service with rotating physicians.

Like the idea of a family doctor who tracks your case history over years and knows your kids? The kind of medicine that can spot problems before they become the kinds of "complex" issues that the University prefers to treat?

Consider living in a different neighborhood. Until you need a liver transplant, that is, or you have a child who needs special treatment at Comer.

I felt at the time of the first post, and even more so now, that a community like Hyde Park needs a family health clinic accessible within the neighborhood by everybody -- not just faculty and staff, but anyone who can pay their bills and takes the chance on locating a family in this community.

While the University demonstrated a commitment to getting a decent supermarket in the neighborhood to replace the Co-Op, by closing the only conveniently located clinic in Hyde Park they are leaving dozens of families without local options for health care. This is a vastly more consequential decision that has received much less attention. While it is now much more enticing for people to shop locally for their groceries, it will soon be much more difficult for them to shop locally for a doctor.

Many families and individuals have already adjusted to this reality. In the comments to the original Hyde Park's Impending Health Care Desert post, it became clear that a large group of people had either resigned themselves to migrating north for primary care, have satisfied themselves with neighboring South Side, Federally Qualified Health Clinics, or somehow or another see physicians at DCAM for regular primary care.

It should be clear that the last option is not a reliable one in this neighborhood unless you are already in the system, and even then, it's not clear how many physicians will be retained.

A recent promotional brochure for the U of C had this to say about Hyde Park health care options:

U.S. News and World Report consistently selects Hyde Park's own University of Chicago Medical Center as one of the best hospitals in the United States...Also under the Medical Center umbrella are the Duchossois Center for Advanced Medicine, an outpatient facility; clinical training programs of the Pritzker School of Medicine; and several health care locations throughout the Chicago region.
The "clinical training programs of the Pritzker School of Medicine" are what you get as a walk-in from medical residents at DCAM, and there is no mention of a primary care health clinic in the neighborhood.

Ready to move your kids cross-country for that faculty job, knowing that the resident who treats them at DCAM will be gone in a few years and replaced by another?

The University of Chicago can do everything imaginable to encourage retail in Hyde Park, it can do a magnificent job coordinating the redevelopment of Harper Court, but if the families who chose to buy homes, pay property taxes, and volunteer at the local school can't see a doctor without having to travel many miles away from the coming $700 million medical center, then the University will undermine virtually everything else it accomplishes in terms of making Hyde Park a desirable place for people to settle in and live.

[This post also appears on Huffington Post Chicago]


Jessi said...

Something tells me that places like the Mayo Clinic or Cleveland Clinic aren't doing a whole lot of the public outreach business either. UCMC is a top-20 institution for specialties just like they are. There are plenty of other neighborhoods in Chicago, not to mention peer cities to Chicago, that don't have huge hospitals. Their residents make do with small general care practices. We don't have a lot of those in HP yet because UCMC has been trying to take care of that niche for quite a while. If they stop doing so, the general practitioners will come. I'm all for clinics and preventative services but I am not convinced that having it all be run directly by UCMC is the best way to serve HP anyway.

Anonymous said...

It's strange there are no private practice internal medicine/general practice physicians around here. The suburbs are full of them. We have dentists, optometrists and a "dermatalogy" (sic) office. Why no family doctors?

chicago pop said...

We don't have a lot of those in HP yet because UCMC has been trying to take care of that niche for quite a while. If they stop doing so, the general practitioners will come.

Just like all the retailers and supermarkets. Just get the dead hand of the University out of the completely efficient medical market and competition in pediatric clinics will bloom on the South Side. That's why in a Lincoln Park zip code there are EIGHT pediatric clinics, and in 60615 there is ONE.

Is the 47th Street pediatrics group crowding out the competition from those extra 7 clinics that would otherwise be here? I don't think so.

There is a reason Mayo Clinic doesn't need to concern itself with general care. It's because Mayo Clinic is located in Rochester Minnesota.

Rochester, MN Population: approx. 100,000. Median household income: between $50-60K.

Hyde Park pop: less than half that. Median household income: between $27-38K.

Given these numbers, what makes anyone at the hospital think that pediatric clinics will rush in to a neighborhood that has to be helped to maintain a major supermarket, let alone other basic retail amenities?

As clumsy as it often is, University of Chicago administration does recognize that part of its overall strategic concerns involve making its immediate environs a convenient place to live for the middle class without whom Hyde Park would collapse. It needs to be involved in making things happen for the better.

The Hospital doesn't seem to share that sense of strategic necessity.

LPB said...

Even though I generally agree that medical providers will "follow the money" (which, by the way, is exactly what UCMC is trying to do by concentrating on high-margin, high-tech procedures/treatments by specialists), I'm less confident that primary care providers will be flocking to Hyde Park for a number of reasons, including those CPop pointed out in his comment. The sheer population and income numbers in Hyde Park vs. Rochester MN make a pretty clear argument.

According to the Rochester MN site, 95% of the town's population are covered by health insurance. I have no idea what Hyde Park's numbers are, but I'll bet my bonus it's less than 95%. And as you can imagine, whatever the Hyde Park number is, it will surely be considerably lower when you expand the geographic reach to include the surrounding south side neighborhoods. Keep in mind that nationally, approximately 85% of the American population is covered through private and public insurance, leaving 15% uninsured. So, Rochester's 5% of uninsured is *significantly* lower than the national number. And, it's almost certainly higher than the national numbers in Chicago.

One data point from 2002: The number of people in Illinois without health insurance is up for the second year in a row, to 15.9 percent, says a new report by researchers at the University of Illinois at Chicago. In Chicago, the proportion is much higher, 22.7 percent. (Sun-Times, 2/4/2002).

Because primary care, in general, is less generously reimbursed than specialties, volume becomes the name of the game for any PC practice. So, if you're a primary care practitioner in Chicago, you will probably follow the money and volume straight to the north side.

Further, Mayo doesn't have to worry about losing its well-insured primary care patients to other practices. There seem to be two major primary care practices in the town, and it's unlikely that any significant proportion of patients are being siphoned off to another PC practice two towns over. In other words, Mayo participates in a primary care oligopoly in Rochester.

On the other hand, based on earlier comments on previous posts, there are certainly a proportion of Hyde Park residents who have simply decided to receive their primary care on the north side (including myself). Considering the number of private PC practices in Chicago, the competitive landscape doesn't come anywhere near an oligopoly. So, any PC provider in Hyde Park (whether it's UC or another entity) is hit with a double-whammy where the well-insured patients are constantly siphoned off to the north side, and only a large pool of un- or underinsured patients who need community outreach to take their place. Conversely, Mayo benefits from its location where there is little need for outreach -- not surprising when 95% of the town's population is insured -- and all those well-insured patients are extremely unlikely to migrate beyond the town borders.

To be clear, I'm not at all dissing Mayo's quality of care. Just because Rochester residents don't have too much choice in PC providers doesn't mean they aren't happy with what they're getting from Mayo or its primary competitor. Based on what I know of Mayo through friends and family who have been patients or trained there, I actually think it's one of the best-run, highest-quality medical providers. My own anecdotal sense is consistent with the findings from the 2008 Dartmouth Atlas report on chronic illness care. From a consumer standpoint, I think choice only becomes an issue when existing care isn't satisfactory.

Richard Gill said...

It isn't surprising that such a high percentage of Rochester residents have coverage; it's a company town. Rochester is probably a pretty good place to live, other than the weather. Think Chicago is cold in the winter?

One reason Mayo doesn't need to deal a lot in general care or outreach: it's a go-to place. It's almost a cliche that people "go to Mayo" for sprecialty medicine. Unlike U of C Hospitals, I'd guess that Mayo has hotels galore almost next door. But then, Rochester probably isn't populated by harrummphing old 39th Precinct-style NIMBYs.

Yael said...

Anyone have experience with Hyde Park Associates in Medicine? It's on 52nd Place near Lake Park, I believe. I've never been there, but was just talking with someone who turns out to be a physician there. Was surprised to learn of a clinic that isn't affiliated with UofC. I know they take BC/BS (Maroon Plan)...not sure about other insurances.

bornatreese said...

Yes, I've gone to Hyde Park Associates in Medicine for a long time-- specifically to avoid a U of C practice. They've just sold their practice to Advocate, but will continue with the same docs and staff.--don't know what will change administratively. I've been to several of the docs there, and I like them. This is the practice from which Dr. Quentin Young recently retired. If you pay for visits out of pocket (I have very high deductible insurance) their prices are reasonable.

Beckett said...

If you're interested in reading more news coverage about healthcare clinics and the Med Center's emergency care policy, these links are a fairly thorough collection: