Editor’s Note: Below is the first in a series of regular contributions from our President and CEO, Dr. John Brumsted, to Fletcher Allen’s blog. Dr. Brumsted will share his perspective on a variety of issues impacting academic health care delivery, with an emphasis on Vermont’s leadership in health care reform. This installment discusses the concept of an integrated delivery system – a network of health care providers and/or organizations that provides coordinated access to the right health care services, at the right time, in the right place.
John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.
One of my most formative professional experiences occurred early in my career. I received a National Health Service Corps scholarship to help pay for medical school and was obligated to serve two years in a designated physician shortage area as payback. For a host of reasons, all bureaucratic and irrational, the term of my service began after just one year of graduate medical education, a surgical internship. The only place that would have me was Randolph, a small, very rural town in the southwestern corner of New York State.
I was to be the only physician — the “Town Doc.” I had an office in an old converted fire station, a receptionist and, thank goodness, a very experienced physician’s assistant (PA). Thirty miles away was a 20-bed hospital with a pediatrician, internist and general surgeon on staff. Tertiary care was available 90 miles west in Erie, PA and 70 miles north in Buffalo, NY.
I rapidly realized that, due to my lack of experience, I would have to depend on others if I was to meet the medical needs of my community. A “mini-integrated delivery system” was born with the PA and me as the primary care initial point of contact and the pediatrician, internist and general surgeon as our back up should things get too complicated.
Based on the experience of our back up, specialists in Buffalo were identified and referral relationships developed rapidly. This team approach allowed a very inexperienced physician to credibly meet the primary care needs of the community. The importance of our medical outpost to the local populace could not be overstated. Without us it would be at least a 30 mile drive, frequently in very inclement conditions, to access even the most basic of services.
As I have contemplated the development of our integrated delivery system at Fletcher Allen Partners, I reflect back on these times and the lessons learned with some frequency. The critical need to have ready access to primary care, the benefits of linking primary care to other components of the health care delivery continuum and that a team approach synergistically maximizes the impact of each team member. I believe these are good lessons for all of us to keep in mind in an era of health care reform.
John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.
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It’s good to hear about the formative years of a physician, and there is no doubt that integrated care systems are the way forward for hospitals such as Fletcher Allen. This is refreshing to hear.
I liked seeing a personal side applied to the FAHC discussion.
Ironic that the ‘team approach’ to health care has, for decades, been leaving women off the team – especially in women’s health. We now have yet another man in charge of OBGYN. We shall see how far the ‘team’ approach extends.
FAHC is $400 million in debt from the poorly-designed and executed remodel – which neglected the oldest parts of the hospital that are even now long overdue for revamping. Maternity care and women’s health are, we know, a huge income stream for this and every other hospital. The current costly model of overuse and overtreatment must be examined in light of FAHC’s financial status.
FAHC and UVM OBGYN have ignored, and opposed, the wishes of the women whom they supposedly serve (trying to shut down the midwifery service; no integrated maternity-care options; limited in-hospital birth options; and a 25-30% total (NOT primary) surgical-birth rate, for no good reason but ‘practice cases’ for the residency program – which has just added another slot. And surgical intervention can double the cost of an in-hospital birth, especially if NICU is involved – which often occurs for purely iatrogenic reasons.
What does Brumsted’s ‘team approach’ mean? At UVM, there is no midwifery school, nor any affiliation with regional nurse- or certified midwifery training programs – though midwifery care is what women want, and – according to the evidence – the best and safest care available. Recognition and support of certified professional midwives has eroded to nothing under the current regime. UVM docs have worked hard to curtail women’s access to options in childbirth, in an ‘our way or the highway’ approach. UVM does not promote primary caregivers’ training in maternity care – which would be truly family-centered health care. Now the push is for OBs – surgical specialists – to be classified as ‘primary care’ docs, driving up overuse, overscreening, overtreatment, and costs, and further fragmenting women’s care away from the family-centered model.
For too long have men been in charge of women’s health, pushing their own needs and agendas ahead of our own; for too long have the wishes of the people been ignored. It is time for regime change.