Excellence Through Physician Collaboration
Described in news releases as “an exciting time,” the fall of 1997 signaled the dawn of a unique, new version of healthcare delivery in metropolitan Omaha and the region.
Today, the merger of the hospital and clinical operations of Clarkson Regional Health Services and the University of Nebraska Medical Center (UNMC) into one entity — The Nebraska Medical Center — is remembered as the historic first step bringing together the efficiencies and experience of private practice and the educational and research aspects of academic medicine.
“The collaboration of private practice and academic disciplines makes The Nebraska Medical Center much greater than the sum of its parts,” says Timothy Kingston, MD. “We have worked very hard to create an environment here that is completely different than any other medical facility in the region.
There’s nothing like it.”
Dr. Kingston, a general surgeon and a partner in Surgical Services of the Great Plains, has spent just over three decades practicing medicine at Clarkson and The Nebraska Medical Center. At the time of the merger, he was a Clarkson board member and past president of the Clarkson medical staff. He was part of the original 12-member board — with equal representation from Clarkson and UNMC — selected to oversee the new entity.
“This place is much more than that,” he says. “The concept we’ve put forth here is unique, and the private practice element is essential to its success.”
As the teaching hospital for the University of Nebraska’s health sciences programs, The Nebraska Medical Center is the state’s largest healthcare facility — with more than 1,000 physicians on staff. Closely affiliated with UNMC, The Nebraska Medical Center hosts more than 350 medical and surgical residents and assists in the training of hundreds of medical students.
“In reality, the two disciplines of academic and private physicians are much closer than people think,” says Peter Whitted, MD, an ophthalmologist with Midwest Eye Care, PC, and chief of Surgery at The Nebraska Medical Center.
He says designers of the merger realized the potential advantages of bringing the two disciplines together.
“At the time, improving efficiencies seemed very important,” he says. “The thinking was, there’s no need to have an arms race between two entities that are right across the street from each other. Bringing them together would be a way to use these resources better.”
Timothy Wahl, MD, FACP, is an endocrinologist with Diabetes and Endocrine Associates and medical director of the Diabetes Education Center of the Midlands. Innovation has always been an element of private practice, Dr. Wahl says.
“In the late 1980s, Clarkson was the first center in the Midwest to offer implantable insulin pumps,” he says.
Dr. Wahl says he was the first physician to become involved in telemedicine, accessing patients in outstate Nebraska several times a year from Omaha by utilizing the audio-visual center at UNMC.
He says both entities would benefit from further sharing of resources and expanded educational efforts. “The sheer volume of patients we see on a regular basis could greatly benefit the students and residents,” Dr. Wahl says.
When considering the number and variety of patients seen, private practice physicians have the ability to offer medical students and residents a broad range of experiences, says Pamela Santamaria, MD, a neurologist at The Nebraska Medical Center and president of Neurology Consultants of Nebraska.
“Residents rotate with us through the Clarkson Family Medicine Residency Program,” she says. “With us, they get to witness not only a greater variety of cases but also experience a different type of patient care where there are often fewer providers and staff.
“Most residency programs only focus on academic medicine, but in reality most residents go into private practice. Having private practice groups and academic groups working together really enhances the educational experiences for the residents.”
Dr. Santamaria says there are benefits of having her private practice clinic a few steps away from the academic neurology side.
“As a general neurologist, I am able to see a high number of patients from many different referral sources,” she says. “The higher number of patients seen in private practice leads to more referrals to the subspecialists on the academic side. Both sides benefit from our arrangements.
“The relationship has helped recruit physicians to my practice, and has given me access to ancillary staff, including case managers and equipment, that I would not have been able to utilize if I were in private practice in west Omaha,” she says. “It’s amazingly beneficial, not just for me but especially for my patients.”
Charles Enke, MD, professor and chair of the Department of Radiation Oncology at The Nebraska Medical Center, says his department has also benefitted from the support and expertise of both private and academic physicians. “Our department is committed to training future radiation oncologists,” says Dr. Enke. “Due to the support of the department by physicians affiliated with UNMC, as well as The Nebraska Medical Center, we are one of 26 accredited residency programs in medical physics in North America. We also hope to receive final approval for a medical residency program in Radiation Oncology starting in July 2010. Our commitment to the training of both radiation oncologists and medical physicists will allow support to the private practice and academic groups in the future.”
James Canedy, MD, orthopaedic surgeon at The Nebraska Medical Center, knows both sides of the equation. He is president of Private Practice Associates and president and executive director of SimplyWell LLC. He also has served as an adjunct associate professor whose main teaching role is orthopaedic education coordinator for Clarkson Family Medicine, where he works with family practice residents.
Founded by Dr. Canedy and other physicians, SimplyWell is a change management process in which participating companies obtain simple yet effective programs proven to result in lower healthcare costs, increased productivity and improved employee health. Participating employees are enrolled in an online, personal health-tracking program that identifies areas of immediate concern and offers an action plan to improve health and minimize future risks.
“Through SimplyWell, we have worked with academic physicians who have served as consultants for editorial content and new programs,” Dr. Canedy says. “We are in discussion with the College of Public Health and Department of Family Medicine to conduct some research.”
He says leadership is a key to making the mix of academic and private practice physicians at The Nebraska Medical Center work properly. He credits Glenn A. Fosdick, president and CEO of The Nebraska Medical Center, with providing the proper direction and support.
“We are fortunate here in that the amount of physician input is very unique,” Dr. Canedy says. “From the Board of Directors to strategic planning, Glenn does a wonderful job involving the physicians.”
Dr. Whitted agrees. “Glenn is a gem,” he says. “He understands. He gets it. No matter whether you’re an academic or private physician, he’s here to enhance your practice.”
Dr. Canedy says the combination of the two disciplines is a source of pride for the physicians. “I think we’ve got the best health system in the community, and we are continuing to grow in the right direction,” he says. “And I’ve always felt that if you stop improving, you’re in the wrong business.”
Better utilization of resources, as well as sustaining growth and improvement, were the heart of the merger in 1997, Dr. Kingston says.
“This all came about when the word everywhere was that we had become overbuilt with hospital beds,” he recalls. “There was talk about empty beds and vacant buildings. As it turned out, that is not what happened. Still, we were all looking for ways to make things work better.”
The plan had its detractors, and some private practice physicians left Clarkson, Dr. Kingston says. “We lost a fair number of physicians who were skeptical of the merger, afraid Clarkson would lose its identity and that there would be no room for private practice.”
As with the prediction of empty hospital beds, that was not the case.
“Because of the success we’ve had, many of the private practice physicians who left have returned,” Dr. Kingston says. “We have a thriving private practice group here and it’s growing. That’s as good a testament to its success as you can have.”
He says the two disciplines are quite complementary. “For example, the oncologists at UNMC have benefitted from our private practice arm because we are sending them patients,” he says. “The same is true for us, because many of our physicians are seeing patients we would not have access to if we were not located on this campus. There are many, many benefits both sides bring to the common goal.”
Dr. Whitted says he hopes the effort to incorporate more efficiencies and input from the private practice side into the system will persist.
“We have what has become a tertiary medical center where both the private practice and the academic disciplines flourish,” he says. “It is an advantage to UNMC to have our quality private practice surgeons and specialists nearby, and it’s an advantage for patients to have the options we collectively make available.”
Improving patient outcomes has always been a primary goal of the merger, Dr. Whitted says.
“The richness of this system is having multiple options, options that don’t exist elsewhere, options that are enhanced by the input of both practice styles,” he says. “If we center on creating a better, more efficient and safer patient experience, then we will continue to do better. After all, it’s not about the physician. It’s about the patient.”