Recruiting report: Local doctor, UPMC differ on hospital priorities
Local doctor, UPMC differ on hospital priorities
Editor’s note: This is the second in a three-part series.
By William Kibler
rimary care can pull a lot of weight in the health care system, but big health care organizations, including UPMC, tend to regard it lightly, according to Dr. John Reinhardt, principal of Reinhardt Family Practice in Altoona.
“The proof is in the pudding,” Reinhardt said.
The “pudding” includes the local hospital’s tertiary trauma center, connected to a big emergency department, a cancer center whose name refers to UPMC’s renowned cancer complex in Pittsburgh, and a breast health center, along with telehealth connections and various other programs that show the local community how the hospital here reflects the brilliance of the Pittsburgh-based health care giant whose name is on the facade.
“Wonderful” things, according to Reinhardt. And yet, UPMC has somehow failed to solve what should be an eminently tractable problem — recruiting a sufficient number of family doctors to practice here, he said.
It’s not easy to attract doctors to this city — a rust belt town with long winters, Reinhardt concedes.
“But if they really wanted to, they could do it,” he said.
That would take money, however, he said.
Hospital: ‘Recruiting priority’
Primary care is simply not a priority for management in the way that a new cath lab would be, Reinhardt said.
The hospital regards family practice as a “loss leader,” like the inexpensive T-shirts at Walmart — designed to get you in so they can sell you the stuff that pays, he said.
Family doctors are regarded primarily as entry points for services like X-rays, Reinhardt said — or like the glitzy programs the hospital launches with news conferences.
“We’re not the prettiest girl in the dance,” he said. “Obviously, their thrust is the big white tower over there.”
Primary care access is a problem for health systems and consumers all over the country, wrote UPMC Altoona spokeswoman Danielle Sampsell in an email.
“This problem is not unique to the Blair County area,” she wrote.
UPMC has been trying to deal with it, having increased investment of time and resources in primary care recruitment after merging with the local hospital six years ago, Sampsell wrote.
“Primary care doctors remain at the top of the recruitment priority list for us,” Sampsell wrote. “Since the merger, MORE primary care doctors have joined UPMC in this region than there were previously … a clear demonstration of UPMC’s commitment to recruiting and retaining of primary care providers for our communities and our patients.”
According to Reinhardt, an indicator of the hospital’s indifference to the family doctor shortage is the presence of 25 hospitalists — primary care or internal medicine physicians who work regular shifts in the hospital making rounds that replace those formerly made by the patients’ family doctors.
“If there were 25 new family doctors in this area, how wonderful that would be?” Reinhardt said.
Health plan distinction
UPMC can be more than merely indifferent, according to Reinhardt.
“It can be openly hostile,” he said.
When the organization first took over the local hospital, it created a distinction between “preferred” and “in-network” providers for the cheapest option on its health plan, Reinhardt said.
His practice was in-network, but not preferred.
It fooled some of his patients, who saw his name on the in-network list, signed up, then were told they needed to pay specialist co-pays when they came to see him.
“Everybody was up in arms,” he said.
Reinhardt appealed to the insurance commissioner, who overturned the practice.
Still, given that a third of his patients have the UPMC health plan, “it was scary,” he said.
The trend at Altoona started 20 years ago with an ambition to become a tertiary trauma center, Reinhardt said.
That took major resources, time and energy, he said.
It signaled an approach that betrays management’s “very poor” understanding of community needs, Reinhardt said.
“The center of their world is the hospital,” Reinhardt said. “(And) to a great extent it’s about the bottom line.”
Reinhardt was working as a hospitalist 10 years ago, and when he left to start his own primary practice, CEO Jerry Murray told him he was bucking the trend, as there wasn’t much of a requirement for what he planned.
Murray turned out to be wrong, according to Reinhardt.
“We have 16,000 patients, and we’re still hiring,” he said.
It takes 30 to 60 days for patients to work through his wait list, although if someone is ill, it can be quicker, Reinhardt said.
He hired two doctors two years ago.
There are five in the practice now, including himself, and a certified nurse practitioner.
“I could hire four more (physicians) tomorrow,” he said.
Family doctors, who come to know their patients individually, are the best way for people to access the health care system, but that access is limited when there’s a shortage, Reinhardt said.
People are going to find a way in, one way or another, he said.
Many who lack a family doctor try to make appointments with specialists directly, he said.
But an estimated 40 percent who do so turn out to be in the wrong place, he said.
“(Moreover), if you get your high blood pressure managed by a cardiologist, it costs more, (yet) your blood pressure isn’t under better control,” he said. “It’s not good for the cardiologist or anybody else.”
Others who don’t have a family doctor go to the emergency room, and emergency rooms also cost more, he said.
When he came to Altoona Hospital in 1992, there were 18 ER beds, Reinhardt said.
Now there are 52, and the department can expand further, he said.
Some patients lacking primary physicians go to urgent care, and that, too, is more expensive, Reinhardt said.
“The cheapest way is through the family doctor,” Reinhardt said.
And that’s as far as it needs to go in many cases, he said.
“I can handle the vast majority of things that come through the door,” he said.
Mirror Staff Writer William Kibler is at 949-7038.
TUESDAY: Local doctor founds first pure Direct Primary Care practice in area.