Among reasons that UPMC Altoona will downgrade from its current Level II status as a trauma center to Level III in September are to help lure back local surgical groups that have shunned the hospital, due to on-call obligations connected with the current trauma designation, and because of efficiency issues for surgeons caused by a shortage of hospital staff, according to a registered nurse who spoke recently to the Mirror.

A couple surgery groups have been doing all their elective surgeries like joint replacements at other hospitals, while others have reduced their use of UPMC Altoona, all to avoid the need to take on-call trauma cases at all hours, which can be “burdensome,” especially when it compromises their sleep and they’re scheduled for operations soon afterward, when they may not be at their best, said Cindy Schuma, who’s been a nurse for 47 years — 35 at UPMC Altoona and its predecessors, and who currently works in the recovery room. Daily surgical cases in the last few years have fallen from nearly 50 to about 25, Schuma said.

Some surgeons are also reluctant to use UPMC Altoona because of the hospital’s inability, due to lack of staff, to provide them sometimes with two operating rooms instead of one, which means they can’t alternate between the rooms and handle a maximum caseload — but instead must wait an extra 15 minutes between cases — an issue rooted in the hospital’s unwillingness to pay enough to attract a sufficient number of staffers, according to Schuma.

When the hospital drops to Level III, the on-call obligation will disappear, and the hospital will have a better chance of luring those surgeons back, according to Schuma.

The hospital’s initial explanation for its plan to drop from Level II to Level III was that the demand for high-level trauma services has declined, and that “pretty much summed up the reasoning,” said hospital President Mike Corso, when asked about what Schuma said.

Still, Schuma’s contention about the on-call issue “is factually accurate,” Corso said.

And the new designation as a Level III center will reduce or limit some on-call requirements, he said.

“(But) I don’t know that (the surgeon’s resistance to on-call duties) is the driving force (behind the hospital’s switch),” the president said.

Moreover, a reluctance to commit to on-call duties that cut into home life isn’t unique to Altoona, according to Corso.

It’s driven by a widespread desire for work-life balance, coupled with the greater leverage doctors have because there are fewer graduates coming out of medical school, along with an increasing number of less-grueling options available to new doctors, according to Corso.

Work-life balance is a “huge deal,” and the focus on it is probably a good thing, according to Corso.

Optimizing resources

The hospital tries to accommodate surgeons’ desire for additional rooms when it can, so they can operate more efficiently, according to Corso.

“We work daily to optimize OR staff and resources for our patients and clinicians” — with “throughput and capacity” being evaluated throughout the day, he wrote in an email. “However, there are many reasons why (offering a second room) is not always an option,” he added.

OR scheduling is complex, according to Corso.

The hospital is having trouble recruiting staff largely because it doesn’t pay enough, according to Schuma, speaking in connection to the hospital’s being unable sometimes to supply a second operating room for surgeons.

“The wages here are very stale,” Schuma said. “Very plateaued.”

It’s hard to recruit nurses and other staff when they can make more elsewhere, she said.

One X-ray tech quit to work for Sheetz at higher pay, Schuma said.

Another went to a medical facility near State College for $10 an hour more, she said.

And a nurse went to the Van Zandt VA Medical Center for better pay and benefits, she said.

“I know it’s a business, and there’s the bottom line, but it’s too much the bottom line,” Schuma said. “We’re not talking about a grocery store.”

The hospital claims that it doesn’t have problems recruiting in Pittsburgh, but there are lots of facilities in Pittsburgh and there are schools that provide “a huge influx” of new nurses there, which makes that city’s recruiting environment different than it is in Altoona, she said.

The hospital can’t take “a cookie cutter approach” with wages, Schuma said.

The hospital has enough money to pay what’s necessary to get people to work here, Schuma said, citing high executive pay and reported use of a private jet for executives.

Recruiting an issue

Recruiting is an issue throughout the medical field, and all over the country, according to Corso and UPMC spokeswoman Sarah Deist.

The pay scale at UPMC is “competitive,” Corso said. “Not always the highest and not always the lowest,” he said.

Altoona may pose additional challenges due to its rural character, especially in recruiting physicians, he conceded.

“Altoona is not exactly a metropolis,” Deist added.

“We love it here,” Corso said. “But sometimes people may be looking for something that Blair County doesn’t offer.”

That’s especially true for people raised or trained in bigger cities, Corso said.

It’s easier to recruit people with local ties or who grew up in an area similar to ours, Corso said.

UPMC engages in approaches to employee management that harm morale, which doesn’t help in the retention or recruitment of employees, according to Schuma, who cited the case of a clinician who planned to retire next year, but who lost her job due to money-saving cuts.

The clinician was called into a manager’s office and informed that she was gone, while another manager boxed up the clinician’s belongings in the clinician’s office, after which the clinician was escorted out of the building, without having the opportunity to say good-bye to her staff, Schuma said.

It was “belittling, insulting and very upsetting,” Schuma said.

It hasn’t seemed to Schuma that the number of incoming Level I and II trauma cases have actually declined, based on the number of announcements that she hears on the hospital’s public address system, Schuma said.

But those preliminary announcements based on field assessments don’t necessarily translate into how cases ultimately get classified, according to Corso.

“The vast majority of cases we get fit our (proposed new trauma) level,” Corso said. “We’re trying to match the acuity to what’s happening in the community.”

Thus, dropping down to Level III isn’t likely to change the number of trauma cases that end up in the Altoona Emergency Department, Corso said.

The hospital will still be a designated a trauma center, he said.

“(But) things change, and we need to focus our resources where we can,” he said.

It’s still to be determined how much less money it will cost to support the Level III trauma center, but it probably won’t represent a major budgeting change, Corso said.

There will be no loss of staff positions because of it, he said.

Patients may need flown to Pittsburgh

The main problem with UPMC Altoona dropping from Level II to Level III is that victims of traumas like compound fractures caused by vehicle accidents will need to be flown out of town, probably to UPMC Pittsburgh, which means an expensive medical helicopter flight and the expenses and upheaval connected with lodging and travel for the families of those patients, Schuma said.

Many people in our area will have a hard time affording the additional costs, Schuma predicted.

“That is going to be a big hardship to our community,” Schuma said.

It happens even now that some trauma cases need to be transferred to Pittsburgh, with all that entails for patients and their families, Corso said.

The biggest significance of the coming change at UPMC Altoona for Penn State Associate Teaching Professor of Health Policy and Administration Richard Shurgalla of Centre County is that the nearest higher level trauma center will be farther away.

Instead of going to Altoona, the destination for trauma patients in Centre will likely be Geisinger Medical Center in Danville or Milton S. Hershey Medical Center in Hershey, Shurgalla said.

The downgrade can’t be easy for UPMC, according to Shurgalla.

“It’s a difficult decision for any organization to downsize anything,” the professor said. “For most health systems, it’s not what they want to do. They’re usually forced by economics or staffing.”

The hospital is probably looking at “what makes the most sense (financially) and how to provide to the community what is necessary,” he said.

Operating a trauma center, especially a Level I or II center, is very costly, Shurgalla said.

That expense is incurred not just in ensuring the hospital can provide trauma treatment, but also to ensure it can provide specialized followup care — for example in the intensive care unit, Shurgalla said.

There is a financial incentive to discontinue providing such a level of service “if the volumes are not there or the payor mix for trauma is not solid,” Shurgalla said.

Because of liability insurance requirements for drivers, care provided for car accident victims is generally reimbursed better than care given for gunshot or stabbing victims, he said.

Payments for the latter may not be close to offsetting the hospital’s costs, he said.

Economics certainly weighed into the UPMC Altoona decision, according to Shurgalla.

He’s not accusing UPMC Altoona “of doing anything nefarious,” he said.

“(But) UPMC is a financially driven organization, there’s no question about that,” Shurgulla said. “Most organizations in today’s world have to pay attention to (finances), or they’re not going to be in business long.”

It’s generally a matter of where to spend an organization’s “limited financial resources,” he said.

Mirror Staff Writer William Kibler is at 814-949-7038.