Chicago Top Docs Named But What's Missing?

The January 2008 Chicago magazine (yet to hit the web and news stands) names Chicago's top doctors.  It is a great honor to be on the list. Those selected have been nominated by peers and vetted by a fairly rigorous selection process designed by Castle Connolly Medical LTD. 

First, a disclaimer, and a congratulations.  My wife, Dr. Michelle Gittler, has been named for the 3rd time as a Top Doc in her field of Physical Medicine and Rehabilitation at Schwab Rehabilitation Hospital. And she truly is one. I'm very proud of her.  Imagine coming home to that every night! And hopefully,  I get to be the spouse guest again this year  at a swank downtown reception in honor of this year's Top Docs.

But something is missing from the Chicago and Castle Connolly Report.  The major safety net hospital serving patients without regard to the ability to pay is conspicuously left off the magazine's index to hospitals. 

That's right, John H. Stroger Jr. Hospital of Cook County is apparently not a hospital in the minds of Chicago magazine or Castle Connolly.  

Ignore its  244,112  emergency department and urgent care visits in 2006* (University of Chicago 80,000 -- Northwestern 73,500 -- Cook County safety net Provident 53,974 -- University of Illinois 52,000 --  Mt. Sinai 50,250, -- Rush 46,000 -- Advocate Illinois Masonic 38,122).  

Also ignore their good health outcomes -- the fact that the Cook County Bureau of Health Services is one of the largest cancer care providers in in Illinois with 5-year survival of Stage II breast, colon and lung cancers all significantly better than US averages.  Operative mortality for cardiac surgery is better than national  benchmarks despite serving a population more likely to be high risk to begin with.  

Another example is neonatology survival.  Despite caring for smaller premature infants, the Stroger neonatal ICU has a greater survival rate than the national average.

Additionally, the County-run CORE center cares for 31% of all known HIV patients in Chicago and 20% of all known HIV patients in Illinois.

We can't ignore what County is famous for:  trauma care.  Of 6 trauma centers in the Chicago region, the Stroger Trauma Unit sees 40% of all trauma cases.  If the patient comes in alive, there is a 95.5% chance that the trauma team will save their life.

When you include the entire ambulatory health care network of Cook County, almost 500,000 patient visits were accomplished in 2006.

Given the sheer size of the health care operation and the exemplary health outcomes odds are there should at least one "Top Doc"  at Stroger Hospital or within the Cook County system named by Chicago magazine and  Castle Connolly.

Yet, conspicuously, none of Chicago's "Top Docs" are at Stroger Hospital, or for that matter, in the entire Cook County Bureau of Health system. 

Perhaps the "Top Doc" selection methodology is skewed towards physicians who serve patients who have insurance and access to academic and private medical centers leaving safety net docs largely unrecognized.

I hope that next year's Chicago magazine report recognizes top docs for all.

______

*Stroger Hospital 2006 -- 124,880 visits in the main Emergency dept., 12,678 in the Pediatrics ED and 103,553 visits in the walk in urgent care Ambulatory Screening Clinic.

Cook County Bureau of Health is Not the Only One

Almost absent from the discussion about County budgets and safety net health care is the realization that community health centers are a big part of the picture.  In the Chicago metro area, community health centers (CHCs) take care of 500,000 individuals, regardless of their ability to pay; in Illinois, we care for almost 1,000,000;  in the US 16,000,000. 

According to the Illinois Primary Health Care Association, community health centers in in Illinois provide cost-effective care. Health care costs for CHCs are an average of 30% lower than other providers serving the safety net population.  CHCs save dollars spent on unnecessary emergency room care and through the lower use of specialty and in-patient hospital care. With 268 primary care sites in Illinois, over half of those in the Chicago metro area, CHCs are a decentralized solution to primary care delivery.

Cook County leadership should recognize the critical role played by CHCs.  By collaborating on health care services for the under-served, CHCs  save the County dollars while improving the overall quality of care.

Important collaborations between the Cook County Bureau of Health Services and CHCs already exist but are at risk of being cut due to the County's budget crisis.  CHCs may no longer be able to accept referrals to provide primary care to patients released  from County facilities such as Stroger Hospital's  ER if the County cannot provide specialty care for CHC patients in exchange. Ditto for County's provision of pharmacy services for those County patients enrolled for ongoing care at CHC who have the most complex of chronic illnesses.

Only visionaries in health care policy and planning who have a sharp financial accounting pencil currently see the tremendous potential synergy between CHCs and the Cook County Bureau of Health Services.  The Bureau is not the only one out there providing safety net health care and needs to stop acting like it is.