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.

Who should run health care in Cook County?

Who should govern the Cook County Bureau of Health Services?

The current rubric gives the Cook County Board responsibility for oversight of public health and health care. We need experts who know how to run hopsitals and clinics. Most experts agree that the Cook County Board must relinquish oversight to an independent health commission. This is not new news. Earlier this year health experts, under the umbrella of Northwestern University's Feinberg School of Medicine came together and recommended this.

You can read the whole report from Northwestern University’s Feinberg School of Medicine about important priorities and directions that can be taken by Cook County Bureau of Health. The authors of this report should know. They are all veterans of the Cook County Bureau of Health Care system. They have worked there. They know the inside information. There are successful models from around the country that they draw upon in the recommendations section.


Not to be left out, Cook County Board President Stroger appointed his own Blue Ribbon Commission. Read the Blue Ribbon Commission Report to get a sense that we run health care in our County as if it was some feifdom from the middle ages. Time to turn it over to the experts in hospital management, public health systems and financial outcomes. We'll see if President Stroger has the political courage to follow these recommendations.

Cook County Bureau of Health Cuts Now to Spend More Later

The Cook County Bureau of Health is trying to close a budget deficit. Currently the round peg of $835M in health system expenditures has to fit into the square hole of a $730M target. An historic closing of County-run community clinics combined with one of the largest layoffs of doctors and nurse practitioners has created repercussions across the region. The problem? No strategic plan, no governance by health care experts.

Meanwhile, the response by Cook County managers is to strangle prevention efforts and to cut resources that allow people to get health care close to home, at a neighborhood clinic. Let's keep the emergency department free to see true emergencies instead of clogging it up with folks who just need a refill on their diabeted medication.

Paradoxically, cutting back on neighborhood-based care will put more stress on the system by forcing patient to stand in line for routine services at Stroger Hospital. Or worse, wait until they are too sick and end up with costly hospitalization.

Can someone do the math?