Youngstown Northside Hospital Sold: Who Is Steward Health Care?

Today it was announced that Northside Medical Center in Youngstown, Ohio (the hospital in which I was born) is being sold, along with three other area hospitals to Steward Health Care of Boston from Community Health Systems company (WKBN). A total of eight hospitals in Ohio, Pennsylvania, and Florida are included in this deal.

Who Is Steward Health Care? According to the Boston Globe, Steward Health Care System was founded in 2010 to take over the hospitals formerly run by the Archdiocese of Boston. Steward is a for-profit health care provider and is backed by Cerberus Capital Management.

Why did Steward buy these hospitals? Since entering the market in 2010, Steward has become one of the largest health systems in Massachusetts, according to the Boston Globe. On September 26 2016, the Boston Business Journal reported that "Steward Health Care announces national plan, $1.25 billion investment." Around that same time, Modern Healthcare reported on September 24, 2016, Community Health Systems, "Why one of the largest US hospital chains is dismantling itself." Sounded like the business perfect storm.

What's good about Steward? It seems to be able to turn losses into gains. In fiscal 2011, the first year of running the hospitals, Cerebrus reported a $14.6 million loss (modern healthcare). However, by 2015, the company showed an operating profit of $131 million (boston globe). During this process, Quincy Medical Center was closed in 2014. 

What's bad about Steward? In addition to closing the hospital above, Steward has been fined over $40,000 for failing to submit financial data on time to state agencies in Massachusetts. The Boston Globe states, "The company remains locked in a dispute with state officials over what financial information it must disclose." I'm no bureaucrat, but I would imagine Steward would have to submit financial information to Ohio, Pennsylvania, and Florida where they now own hospitals. Are more fines in the future?

What does this mean for the Youngstown, Ohio hospital market? For those locally here in the area, it is no secret that Northside Hospital has been struggling, even before Community Health Systems purchased them. Meanwhile, its local competitor, Mercy Health, has been expanding its presence in the Valley. In addition, regional competitors Cleveland Clinic and University Hospitals of Cleveland have been trying to come in from the north, and University of Pittsburgh Medical Center (UPMC) has been trying to come up from the south.

So, this area, like other areas in Ohio, is becoming a very competitive hospital market. What will be the fate of Northside Medical Center in Youngstown, Trumbull Memorial Hospital in Warren, Hillside Rehabilitation Hospital in Warren, and Sharon Regional Health System? Looking at the short history of Steward, and, let me tell ya, I'm no economist. But, my guess is that it's likely that one, or more than one of these four hospitals may be closing in the near future. Which one(s)? We'll see...

Second Child Dies From Flu Illness In Columbiana County

For the second time in two weeks, a child dies from influenza related illness in Columbiana County, Ohio. On Jan 28, 2017, CJ Avila from Salem, passed away. On Feb 11, 2017, Colton Williams from East Liverpool passed away at East Liverpool City Hospital.

According to the CDC, there have been 20 pediatric deaths nationally from influenza related illnesses. In Ohio, in addition to the two pediatric deaths here in Columbiana County, there was the death of a 6 year old girl in Cuyahoga County, and the death of a 7 year old girl in Fulton County.

In the past two weeks, I've been getting a lot of questions about influenza, especially with these deaths locally. Is it time to panic? Absolutely not! But, here is some information to know during this critical time.

Is it too late to get a flu shot? Absolutely not! Visit your doctor as soon as you can. However, you have to know that the flu shot does not immediately take effect. It may take up to two weeks for your immune system to respond. Until then, wash your hands frequently and utilize the other preventative measures below.

How does the flu spread? Flu viruses are thought to spread mainly from person to person through droplets made when people with the flu cough, sneeze, or talk. People infected may be able to infect others beginning one day before symptoms develop and up to 5-7 days after becoming sick.

What are everyday preventative actions?

  • Try to avoid close contact with sick people.
  • If you or your child gets sick with flu-like illness, CDC recommends that you (or your child) stay home for at least 24 hours after the fever is gone. The fever should be gone without use of medication.
  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
  • Avoid touching your eyes, nose, and mouth. Germs spread this way
  • Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

Thanks to WKBN-TV for including a soundbite in their report: "7-Year-Old East Liverpool Dies After Flu-Related Illness" from Feb 13, 2017

February Is American Heart Month

President Lyndon Johnson proclaimed the very first American Heart Month in February 1964 and it has been proclaimed every year since then. Even though we have made great strides in the diagnosis and treatment of heart disease, it remains the leading cause of death in the United States. Every year, one in four deaths are caused by heart disease. Here are some quick tips to remind you of your heart disease risk, symptoms of a heart attack, and what you can do to prevent heart disease.

What are the Risk Factors for Heart Disease?

  • High Blood Pressure
  • High Cholesterol
  • Diabetes
  • Smoking
  • Family History of Heart Disease

What are the Symptoms of a Heart Attack?

  • Discomfort, pressure, or heaviness in the chest
  • Discomfort radiating to the back, jaw, throat, or arm
  • Sweating, nausea, vomiting, or dizziness
  • Rapid or irregular heartbeat

What are the best steps to Prevent Heart Disease?

  • Regular checkups with your doctor
  • Stop smoking
  • Exercise about 30 minutes most days of the week
  • Eat a heart healthy diet
  • Get enough quality sleep

Of course, if you have any symptoms that resemble a heart attack, call 911 or go to the nearest emergency room immediately. As I discussed previously, kick off the new year right, and make a visit to your family doctor and get your regular checkups and health screenings!

#SaveToledoFM - Show Your Support

There has been a lot of traditional media and social media support for the WW Knight Toledo Hospital Family Medicine Residency whose closure was announced less than 10 days ago.  For those on twitter, follow the hashtag #SaveToledoFM. And, you'll see from this blog, I've been writing a lot about the people affected in that area.

How can you show support? First, join and sign the petition on entitled, "Save W. W. Knight Family Practice Residency." In the first few days of the petition, they have garnered more than 1000 signatures. Join the cause and click on the image below.

Secondly, show your support on social media by taking a selfie with the #SaveToledoFM image created by the Ohio Academy of Family Physicians who placed the image on their facebook page. You can get the image by clicking on the image above or below. Show your support for #SaveToledoFM and post your selfie on twitter with the hashtag. Thanks for continuing to raise awareness for this important story!

Inauguration Day Thoughts

Stop reading this. Stop reading now. Unfriend me now. Unfollow me now. This blog post will neither gloat nor whine. This is not the blog post that you think. I am not a partisan. I am a pragmatist.

I admit that I'm a little bit of a political junkie. The first presidential inaugural I remember was in the 6th grade, when I was glued to the television watching Ronald Reagan, while the rest of the kids in the class were chatting at lunchtime. Fast forward to the 1992, when I was in college, and I remember seeing Bill Clinton & Al Gore exit the campaign bus in Youngstown, Ohio, and my friends and I were fascinated by the energy of the crowd. Fast forward again to 2009, when I watched the inauguration of Barack Obama on my computer screen, live video streaming as I was seeing patients that January day.

Now, it's January 20, 2017, and two simultaneous events will happen today, for which I will be very proud American. First, I have always been fascinated by the most peaceful transfer of power in the world. In many parts of the world, regime change sometimes involves the military, shots fired, and people killed. But, not in the United States where we have a presidential transition team, tradition and pageantry, honoring the past, and looking forward to the future.

The second event of which I will be most proud will be the great tradition of self expression and the right to protest. This week, in addition to news stories about the inauguration, there have also been stories about people who will be protesting the inauguration events. And, I have no problem with that. I'm proud that we have a country in which both events can occur at the same time. And, I have friends who will be participating in the inauguration, and I have friends who will be participating in the protests today, both in DC and on social media. Even though it seems like we're more divided than ever, my hope is that we can find common ground and some kind of civility will return to our nation.

#SaveToledoFM - TV Interviews

On January 16, 2017, one of the local television stations did a story called "ProMedica Cuts Family Practice Residency Program." In this interview are physicians Nate Balusik, Ann Steck, Lindsey Bostleman, and Stephanie Williams. Hopefully, this story is gaining traction, and more print and television media will start talking about #SaveToledoFM

Addendum: In addition, another local television statement did a story on the late local news called "ProMedica To Ramp Down Toledo Hospital Residency Program In Future." Our friend Dr. Holly Dickman gives a soundbite in this story, in addition to a patient of the residency protram, and a ProMedica administrator. The public relations war is on! 

#SaveToledoFM - Deema's Story


In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

Deema Yousef, MD, is a current resident of the program. She reached out to me to share her perspective of someone scheduled to graduate from the program later this year. My questions are in bold below. Here is Deema's story, in her own words...

1) My first question is about Family Medicine in general. How did you come to choose Family Medicine as your specialty and residency? Why do you love Family Medicine, and why is Family Medicine care important to the Toledo community? 

I chose to go into Family Medicine towards the end of my first year of medical school. This was after interacting with a fantastic mentor who led our clinical medicine group. She is a Family Medicine Physician. For our clinical medicine learning, she shared her unique patient experiences that ranged across different ages and complexities. She even practiced obstetrics. Her experiences in medicine, as I was hearing them, highlighted what I thought the role of a physician really is growing up - trained to care for each member of the family.

During third year of medical school, clinical rotations solidified my decision to go into Family Medicine. I really enjoyed rotating through the different specialties, and I didn't want to focus on one area of interest. More importantly, I enjoyed creating relationships with patients to know how to best care for them.

When I was considering residency positions, I traveled to Toledo to solely interview at the Toledo Hospital Family Medicine Residency Program. I immediately connected with the people at the program. It was evident from my interview day, this program includes a comprehensive multidisciplinary learning approach to prepare me to practice the full spectrum of Family Medicine.

Toledo is a city which high obesity rate and with that, there is a high rate of obesity related chronic conditions that impact the quality of life. Preventative and comprehensive care is needed to counteract. and treat these conditions. Also, the shortage of primary care physicians that is felt across the country is certainly recognized in Toledo. Most primary care practices in the city are not accepting new patients and if they are, the wait to be established is a period of at least 2-3 Months. Toledo certainly needs more primary care physicians, and the answer is to expand residencies like ours, not close them down.

2) Tell me (and my audience) about how you learned about the closure of the program, and how it was announced to the residents and the program.

This past Thursday afternoon (January 12, 2017), the faculty, residents, and clinical staff were all either paged, or telephoned, to attend a mandatory meeting that same day. The hospital staff divided the faculty, residents, and clinical support staff into three respective groups. We were all notified of the decision by hospital executives. After they made the announcement to the resident group, they allotted time for questions and discussion. The executives who spoke to the residents were both empathetic and genuine in their concern for the changes that lie ahead.

3) What has been the reaction to the announcement from the residents and the faculty at the program?

The following morning, I was scheduled to see patients in the office all day and it was hard to be working as everyone appeared disheartened. There were many mixed emotions shared by the staff, faculty, and my fellow residents; mainly sadness, frustration, and confusion.

4) In your opinion, why is it important for the Toledo Hospital Family Medicine Residency program to remain open?

We have a mission statement (click here). It beautifully and comprehensively captures the answer to this question. I invite you to please read it.

5) What kind of response would you like generated from the local community, the residency program alumni, and the Family Medicine community in general?

Already, the response has been tremendous. Our alumni are contacting community leaders, hospital executives, local business owners, and the local media to voice concerns about this decision. We are working together to request that ProMedica executives reconsider their decision in "phasing out" this fantastic residency program. 

Also, our local and national Family Medicine chapter leaders, including those with AAFP (American Academy of Family Physicians), MAFP (Michigan Academy of Family Physicians), and OAFP (Ohio Academy of Family Physicians), have been incredibly supportive; they have already extended helpful advise to us, and used their social media accounts to raise awareness of ProMedica's decision.

We kindly ask this movement of support to continue in hopes of compelling ProMedica Health to reconsider their decision to close our residency program.

#SaveToledoFM - The Resident Manifesto

In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

As you can imagine, individual residents have been hesitant to speak freely. However, I did receive a message from a resident at the program, and that person wanted me to share their "mission statement," which they hope will shed some light on their thoughts as a group during this difficult time (disclaimer: the photo above is a stock photo, and not of actual residents in the program) Their "mission statement," what I call their "Resident Manifesto" follows below...

We Are Family Medicine

We are Family Medicine resident physicians. Our specialty is people. We treat patients from the moment they enter the world until the day they depart. We practice obstetrics, pediatrics, geriatrics, and more, often in the same day. If we cannot manage a problem, we become the quarterback, directing and coordinating care between specialists, and other health professionals.

We train at the Toledo Hospital Family Medicine Residency Program, also known as W.W. Knight Family Practice. We are a multi-disciplinary team of physicians, nurse practitioners, pharmacists, experts in social work and psychology, registered nurses, medical assistants, and many other wonderful people. Together we take care of more than 5000 patients in the office, hospital, and skilled nursing facilities. Many of our patients have complex medical issues and live below the poverty line. They often find a home at WW Knight when they have no where else to provide their healthcare needs. We take pride in providing excellent care to a complex and underserved population. Our patients are the reason we rise for work each day. We strive to act as their advocates. and to fight for their well being.

According to the Health Resources and Services Administration, there will be a shortage of 20,400 doctors in the United States by the year 2020. Each year, we add six physicians to that shortfall. In Toledo, this gap is felt acutely. It commonly takes three months to schedule with a primary care provider, if a provider is taking new patients at all. For over 40 years, WW Knight has trained high-quality physicians, 65% of whom practice in the local community. Our residents and alumni care for tens of thousands of people in this region, and yet more is still needed.

Unfortunately, it has been decided that WW Knight should be shut down. Our current intern class, scheduled to graduate June of 2019, will be our last. We were told that the program, at this time, does not meet evolving community needs. On paper, our residency does not look profitable. While that loss is significant, we do not believe it captures adequately our value to the community. We provide a safety net for thousands of people who, bluntly, would have difficult time finding another provider in an already overtaxed system. At this time, we do not know what will happen to them.

We empathize that healthcare is a business, and a difficult one at that. We cannot, however, accept termination of our residency as a sustainable solution to this quagmire. Family Medicine is the foundation of American health care. If the base of the pyramid is weak, the entire structure is at risk. Although we face an uncertain future, our present is simple: We will continue to work and fight for our patients. We will continue to provide outstanding and compassionate care.  We will do so until they shut our doors. Our specialty is people. We are Family Medicine.

#SaveToledoFM - Katie's Story

In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

Katie Karhoff, DO is a recent graduate of the program. She reached out to me to share her perspective as an alum. My questions are in bold below. Here is Katie's story, in her own words...

1) My first question is about Family Medicine in general. How did you come to choose Family Medicine as your specialty and residency? Why do you love Family Medicine, and why is Family Medicine care important to the Toledo community?

I chose Family Medicine so I could be involved in all aspects of patient's care and could care for them across the lifespan. I didn't want to focus on just one area because to me the whole person was important. I love the personal connection I have with my patients and now that I've been an attending for 3+ years, I have really gotten to know my patients and it's almost like seeing a friend when they come in for a visit. I love that I have sometimes three generations of families that I care for. I love that they refer to me as "their doctor." As whole, the WWKnight residency plays a huge impact in Toledo. We would often care for people who might not have primary care otherwise, and I can only see a negative if the program is closed.

2) Tell me (and my audience) about how you learned about the closure of the program?

I learned the news through a Facebook post of another graduate of the program. I am a 2013 grad of the program.

3) What has been the reaction to the announcement from the residents and the faculty at the program?

I'm still friends with a lot of the staff, and I know they are heartbroken. Some have worked there for many years and have cared for the same patients for quite a while. The whole program is like a family and to close it would be devastating.

4) In your opinion, why is it important for the Toledo Hospital (WWKnight) Family Medicine Residency Program to remain open?

The program focuses on training competent, well rounded Family Physicians. Coming out of residency, I felt very equipped to handle so much on my own. We get a great breadth of educational training at a tertiary care center, and can take this knowledge to smaller towns that way, we don't always have to send our patients elsewhere. As I stated above, the community that the residents care for might not have access to primary care otherwise, so they provide much needed care. Many of our grads stay in the Northwest Ohio region, so if the residency would close, I'm not sure you would still see that same statistic. With a shortage of primary care physicians, we need to keep the caliber of doctors in the state.

5) What kind of response would you like to see generated from the local community, the residency program alumni, and the Family Medicine community in general?

As an alum, I was heartbroken to hear of the closing. Being established for over 40 years, I have never thought a program of that caliber would be closed down. It was a highly sought after residency and we had so many applicants each year and had no problem filling the spots for each class. I have nothing but respect for the attendings I trained under and still keep in contact with many of them. I really feel like my education was top of the line and think it would be a shame for this program to no longer exist. I really hope that all of our efforts can raise awareness and perhaps a better outcome will happen for this amazing program.

#SaveToledoFM - OAFP President Speaks Out

In a previous post, I reported the impending closure of the Toledo Hospital Family Medicine Residency Program which will have huge implications in the delivery of primary care and Family Medicine in that community.

Ryan Kauffman, MD, FAAFP, President of the Ohio Academy of Family Physicians (OAFP), issued a statement on January 16, 2017 entitled, "ProMedica Toledo Family Medicine Residency Should Not Be Closed When We Have Shortage of Primary Care Physicians in Ohio." The statement follows:

"It is most disturbing to hear that ProMedica plans to close its Family Medicine Residency Program at Toledo Hospital at at time when we have a shortage of primary care physicians in Ohio.

According to the Robert Graham Center for Policy Studies, Ohio will need an additional 681 primary care physicians by 2030 based upon changes in the number and age of the population of Ohio.

We know without a shadow of a doubt that a strong primary care-based health system leads to better health, better care, and lower costs. Evidence shows that access to primary care helps people lead longer, healthier lives. In areas of the country where there are more primary care physicians per person, death rates for cancer, heart disease, and stroke are lower and people are less likely to he hospitalized. Adults in the United States who have a primary care physician have 33% lower health care costs.

ProMedica's claim that the decision was based on national trends shifting Family Medicine residency programs from large, tertiary care medical centers to community hospital settings seems disingenuous given their decision just over two years ago to close the Family Medicine residency at Flower Hospital, which is a smaller community hospital.

Granted residency slots for primary care don't generate the money that subspecialty residency slots generate. Therefore, subspecialty residency slots are favored. Nevertheless, we should be producing the types of physicians that meet population health needs, not the ones that are going to make the most money for the hospital system.

The bottom line - patients who have access to primary care, experience better health and better care at lower costs. It makes no sense to close a Family Medicine residency program when we have a shortage of primary care physicians in Ohio."