How St. Vincent's Doctors Coped with Loss of Hospital
This is the second of a two-part profile on Dennis Greenbaum, M.D., former chief of critical care medicine and chair of St. Vincent’s Hospital’s department of medicine. In Part One, Dr. Greenbaum offered his post-mortem on the events that led to the closure of the 160-year-old West Village institution. In this installment, he discusses the fate of the former physicians.
As a doctor-turned administrator at St. Vincent’s, Dr. Dennis Greenbaum experienced and saw up close the emotional toll exacted by the demise of the hospital. Reactions between these two groups tended to fall into two categories, says the doctor. “One was that people became really depressed — this was very much like a death in the family.” Dr. Greenbaum lost 20 pounds after the hospital’s closure was announced; another administrator lost 25 pounds. “The other major emotion you saw was that people became very angry,” he adds. The situation was complicated by the fact that while there is plenty to be angry about, the tangled and somewhat murky causes of the hospital’s death make it less clear-cut who the real culprits are, Dr. Greenbaum notes.
Suddenly unemployed doctors formed two separate Google groups for physicians to share job information and career updates. Dr. Greenbaum receives updates from each group several times a day and says he is still writing letters of recommendation for job-seeking former colleagues.
Contrary to expectations, it was the hospital’s staff physicians who had the easiest time finding new positions. Six practice groups were picked up by other hospitals. One exception was a Chinatown multi-specialty staff burdened by the high rental cost of its Elizabeth Street clinic. Practices housed on 14th, 24th and 52nd Streets, however, “went seamlessly,” says Dr. Greenbaum, its members’ salaries absorbed by their new overseeing hospitals. Most of those picked up were general medical teams, although there were specialized groups as well. The hospital’s highly regarded HIV-AIDS practice, for example, was snapped up and divided between Mt. Sinai Hospital and Continuum Health Partners. For existing hospitals, “It was an opportunity to pick up functioning practices, infuse them with a modest amount of capital and improve the efficiency and financial viability of the practice,” says Dr. Greenbaum.
In contrast to St. Vincent’s staff physicians, it was private practitioners — those who had their own practices and admitting privileges at St. Vincent’s — who had a harder time, even though they were part of the hospital’s referrals base and accounted for over half of the hospital’s inpatient population. Many of these doctors had developed important referral patterns and worked closely with different practice groups; at their new hospitals, they lost any unofficial standing they had accrued at St. Vincent’s.
Even before St. Vincent’s closed, however, its medical department was hurting. Although Dr. Greenbaum’s former practice group, critical care, was profitable, he says it could have been more so if the 2000 merger of the hospital with six other Catholic hospitals had not occurred. The merger, which created St. Vincent’s Catholic Medical Center (SVCMC), drained the West Village hospital’s $200 million cash reserve. As SVCMC’s debts mounted, St. Vincent’s staffing suffered, and physicians spent less time taking care of patients, reducing both efficiency and profits.
“One problem,” says Dr. Greenbaum, “is that [St. Vincent’s] tried to provide a large number of services with limited resources.” For example, cardiac surgery is very expensive to manage, requiring highly qualified staff and equipment. “It’s a very expensive proposition. If you’re going to pursue that initiative, you’re going to take resources away from other programs.”
Although specialty programs can be hugely profitable, the problem with cardiac care was that improved coronary heart disease prevention measures have dramatically reduced the number of cardiac patients in all hospitals. Managed care reimbursement rates, meanwhile, began to reward volume over quality, hurting smaller hospitals and specialty groups. Many of these problems were not specific to St Vincent’s, but the timing of their onset exacerbated an already dire financial picture.
“At this point, the damage is done,” says Dr. Greenbaum. “Even if a new hospital opened and they hired new specialists, you wouldn’t know if they can work together.” St. Vincent’s practice groups, some of them based on relationships decades old, will not form the structural base of a new institution. Dr. Greenbaum cites the dramatic 1997 case of Jane (“Saint Vincent’s Save My Life: Jane’s Story,” WestView, Oct. 2010) — in which doctors’ rapid response helped save a young West Village woman’s life after she was suddenly attacked by bacterial meningitis — as an example of the importance of such relationships.
He was at his home on 13th Street that night in 1977 when Dr. William Mandell, a St. Vincent’s infectious diseases specialist, called him, Dr. Greenbaum recalls. He went immediately to the emergency department, “because I know when Bill Mandell calls me, it’s serious.” Greenbaum’s critical care group had worked together for eight years when Jane’s crisis occurred, and remained “essentially unchanged” for another 13 years until the hospital closed; the fact that members knew each other so well and trusted each other enabled a level of speed and efficiency that a less seasoned group could not have hoped to approach. The critical care group Dr. Greenbaum formerly headed is now at Lenox Hill Hospital. “At least they are together and can make a difference there,” he says. “They are superb physicians.”
St. Vincent’s demise also meant the dissolution of some “very highly competitive fellowship programs in critical care, cardiology and oncology,” adds Dr. Greenbaum. There were 25 fellows in cardiology and five in critical care, programs that have so far not been revived at other institutions.
From a personal perspective, Dr. Greenbaum, who hasn’t practiced critical medicine for ten years, says, “I can’t go back to practicing that specialty — a lot has changed in those ten years. I’m not as marketable as a younger person or a physician with an established private practice.” He adds, “I left home at six-thirty every morning and returned at seven-thirty at night — I spent more than half of my life at St.Vincent’s…losing it is like losing a family. Regardless of what I end up doing, one thing is certain — things are never going to be what they were before.”