President's Page

President's Page
December 2004

Uncertain Future:
Continuing to fight the good fight

by Warren E. Lichliter, MD
2004 DCMS President

As I write my last column of the year, the uncertainties of the future are around every turn. The Dallas County commissioners court has just received the final report from Health Management Associates, the firm it hired to analyze Parkland's role and future in North Texas. The Texas Legislature goes into session in January, and many of the issues affecting medical care and our practices-the Board of Medical Examiners, the Medical Practice Act, Medicaid funding, workers' comp-are now up for review. As predicted, lawsuits across the country are challenging the gains made in malpractice reform. These are the very topics our county medical society has been dealing with throughout the year, and because nothing in the legislative process changes quickly, these are the topics you will see Les Secrest address in this column next year.

There is a pressing need for Dallas physicians to be aware of issues related to Parkland, UT Southwestern, and their relationships with the rest of our medical ecosystem. The demand on our region's healthcare delivery system for the uninsured population has placed the county commissioners in the unenviable position of either raising taxes or cutting services at Parkland. Although some continue to believe that running a tighter ship is the answer, this simply is not reality. You can only tighten the belt so many times before you have to call it what it is-cutting services.

As an outgrowth of that dilemma, the commissioners hired HMA to analyze and make recommendations on sustaining Parkland's mission. This analysis has illuminated many potential problems at Parkland and its ongoing and future relationship with UT Southwestern Medical School. The commissioners recently rejected the school's request for a $20 million increase in its 2005 funding from the county, largely because of their desire for better information on the actual costs of the school's services and because the HMA study was incomplete.

With release of the study results, many Dallas physicians are concerned that the school has profited in its contractual relationships with Parkland or at least that the school has no real idea of its actual costs. This has caused the school's leadership to worry whether the commissioners or public will conclude that a real reduction in the county budget to cover the school's clinical responsibility might be warranted. In response, the medical school has indicated that without adequate reimbursement, it may have to reduce contracted services, which again has raised the specter of Parkland patients flooding other area facilities.

In addition to the pressure for more accountability and a review of the relationship between the school and Parkland, there is increasing concern-largely unreported and not discussed publicly by the medical community-that the long-standing, healthy "town and gown" relationship between the medical community at large and UT Southwestern is at risk. Because of decreased graduate medical education funding, increased difficulty in obtaining grants, and lowered reimbursement for all medical services, UT Southwestern has looked at expanding its clinical services as a way to maintain or increase faculty income. UT Southwestern has taken over St Paul Hospital to expand its clinical delivery in the private medical community. The school has announced plans to develop a major oncology center in North Dallas, surrounded by all of the major Dallas health systems. UT Southwestern's faculty leadership has publicly stated that its future income depends on private practice.

This has caused the medical community to wonder if Parkland still holds a place in UT Southwestern's future. In the last 60 days, St Paul and Zale Lipshy University Hospitals have been designated as state hospitals, like MD Anderson. Although UT Southwestern did not request state funding, it has the potential to impact future state funding and current operations. Does UT Southwestern want to increase competition with existing delivery systems? Does it intend to decrease its services at Parkland and push the care to the rest of the community? Is it trying to do this while being reimbursed favorably because of its state and county funding?

This unrest comes at a time when the entire community needs to be working together to solve the issues of Parkland, the uninsured, and the future of medicine in North Texas. Your DCMS executive committee has discussed these complex problems and is developing an agenda to help solve these issues. Dallas enjoys a national and international reputation for its excellence in medical education, research, leadership, and care that has been created through the work of all of our institutions and physicians. To maintain this reputation, we need the continued success of Parkland, UT Southwestern, and the medical community. None of us would benefit from the failure of any of these entities, and this message must be clearly articulated to the county commissioners, UT Southwestern, and the medical community, which is waiting expectantly for long-term answers. Your medical society's involvement with these issues over the past year will help facilitate that discussion.

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