Now there’s a title that can lead in many directions! In the last three decades few hospital systems have undergone the growth spurt that we have witnessed in Roanoke. Some had their origins back in the era of W.H. (Ham) Flannigan; others are so current they are on the front page almost daily. It was Mr. Flannigan’s foresight that set the stage for the huge enterprise that we have today. A half century ago, he began purchasing real estate for the hospital. He had the vision that someday, Roanoke Memorial would need it; he was certainly right about that.
When Carilion announced some years ago that they were giving 25 million dollars to start the Carilion Biomedical Institute, many wondered what they were thinking. Today, it’s still not clear what happened to that organization. It may well be involved in its original purpose of developing biomedical ideas that are marketable; if so it has maintained a very low profile. Perhaps it will find a renaissance in the near future.
As the purchasing of primary care practices by Carilion grew during the 1990s, the handwriting on the wall was still somewhat murky but the fear that referral sources to the specialists would be cut off seemed unwarranted. Carilion had no specialists in their system so those in a referral practice felt secure. That has changed radically. There are more than 600 physicians in their employ and many of them are well-qualified specialists.
Now we have the integrated practice model—aka The Carilion Clinic. When that idea was first presented, it came as a surprise to, not only the private physicians in the area, but also to a highly placed board within the Carilion system. It has been suggested that conferring with those who had spent a lifetime in practice here might have made the launching of the concept a little less tumultuous. Carilion’s reasoning may have been it would be easier to get forgiveness than permission from the specialists. That has proven so.
Early TV spots suggested that the area had been suffering with substandard medical care for years; the Clinic would eliminate that. Hackles were raised, long years of collegiality evaporated, and fears of what was yet to come quickly surfaced.
It wasn’t long before angry accusations from private practitioners led to activists groups who opposed the Clinic model. It was a classic case of, “Where does the gorilla sit?” “Wherever it chooses,” is the answer. The gorilla did not sit, but continued to march along with plans for a new medical school and multi-million dollar clinic building, a hotel (privately financed), and other as yet to be disclosed plans.
It has become apparent the independent practice model, particularly for the primary care physicians, is doomed. It is going the way of the house call; my generation received much criticism for abandoning that time-honored tradition. It was too inefficient to survive. My hat is off to those few practices trying to surf this juggernaut of a wave. They will be the last of their breed for a variety of reasons.
Now Carilion faces the charge that there is pressure for their physicians to refer internally, that is, to other Carilion physicians. That contention has found its way into the courts. While Carilion insists there is no such policy, as one who spent 30 years in a referral cardiology practice, that’s how the system works. Carilion does not need to state the policy; physicians refer to those with whom they work on a daily basis, particularly if they have a common institutional interest. The Clinic has positioned itself to do that quite well. An important offshoot has been the strengthening of Lewis-Gale and their allies; they have responded to the increased competitive pressure from Carilion with expansion plans of their own.
Take a drive down Reserve Avenue and then tell me you’re unimpressed by what you see. The courts will decide whether Surfaces, the only business still standing, will survive. I hope the owners will be treated fairly, but anyone who thinks that shop will be there in ten years hasn’t kept up with the history of medical development.
In five months the inaugural class of the medical school will arrive. It will mark the beginning of a whole new era in higher education for southwestern Virginia. Carilion has created thousands of jobs, invested hundreds of millions of dollars in the community and capitalized on the vision of Mr. Flannagan. There are numerous conflicts yet to be resolved. I hope they will be approached in an open-handed manner by all who are involved.
We all have an investment in seeing this enterprise succeed. Those of us who have spent our professional lives in this medical community still have one thought in mind: We strive for the best medical care for everyone. Those in private practice still believe that; in my judgment, Carilion believes it, too.
Change is hard and there will always be those who, like me, originally opposed the integrated clinic concept. I believe the time has come to help them succeed as well as support viable competitive options.
By Hayden Hollingsworth [email protected]