WHAT WILL BE -(2)

To continue on the changes in the health delivery system that are going to impact on our city’s future.

There are other changes in the relationships of doctor and patient. With the increase need to see more patients in a given day pushed by reduced reimbursement per unit visit; doctors have tended to have longer in office hours. They have also tended to become “8-5” doctors.

The Hospitals in their merchandizing all aspects of medicine have found that it was profitable to employ in hospital doctors; at first super specialist and increasing to all aspects of care. In some hospitals there were restrictions on outside physicians treating patients in the hospital.

PCPs and others found that including travel time it was less cost effective to see a patient in the hospital than in the office. With the hospitals encouragement more doctors turned their hospitalized patients over to a hospitalist.

There is no longer a real doctor patient relationship throughout all an illness. Moreover there is an increasing shortage of PCPs and certain specialists in many areas such as urban New Jersey. Part of the shortage of PCPs in group practice is met by use of Nurse Practioners and Pas. However good as many are their training does no equal by any means that of an MD or DO.

Taking the above into consideration and for the purpose of this paper I am not addressing the issue of physicians restricting the number of patients in their practice. This is a problem which will become more prevalent as the ACA impact is felt.

But we are discussing a new use of Muhlenberg’s property. I have heard many talk of a “Medical Mall”. I do not have any concept as I wrote in a previous blog what is meant. I also believe that those who speak of such a thing also do not have any true concept except in a flight of fancy.

The reality is that we are five years too late and as I wrote in the previous blog we missed any opportunity to obtain any replacement of even a part of Muhlenberg’s services.

To start from scratch a hospital will need a core of physicians; PCPs and Specialists who have restricted their in hospital care are not going to change for a local hospital.

If the new institution comes staffed for all problems the overhead will be unmanageable for prolonged period of time until doctors are willing send patients there and people are willing to go. 

At best the hospital could only serve short term (a few days) care of patients that do require exotic elective or emergency surgery.

That leaves the Mall to be composed of a walk-in facility or urgent care and a true emergency care facility plus doctor’s and ancillary services offices.

With the increasing shortage of practioners and the decreasing reimbursements, I find it unlikely for anyone to start an office in Plainfield with the already concentration of new office buildings in Edison and Warren/Watchung.

The above does not mean that we should not make an all-out effort to bring some profit oriented operation to replace JFK.