June 2001 • Volume 7 • Number 6
When one door closes ...
Rescue missions are nothing new to Janelle Goetcheus, M.D. As medical director of Unity Health Care, an amalgam of Washington's Healthcare for the Homeless program and two community health centers the federal government washed its hands of in 1995, she's well-suited for the role.
With the recent closing of District of Columbia General Hospital -- the district's first and only public hospital -- Unity Health Care will now add six more CHCs to that tally.
"This last year in the district has been very difficult in terms of public health," says Goetcheus, referring to the dissolution of the district's public health system, which ran the hospital and its six satellite clinics.
The decision to close the hospital and privatize health care for the city's poor and uninsured was handed down April 30 by the federal control board that oversees the city's financial operations.
Health services will now be administered by a consortium of private entities operating under a program known as the D.C. Healthcare Alliance Network. Inpatient care previously given at D.C. General will be split among several hospitals; outpatient services will be provided at the clinics.
The D.C. scenario reflects a growing national trend: Competition has forced mergers and acquisitions among many medical facilities, with public hospitals losing the most ground over the past two decades. According to the American Hospital Association, since 1999 -- the latest year for which figures are available -- the number of public hospitals was 1,197, down from 1,778 in 1980. That represents a 33 percent decrease. During that same period, the number of private facilities fell from 4,052 to 3,759, a reduction of only 7 percent.
The upshot? More and more uninsured patients are seeking care at community health centers, where health services are either free or based on ability to pay.
And who's providing those services?
"My hunch is that many of these community health centers nationwide are looking for family physicians to serve in both practice and administrative positions," says Goetcheus.
That's part of what led to the formation of a new administrative training fellowship sponsored by the Department of Family Medicine at Georgetown University in Washington, Unity Health Care and two other groups. FP Aviva Zyskind, M.D., is the first Health Center Director Development fellow. In that capacity, she works with Goetcheus in the UHC clinics.
"Family physicians are uniquely suited to work in community health centers because they're trained to see all types of patients," says Zyskind. "Also, many family practice residency programs emphasize caring for the underserved."
The need to expand the nation's network of community health centers is not lost on the Bush administration, which, in its 2002 budget proposal, has called for opening 100 new CHCs across the nation and expanding services at 100 others.
The irony is that the president also supports cuts in Title VII funding -- the very funds used to provide training for FPs and other primary care physicians.
"We need more primary care doctors," says Zyskind. "That keeps people out of the hospital. You have better quality of care and greater continuity of care. You have doctors who know the patients."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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