The advantages of a proposed deal to make Our Lady of the Lake Regional Medical Center the Baton Rouge teaching hospital for LSU are obvious, such as better-maintained facilities and newer technology for patients, medical students and residents. But physicians at Earl K. Long Medical Center wonder how the Lake will manage to integrate medical training and treatment of poor patients in a community hospital setting.
Dr. Paul Perkowski, president-elect of the Capital Area Medical Society, said there are a lot of misgivings and misunderstandings about the process for physicians at both hospitals. There are lots of issues to resolve, he said.
For instance, will the Lake be able to maintain the high quality of education that medical students and residents now receive at Earl K. Long?
"That question hasn't been answered and that really is the biggest concern of doctors like us who train residents and medical students," said Perkowski, a surgeon with privileges at both Earl K. Long and the Lake.
There are a number of other questions, Perkowski said. Will residents feel as connected to the patients at the Lake since the patients will ultimately be the responsibility of a community doctor? Can the Lake's radiology department, nursing staff, and emergency room – already operating at high capacity – handle the influx of patients? Whose responsibility are those patients? Will there be different groups of doctors for LSU patients and the Lake's? How will that affect the LSU patients' care? Will insured patients take precedent over uninsured patients?
Physicians at both hospitals are in the dark, Perkowski said.
Meanwhile, officials at LSU and the Lake have said they would like to complete a cooperative endeavor agreement by the end of the year.
Dr. Richard Vath, the Lake's vice president of medical affairs, said the reason so many questions remain unanswered is that both sides began by taking "the 50,000-foot view" to see whether the collaboration could work in theory.
"What you hear now, I think, is a lot of anxiety about some of the details…and we haven't actually gotten into any of the details," Vath said. "We recognize the devil is in the details, but we have really remained at a very high level conceptually."
Both sides made a conscious decision not to address the impact on individual physicians, individual staff, and individual services, Vath said. The reason people are anxious about the proposal is that they believe the details have been worked out, when in fact they have not.
Vath said the shift from Earl K. Long to the Lake is such a large-scale endeavor that it could take two to three years to complete.
While many elements need to be worked out, the Lake has some definite ideas about how care will be provided, Vath said.
The Lake views the move as an opportunity to improve the access of patients and physicians in training to "best-in-class" technology and facilities, Vath said. There is no physician gap; it's just that Earl K. Long doesn't provide some services that the Lake does.
"As far as having those patients treated, it was very important to us that we actually offer the same benefit to those patients that we offer to our current patients," Vath said.
The LSU patients will not be segregated from the Lake's other patients, Vath said. If an LSU patient needs specialty care from, say, the orthopedic unit he or she will go to the orthopedic unit.
Vath said having academicians work side-by-side with community physicians is a great opportunity for both.
The LSU doctors would enhance the Lake's ability to keep up to date and push the envelope in terms of the academic knowledge base, he said. The Lake's physicians will give the academicians, students and residents the opportunity to learn some of the ins and outs of day-to-day medical practice.
"We saw it again as a nice complement that we would bring to each other," Vath said.
He also said graduate medical education fits well with the community hospital's mission.
There was a great deal of concern after Hurricane Katrina that there would not be enough physicians to treat patients, Vath said. The Lake's primary goal in entering into graduate medical education was to provide for physician training, to ensure that there would be a supply of doctors.
The current proposal calls for spending $129 million to build additional facilities on the Lake's campus.
Perkowski said LSU physicians would like to know that other options are being explored, such as expanding the former Vista outpatient surgery facility on Perkins Road or buying the existing Woman's Hospital when that hospital moves to its new campus.
"I think what everyone would like to see, at both facilities, is why this is the best plan, and why this is the only plan for graduate education and indigent care," Perkowski said.