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Amy Umble is health reporter for The Free Lance-Star

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Fred Rankin and a lesson from his uncle

RankinFred Rankin, left, the president and CEO of MediCorp Health System, has written and spoken publicly about many aspects of the health-care system. Last week during an interview, he recalled the holiday dinners where his father and uncle, both doctors, would debate the merits of hospitals employing doctors, and his own evolving opinion on that issue.

  The issue of whether patients benefit when doctors work for hospitals has been debated recently. President Obama has cited hospitals like the Cleveland Clinic and the Mayo Clinic, which employ their doctors, as models for the nation since they are able to provide high-quality care at a relatively low cost. On Saturday, a New York Times story described Bassett Healthcare in Cooperstown, N.Y., a 180-bed hospital which employs its doctors.

 Many doctors work at a hospital, but few actually work for the hospital. Mary Washington Hospital, for example, employs few of the doctors on its medical staff. Most doctors either own their own practices or work for a private practice.

 Rankin spoke last Wednesday, the day after President Obama’s press conference on health care reform. Below is the exchange between Rankin and me on the topic of hospitals employing doctors:

 Rankin: Who did the president comment on last night who’s got it right?

 Hall: Cleveland Clinic and Mayo Clinic.

 Rankin: And how are those doctors organized?

 Hall: Are they employees?

 Rankin: Every single one of them. Now, I’m not advocating that’s where we go. That’s not how the rest of America operates. Hey, my uncle spent his whole life at the Cleveland Clinic and swore on that. He was aligned with the Cleveland Clinic. My uncle was a gastroenterologist there. He believed wholeheartedly that, at the end of the day, that was the only way we were going to deal with patient safety and quality and cost at the same time.

  My dad was a private physician in Ohio. My dad and my uncle at Christmas time would get into enormous arguments. My dad would call my uncle a socialist, a communist. My dad, bless his soul, he’s dead now, but he was wrong. He was a good doctor, but my uncle got it right.

 Hall: But Fred, I’ve heard you argue against MediCorp hiring doctors.

 Rankin:  I’ve changed my mind. Over the last three-to-five years, I’ve become convinced that, in the end, the only long-term solution is to have doctors and hospitals integrated. Now integration can be many things. But where I’ve changed my mind is that employment is one of those integration models. Where I object is that the regulatory world has put so many barriers for hospitals to do economic deals, joint venture-type relationships. The window to do that has become so narrow that there is almost only one model left and that is employment.