DAYBREAK - UC, Stanford Consult with Faculty Leaders in Merger Review

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1st appeared 12 October 1999

UC, Stanford Consult with Faculty Leaders in Merger Review

With a proposal on how to proceed with UCSF Stanford Health Care expected in a few weeks, officials want to know whether faculty are committed to making the merger work.

UC President Richard Atkinson and Stanford University President Gerhard Casper requested their respective staffs to reassess the merger so that each university could meet its public and private missions and benefit from consolidation opportunities.

At UC, a team headed by William Gurtner, systemwide vice president for clinical services development, has been exploring three options: whether to maintain the merger, dissolve it or modify it.

The merger review was expected to be completed by Oct. 1, but it is taking more time now that faculty have been asked to "raise and address those issues that may be critical to achieving faculty integration," according to a joint statement issued Oct. 1 by UC and Stanford.

After consulting with faculty, the universities will finalize their independent and joint reports and expect to make recommendations to the UCSF Stanford board within the next several weeks.

The UC Regents Committee on Health Services will hear an update on the merger on Thursday, Oct. 14 at Laurel Heights.

Meanwhile, UCSF faculty and staff continue to work on a plan for the smooth transfer of inpatient services and emergency services from Mount Zion to the UCSF Medical Center on Parnassus. It's expected that a plan and timetable will be presented to the UCSF Stanford board at its Oct. 22 meeting.

Originally proposed by UCSF Stanford administrators, the plan to focus on outpatient care, urgent care and ambulatory surgery at Mount Zion was reluctantly endorsed by UCSF School of Medicine faculty leaders last month. Facing losses of $86 million on a $1.5 billion budget, UCSF Stanford will update the status of its overall recovery plan to cut $170 million in expenses, in part by reducing 2,000 jobs across the system at the Oct. 22 meeting.

Measuring Faculty Support

Getting faculty leaders to support further integration of clinical programs beyond the successes achieved in pediatrics is seen as critical to the success of the merger. The state audit report, released in August, was an independent confirmation that during its first 18 months UCSF Stanford has been unable to achieve expected clinical and fiscal benefits due to failure to fully integrate faculty.

At the Regents’ meeting last month, Regent Tom Sayles asked if the faculty has the "will" to make the merger work. Regent Meredith Khachigian, chair of the Committee on Health Services, noted that the success of the merger hinges on faculty cooperation. "It can't work from the top down. It has to work from the bottom up."

But measuring faculty desire to continue the merger is difficult. Prior to the merger, only a handful of UCSF faculty members voiced opposition to the deal. Today, some faculty remain committed to making it work, as long as it does not erode the quality of care, research or teaching. Few have publicly denounced the merger or called for its dissolution.

Lawrence Pitts, professor of neurosurgery and chair of the Academic Senate, acknowledges faculty frustration at the "poor management" at UCSF Stanford over the past 18 months and little input from faculty ‘rank and file’ in decision making. He says the Academic Senate is now trying to enlist the faculty to help UCSF Stanford regain financial stability.

"The faculty recognizes that the problem has several ‘faces’ that make solutions difficult," says Pitts, referring to managed care and poor reimbursement rates. "With or without the merger, we must try to reduce costs as far as medically safe and appropriate, and must try to design and conduct programs that will make patients want to come to UCSF Stanford. The institutions must be fiscally sound to allow the faculty to continue their historically important roles of excellence in teaching, research and patient care."

Neal Cohen, professor and vice chair of anesthesia and chair of the School of Medicine's faculty council, says that although the faculty is disheartened, he believes that faculty "will do whatever is necessary to allow UCSF to continue to be a premier academic medical center.

"But," Cohen says, "we want to know that the leadership understands and appreciates UCSF's academic mission. They need to know what has worked in the past at UCSF: That faculty, hospital administration and University administration work together to find solutions, and solutions are not imposed on us."

Asked if the success of faculty integration of children's health services could be replicated in other areas, Lee Goldman, acting vice chancellor for medical affairs, says yes.

However, he says, virtually all efforts to integrate clinical services were frozen when news of UCSF Stanford’s financial losses diverted faculty attention. "My guess is it will take time to get those [integration initiatives] started," he says. "I do believe we'll be able to get back on track."

Goldman noted that besides the financial incentives that have prompted collaboration in pediatrics, namely financial help from the Lucile Packard Foundation, it’s not surprising that pediatric clinical integration is further along than adult services. In children's services, UCSF and Stanford's only major competitors were each other, he said, whereas UCSF Stanford’s adult services also must compete with other local hospitals. "Therefore, our ability to make internally focused decisions regarding consolidation is limited," Goldman says.

Still, Goldman believes UCSF Stanford faculty, given time and fiscal incentives, can integrate adult services if academically appropriate.

Asked about the additional obstacle of commuting the 37.5-mile distance between San Francisco and Stanford, Larry Shapiro, professor and chair of pediatrics, noted that faculty have used videoconferencing for weekly meetings and field diagnoses. Only a few pediatric faculty have to travel to both sites to see patients, he said. Some have made other arrangements. For example, an electrophysiologist, who was jointly recruited, has made his home in Burlingame, Shapiro noted.

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