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The white coats in WNY support hospital reform

Most of what we have heard in the last few weeks about the recommendations of the Commission on Health Care Facilities in the 21st Century has come from high-level administrators and physician leaders from the local hospital systems. Many of them occupy positions that would be made redundant and possibly eliminated if the recommendations were implemented. In evaluating their statements, this must be kept in mind.

I offer a different perspective, that of a white coat. My primary responsibilities are patient care in the emergency department and educating residents and students. We white coats in the trenches have nothing to gain or lose on a personal level whether changes are made or the status quo persists.

From where we white coats sit, the work of the commission represents a historic opportunity. Buffalo desperately needs one unified tertiary-care teaching hospital. We have heard statements from individuals and organizations that describe the excellent job done by their institutions and how essential they are to the community. While it is true that Buffalo has many excellent physicians and that there are a few outstanding hospital-based programs, across-the-board excellence is lacking.

Why? Primarily because of the dilution of resources that is a consequence of redundancy. Modern hospital care is very resource- and technology-intensive. To achieve optimum results, appropriate facilities, equipment, staff and a critical mass of qualified physicians from a large number of specialties is required. Our hospitals lack all of these to one extent or another. The reason is simple -- the necessary resources are spread out over too many programs in too many buildings.

Anyone in my position can see this every single day. It is a reality that at best results in inconvenience, frustration and extra costs for physicians and patients, and at worst in avoidable negative outcomes. This situation also makes medical education less effective and makes physician recruitment and retention more difficult.

In spite of being home to a large medical school with many postgraduate training programs, we have a shortage of physicians in numerous specialties in Western New York, and the shortage is getting worse. For many specialties, a primary factor in creating and perpetuating this shortage is the aforementioned lack of a hospital with a critical mass of resources.

The recommendation of the committee to merge the tertiary functions of Buffalo General, Millard Fillmore Gates and ECMC is thus just what the doctor ordered. Closing buildings to save money is not the key point; quality is.

We need to create a single tertiary referral hospital with a full range of medical and surgical services for patients of all ages. We need to do this and do it now. Otherwise, we will be witness to another process like the new international bridge, the development of the inner harbor or the coming of Bass Pro.

Richard S. Krause, M.D., of Williamsville is an emergency physician.

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