Close or Negotiate?
Published in The Journal Record
March 9, 2016
My wife and I love the television show, “Downton Abbey.” A highlight of our week is an early dinner on Sunday evening followed by the most recent episode of this English-based soap opera. One of the show’s current travails involves the takeover of the town’s local hospital by a much larger one in a distant city. The main opponent of these interlopers seizing control of the town’s medical institution is the Dowager Countess of Grantham played by Maggie Smith. The tension exists between her and her daughter-in-law over whether to keep the traditional hospital with its lack of sophistication but local control over the enhanced technology that a larger partner would bring.
This reminds me in many ways of the recent controversy over the debate in the legislature about school consolidation. For some having a school district with all its apparent duplication of costs serving less than 200 children seems parochial. This is exactly the trauma that many of our rural hospitals find themselves in today. Does the pride in their community and the allure of self-determination outweigh any benefit of collaboration with stronger and better funded partners?
Residents of our smaller communities understand the trade-offs they are making. Local control over their environment can be even more important that improvements in technology. Many rural hospitals were built after World War II and have operated for years on cash flow alone with no savings and a very small tax base. Their ability to improve their facilities and acquire new technology becomes very limited. As the plant grows old and less attractive their ability to recruit new physicians wanes. They often find themselves in a death spiral.
The dilemma in which many of our communities find themselves is the pride they feel in their local institutions. In some cases, the allure of more sophistication and the resultant loss of autonomy are in dynamic tension. This battle is raging all across rural United States with some communities blessed by favorable economics that are able to make the decision in their own time and at their own pace while other communities simply delay the decision until their poor economics overwhelm them. The result then is either closure or being forced to negotiate with a larger partner with relatively little leverage.