Forced to compete more aggressively and stretch limited graduate medical education dollars, teaching hospitals' longtime academic affiliations are breaking up as never before, spawning opportunities for new suitors.
A "strategic alliance" between Saint Barnabas Health Care System in Livingston, N.J., and New York's Mount Sinai Medical Center exemplifies the trend.
Under a letter of intent announced last week, Saint Barnabas Medical Center and Newark (N.J.) Beth Israel Medical Center will become teaching sites for Mount Sinai's School of Medicine, replacing the Barnabas system's splintered association with Newark-based University of Medicine and Dentistry of New Jersey. The two new partners also plan to evaluate clinical and managed-care opportunities.
Last month, UMDNJ unveiled a new graduate medical education consortium with Hackensack (N.J.) University Medical Center, Morristown (N.J.) Memorial Hospital and UMDNJ-University Hospital. Designed to pool educational resources and expose residents to multiple venues, the consortium "also allows us to build a healthcare delivery system" that could benefit from clinical referrals among participating hospitals, said Stanley S. Bergen Jr., M.D., UMDNJ's president.
Saint Barnabas Medical Center and Newark Beth Israel, its affiliate, were excluded from the consortium, but relations with UMDNJ had been rocky for a while. According to Barry Ostrowsky, executive vice president of the Saint Barnabas system, Newark Beth Israel received notice last June that its affiliation with UMDNJ would be discontinued. Saint Barnabas Medical Center received similar notice this June. The notices affected 250 allopathic residents.
Saint Barnabas executives had seen it coming. "When you're in a relationship, you get vibrations over time," said Ostrowsky, who blames the breakup on UMDNJ's anxiety over competition with Saint Barnabas.
UMDNJ officials had no immediate reaction to Ostrowsky's comment.
Ostrowsky said discussions with Mount Sinai began two years ago over the issue of geriatric medicine, a specialty of the venerable New York institution. "In the course of those discussions," he said, "we began to talk about graduate medical education.
"Actually, if you prune out of the equation the cost of housing medical students . . . (which haven't been quantified), this will be a less expensive teaching affiliation than the current affiliation with UMDNJ," he added.
While Ostrowsky said cost wasn't the driving issue, it will save some $100,000 to $200,000 annually. "The key is having the quality medical school relationship that we need to maintain our graduate medical education programs."
A definitive agreement, expected in 90 days, would build Mount Sinai's growing network of clinical and academic partners. The academic medical center already has a letter of intent to merge with New York University Medical Center (June 24, p. 24) and another to negotiate an academic and clinical relationship with Manhasset, N.Y.-based North Shore Health System.