You are one of a small number of surgical faculty members who regularly staff resident physicians in caring for patients with otolaryngology-head and neck disorders in an inner city clinic. You believe you are providing care for patients who otherwise would not have the opportunity for care: Many are homeless, unemployed, economically disadvantaged, or otherwise not eligible for health insurance. The patient population is quite diverse, owing to a large immigrant population that has increasingly occupied the inner city over decades. You and your colleagues offer a full range of otolaryngologic medical and surgical care, with the surgical procedures primarily performed at the health system’s main teaching hospital, which is not in the same location as the clinic.
Explore This IssueFebruary 2020
Over the past 50 years that this clinic has been in operation, medical students and resident physicians have been taught a great deal about caring for disadvantaged and impoverished patients, gaining an important appreciation for the challenges of caring for this population, as well as better understanding cultural diversity and managing language barriers. From an ethics perspective, it has provided an opportunity for trainees and faculty to “stoke” the fire of altruism, which hopefully played a role in their choice of medicine as a profession.
Unfortunately, you have just learned that the national healthcare corporation that just purchased your not-for-profit community healthcare system has decided to close the clinic in a “cost-cutting” effort to reduce overhead and improve profit margin. They want to reduce the level of staffing throughout the system and cut any expenses that do not contribute toward a profit. Some of the clinic staff may be relocated to the main hospital facility, but others will simply lose their jobs. Medical students and residents will no longer be exposed to a diverse community of patients in need, who may have no other options for healthcare. To say you are “morally outraged” would be quite an understatement. You secure an appointment to discuss the situation with the executive vice president and chief operating officer of the corporation, and present the historical elements of the clinic’s community service, and the need to continue to care for these patients. They listen, but then inform you that they are “running a big business,” not a charity. They may investigate other options for the patients’ care in the community, but at this time it is not a working priority for them, so you need to “walk away from this issue.” Having provided care at this clinic for most of your academic career, you are frustrated beyond belief.
How would you handle this situation? Read more below.