Charlotte Magazine / Charlotte Magazine July 2007 / Diagnosis Charlotte

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Diagnosis Charlotte

Rising costs, two dominant hospital systems, no medical school—just how healthy is the state of healthcare in the Queen City? We talked to local physicians to find out

 

I was on my way in to start my night shift in the ER. Driving past the main door, I saw groups of people milling about, and the parking lot was full. It looked like it was going to be another hectic night—business as usual. Sure enough, as I walked in, there was shouting, and people were hurrying in all directions.

My first patient of the night was a six-year-old with a sore throat. "Don't you have a primary-care doctor for your son?" I asked his mom.
"No, doctor," she answered. "We can't afford health insurance."

Next up, a forty-one-year-old female who'd twisted her ankle—four days earlier. Same story: no insurance. "Doctor, why did I have to wait four and a half hours to see you?" she wanted to know. Next was a twenty-three-year-old pregnant woman with fever and a cough. So far, every one of these patients could have been seen in a primary-care office—if they could have afforded it.

Just about then, a nurse grabbed me and said, "I think you should go into room eight. Abdominal pain, getting worse." The patient, a twenty-one-year-old male, had been experiencing progressively worsening pain for the last twelve hours. It had just hit a "ten out of ten." After getting history, I put a hand on his belly: Severe tenderness right lower quadrant. Uh-oh. Sure enough, a stat CT revealed a perforated appendix, a true emergency. After immediate surgery and a complicated closure, the young man was all right, but he ended up having to spend a full nine days in the hospital, and has an ugly scar to show for it.

The preceding tale was recounted by Marc R. Lewin. He has since left that area hospital for family practice at Carmel Family Physicians. To Lewin, a native of Toronto who earned his early stripes working in Calcutta with Mother Teresa, no less, America’s insurance crisis came as a culture shock. “We have national healthcare in Canada,” he says. “You can see any doctor you want to see.”
Like many, Lewin found himself frustrated by a growing juggernaut of nonurgent patients overwhelming a system that was never meant to cope with them in the first place. “If that young man hadn’t had to wait so long to be seen by a doctor, we might have been able to prevent the perforation and the complications,” he says. “The fact that a lot of uninsured people need to use the ER for their primary care is a huge problem, but often, they don’t have much choice.”

Of course, overtaxed emergency rooms aren’t endemic to Charlotte. But they are symptomatic of one of the biggest challenges facing Charlotte healthcare: growth. Charlotte’s population has skyrocketed over the past two decades. Current census figures place the population at more than 664,000; by 2017, that number will be at more than 950,000. With that growth has come a high number of uninsured patients, particularly as the city becomes a destination for illegal immigrants.

There are other challenges, too. The lack of a medical school lends too much of a corporate, dollar-driven mentality, say some physicians. Others point out that the competition between Carolinas HealthCare and Presbyterian Healthcare isn’t always healthy.

Still, overall, this is a pretty good place to be if you get sick. With a patient base that boasts a core constituency of high-per-capita income, insured residents, Charlotte has been able to attract and support more than its fair share of physicians and medical practices, including those in high-insurance risk disciplines, such as obstetrics, which in other parts of the country—and even the state—are disappearing faster than you can say lawsuit. 

Double-Edged Healthcare?

Charlotte’s unique medical landscape is dominated by two competing healthcare systems: Carolinas HealthCare System and Presbyterian Healthcare System, the latter a subsidiary of Winston-Salem-based Novant Health. Many physicians claim that Charlotte benefits from the presence of the two systems. But to a vocal contingent, this Godzilla-versus-King Kong scenario fosters an unhealthy competition in which doctor-patient relationships are sacrificed in the name of the bottom line. The result? Out-of-system referrals dry up. Doctors who were once self-sufficient have evolved into employees, now beholden to the employers that own their practices. Less-lucrative specialties have fallen by the wayside—all prescriptions for less than optimum care.

J. Bruce Taylor, an OB-GYN, feels that the rivalry “fractionates the medical community.” Taylor completed his residency in Richmond, Va., and has worked in Charlotte for the past twenty-nine years. His practice has been owned by CHS since 1992. “My perspective has been skewed by that relationship,” he admits, “but since the introduction of managed care, and with the OB liability crisis, more and more practices have been driven into corporate medicine.”

This concept of doctors being “owned” by the hospitals that employ them is a recurring theme among physicians. “It’s the way things are moving,” says surgical oncologist Peter Turk, who practices out of the independent Carolinas Surgical Clinic. “It’s definitely an evolution.” Turk admits that if you are not “owned” by one of the major hospital groups, you can sometimes find yourself out in the cold. As a specialist, Turk notes that his referral base has changed over time. “I’ve been in Charlotte fourteen years,” says the Brown University-trained surgeon, “and I’ve always enjoyed a good referral system and interaction with referring doctors. With this splitting between one hospital and another, I’m not seeing the same referrals [as I used to], because now that they own more surgeons, there is a pressure within the hospitals to refer inside their own group.”

“We now have two healthcare systems,” Taylor says (see sidebar for a side-by-side comparison), “which I guess is good for the patients who have the opportunity to pick and choose what they feel is the best from each, but the negative is that you end up with physicians who have historically been very collegial in this environment [who no longer know one another]. When I started practicing medicine here, I knew physicians all over the community because I interacted with them. That does not occur anymore. Basically, the Presbyterian doctors refer to their colleagues, and the CHS doctors refer to colleagues at CHS. The few folks who are independent get what’s left over. Patient care can sometimes suffer as a result of this lack of communication.”

Psychiatrist V. Sagar Sethi, author of Solving Psychiatric Puzzles, was born in India. He received his undergraduate and master’s degrees in pharmacy from Banaras Hindu University, India, and went on to earn his PhD in pharmaceutical sciences from Munich University in Germany, where he graduated magna cum laude. At fifty, he received his medical degree while in Mexico, followed by four years of residency training in psychiatry at Creighton and Nebraska universities in Omaha and the University of North Carolina at Chapel Hill. Sethi has been in Charlotte for more than sixteen years. While he says he loves the town and feels blessed to be here, he says he has found maintaining an independent practice difficult. “We only have two camps that compete pretty fiercely, and they always want to use their own people,” he says. “When you are an independent, your name doesn’t come up, no one invites you to lecture. It’s all very politically motivated. At least, that’s my impression.”