Come Back, Baby Docs! Big City-Hospital Plans Stop Pediatric Exodus

In an elegantly appointed apartment on East End Avenue, Dr. Spencer (Spike) Foreman, the dapper president of the Montefiore Medical Center, stood to make a sales pitch to a rapt and well-dressed audience. The new Children’s Hospital at Montefiore, he explained, would be doing God’s work in providing high-quality medical care for ailing children in the Bronx and elsewhere. “If you can’t get excited about this project,” added the veteran physician-executive, “health care is just not your bag.”

Before the night was over, most of the dozen or so guests had introduced themselves to Dr. Foreman and three of Montefiore’s other star physicians, offering to help pay for the hospital’s state-of-the-art design endowment and operation. Such efforts have helped sustain Montefiore’s furious pace of fund raising, which hospital officials estimate will put them in a position to cover the new facility’s $124 million price tag eight to 12 months before its opening ceremony, scheduled for September 2001.

Even as Montefiore’s top officials were making their pitch, the management of Manhattan’s New York Presbyterian Hospital was busy with its own drive to build a new version of the famous Babies and Children’s Hospital in Washington Heights. Back in 1997, top officials at the hospital had vowed that the new Babies and Children’s Hospital would open its doors by the end of 2000, replacing the aging buildings that house the current version. The project received the approval of the state’s Department of Health, and everything seemed set. But over the ensuing two years, grave financial problems and a high-level internal shakeup-coupled with a sudden absence of news about fund raising-had children’s health advocates mourning the project’s premature demise.

Last July, however, in the midst of all the publicity surrounding Montefiore’s project, New York Presbyterian quietly submitted plans for a more expensive proposal that the state approved in mid-October. And now, New York Presbyterian officials are preparing to announce yet another multimillion-dollar gift for the new Babies and Children’s Hospital, which puts them more than halfway toward their $120 million fund-raising goal.

The mad dash to open two big medical facilities for children within six miles of each other belies a national trend that has seen a slowdown in the construction of children’s hospitals, and underserved children may be only part of the reason for the building boom in New York. According to many experts, New York’s lack of modern hospitals for children-Philadelphia has three such facilities while having fewer people than New York has children-has caused an exodus of highly skilled pediatric subspecialists to other cities. Babies and Children’s Hospital is one of just two children’s hospitals currently operating in the city, the other being the Schneider Children’s Hospital on the Queens-Nassau border.

Most of the departing subspecialists had trained for six or more years in local teaching hospitals, and they are extremely difficult to replace. The new hospitals hope to offer them a chance to practice with the latest equipment among an all-star selection of their peers.

“Subspecialists do practice and aggregate within specialty children’s hospitals, and you do need [those facilities] to attract them,” explained Lawrence McAndrews, president of the National Association of Children’s Hospitals. “I think that if you don’t have the place for those physicians to practice high-quality medicine, then you won’t be able to get or hold on to that volume of subspecialists that you need.”

An example of the type of professional that hospitals are hoping to entice is Dr. Greg Crooke, a pediatric cardiac surgeon who went to Montefiore two years ago from the Children’s Hospital of Los Angeles. “The Children’s Hospital was a tremendous factor in my decision,” he said. “It means that Montefiore is going to become a focal point in Manhattan, the Bronx and Westchester, and once you do that, you can build up a staff with a lot of pediatric specialists. That gets you lots of cross-referrals and just brings patients your way. It gives people a lot of options within the industry.”

The enthusiasm being shown by Montefiore and New York Presbyterian to recruit and retain subspecialists like Dr. Crooke is understandable. Pediatric neurosurgeons and urologists are examples of other subspecialists who are in extremely high demand and can often attract lucrative referrals from all over the world that result in reimbursements of at least several thousand dollars. Judging by initial indications, these stars of pediatric medicine are starting to think twice before leaving New York or remaining in smaller cities.

Doctors Are Impressed

An official of New York Presbyterian said that the children’s hospital had attracted no fewer than 32 subspecialists over the last two years. “I’m sure we would not have been able to attract such talented and outstanding people” without the plan to build a new facility, said Cynthia Sparer, the executive director of Babies and Children’s Hospital. The president of Montefiore’s children’s hospital, Dr. Irwin Redlener, estimates that his department has lured 20 subspecialists to join his staff since the hospital announced plans for the new facility in 1997, and he said that three more could be on the way. “All of the doctors recruited recently were sold on us at least in part because of the new building,” Dr. Redlener said. “When there is a competitive market, a pediatric subspecialist will choose to work in a children’s hospital rather than a general hospital.”

Industry watchers said the planned new facilities are long overdue. “There’s not much in the way of distinctive pediatric buildings in New York,” Mr. McAndrews said. “They’re meeting a very real need if these hospitals increase their focus on pediatrics.”

But the apparent mini-boom represents something of a gamble for the two facilities. The new pediatric hospitals are not expected to become financially self-sustaining any time soon and will be dependent for the foreseeable future on the generosity of wealthy benefactors and, in Montefiore’s case, government-subsidized loans. The new facilities will have enormous day-to-day operating costs, with revenue limited by their relatively small number of inpatient beds. (The new Babies and Children’s Hospital, by far the larger of the two, will have 172.) “A combination of revenue and philanthropy can sustain these new hospitals, but it will require a lot of ingenuity to sustain those sorts of financial expenses,” said Dr. Philip Lanzkowsky, chief of staff at Schneider Children’s Hospital.

As the pace of fund raising continues to heat up, according to some pediatric experts, so will the competition between Montefiore and Babies and Children’s for donations, referrals and, of course, the crucial subspecialists. “They are really being very competitive,” said a pediatric specialist. “They are trying to draw from each other’s resources, trying to get the majority of these patients in the area and leave the other high and dry. It’s not very wise, in my opinion.”

And New York Presbyterian, which has endured serious financial and logistical problems since the 1996 merger between Columbia-Presbyterian and New York hospitals, has already taken severe hits to its traditional pediatric referral base from the increasingly advanced children’s facilities in New Jersey and northern Westchester, where Westchester Medical Center has a specialized facility of its own on the way. “They’re right to redo [Babies and Children’s Hospital], but they’ll have to be careful how grandiose it will be,” said Steven Shelov, chairman of pediatrics at Brooklyn’s Maimonides Medical Center who helped design the Children’s Hospital at Montefiore. “I think it’s kind of crazy that Westchester, Montefiore and Presbyterian are all building at the same time. No one can totally read the tea leaves, but my sense is that it’s a crapshoot.”

But others feel that if there is increased competition, it will not be at the expense of the new children’s hospitals, but of the more traditional pediatric wards that are housed within larger institutions. “It seems to be reasonable planning,” said Dr. Lanzkowsky. “It is not unreasonable for large population masses like the Bronx and Manhattan to have their own children’s hospitals. It may require other hospitals in the area not to provide care for children, but I am supportive of these new children’s hospitals even if it is competition.”

Dr. Redlener, for one, is saying that competition should be the least of anyone’s worries: “New York City has been an aberration with respect to children’s hospitals in the rest of the country. There are 400,000 kids in our immediate area, and I think even if there were two new children’s hospitals being built in Manhattan, we would still be able to keep our beds filled.”

Ms. Sparer, too, dismissed any notion of competition. Referring to talk that Montefiore’s building may be up and running ahead of schedule, she downplayed any sense of competition. “Is it nice to be first? Does it feel good to be first? Of course,” she said. “But it doesn’t change our plan or our determination to see this happen.”

Come Back, Baby Docs! Big City-Hospital Plans Stop Pediatric Exodus