Philadelphia Medicine Fall/Winter 2019 - 29

p h i l a m e d s o c .o rg

Sister Irene Kraus, a nurse who tended the sick, got an MBA
and eventually became the first president of the Daughters of
Charity Health System, is credited with coining the expression
"no margin, no mission." The bottom line is if you cannot cover
your expenses and pay your staff, no matter how noble the
cause, you will eventually close your doors. According to the
American Hospital Association, there were 6,210 hospitals in
the United States in 2017. How many will there be in 2020?
Numerous articles have been written about the finances of the
U.S. health care system, and until the financial issues are solved,
we can expect more hospital closures in the future.

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The closure of Hahnemann University Hospital impacted the
training of over 500 residents, 2,500 employees and countless
patients. Due to the closure, Drexel University College of Medicine gave notices of termination to all of their clinical faculty
shortly afterwards, impacting almost a thousand employees,
including physicians, nurses and staff. All told, the closure of
Hahnemann and Drexel University Physicians is a devastating
tragedy for Philadelphia health care, negatively impacting over
5,000 people and thousands of patients. Many of these patients
have Medicaid insurance products that are not accepted at
other Philadelphia hospitals, affecting their ability to seek care
elsewhere. These patients have a profound understanding of
what has occurred.
Ms. S is a 56-year-old woman who we first saw in our office
for gastrointestinal symptoms. She hated doctors but trusted
her nurse practitioner who referred her to us. She was HIV
positive, had behavioral health issues and felt a mass. She was so
anxious the first time we met she cried throughout the visit, and
we encouraged her to come back again just to talk. Getting her
to relax so we could do a thorough examination took us about
20 minutes. We eventually succeeded, biopsied the mass and
diagnosed her with cancer. She underwent treatment and has
been disease free for the past four years. She routinely comes in
for her follow up appointments, and although there has been
less crying, there is always some anxiety around the visit and
we have to coax her for an exam to ensure no recurrent cancer.
She came in last week crying hysterically, and we were
concerned that she felt a new mass. She told us that now she
was going to die, because very few practices in the city take her
insurance, and even if she finds a practice that does, no one
will have the patience to put up with her like we do. She then
said, "They just take, take, take and take, and we got no more
to give." It was the first time I cried at work since Andres died.
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Fall/Winter 2019-2020 : Philadelphia Medicine 29

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Philadelphia Medicine Fall/Winter 2019

Table of Contents for the Digital Edition of Philadelphia Medicine Fall/Winter 2019