Where are we now, and what has the merger meant to us? We surely haven't experienced apocalyptic events, and I'd venture to say that most of our medical staff members and patients can't identify any particular change in their day-to-day experiences that they can pin on the merger.

I will point out, however, that much has occurred behind the scenes. Administration for the four hospitals has been centralized. I have seen many of our administrators relocate their offices to Candlestick Point. Some physician leaders have had to deal with heavy commute schedules to attend meetings at Candlestick Point or even at Mount Zion or UCSF. This should make all of us appreciate the sacrifices of those select few. The service lines are beginning to take form, and I am pleased that the service line I'm on, neurosciences, seems to be moving right along. [See related story]. The changes experienced by our patients are subtle, and those of

us delivering care - and the administrators supporting our activities - are occasionally frustrated with adapting to new challenges that may take a few puzzling turns before moving ahead. But mostly, I think, we are stimulated by fresh ideas and new ways of dealing with our practice environment. I think that the neurosciences service line exemplifies the type of progress and collaboration the "founding fathers" of UCSF Stanford had imagined.

At the end of its first year, I see UCSF Stanford Health Care seeming to thrive. We haven't 'blown up' as some of our naysayers may have predicted at the onset or as happened following a prominent merger of major academic health centers in New York. All of the facilities of our merged entity have been very busy during the past year. Since much of the increase in patient care activity began prior to the new organization's marketing effort, we can credit our distinctive practices for much of that activity. Nevertheless, the marketing that I've seen since the merger looks effective and imaginative.

All four of the facilities not only successfully passed their Joint Commission on Accreditation of Health Carel Organizations surveys but, by and large, scored well. We also did well collectively in the U.S. News & World Report's "America's Best Hospitals Guide," with Stanford Hospital ranking seventh overall and UCSF Medical Center ranking tenth.

Academically, I believe that we are also making strong gains through collaboration. As associate dean for graduate medical affairs, I have seen the growth of some collaborative residency and fellowship programs between UCSF and Stanford. Our residents, fellows and students have been exposed not to redundant expertise, but instead, they are experiencing complementary and expanded interests and teaching. In addition, many of our services utilize advanced technology such as video teleconferencing, enabling us to learn from each other and benefit from a broad perspective without spending long hours driving from one site to another. Some departments have begun "joint appointments," allowing faculty members to share their academic duties between UCSF and Stanford. Some of these situations have enabled both schools to gain needed expertise and skills in areas where neither school alone could have justified bringing the faculty member on board.

We are now working through the issues of a centralized body that would allow physicians to be credentialed in one location for all UCSF Stanford venues. Once the time-consuming and occasionally frustrating process of credentialing is accomplished, then physicians can more easily apply for privileges at the hospitals or clinics where they wish to work.

Then, each hospital would no longer need to wade through the inefficient process of verifying license, medical school record, queries of the national practitioner data bank, etc., before granting privileges to a colleague already credentialed at a sister facility. In the long run this should make life easier for those of us who do practice at more than one hospital within the organization - and should also save the organization itself from a wasted, duplicative expense.

From a financial standpoint we are told that UCSF Stanford Health Care is on track. We have set and achieved targets in cost savings through reduction in administration and centralization of purchasing. CEO Peter Van Etten has told us that we are seeing stability rather than further erosion in our contracts with third-party payers.

Overall, what had been the experiment of UCSF Stanford has now evolved to a reality that is indisputably worth continuing. We are certainly in a period of evolution with respect to how we practice medicine in an academic environment. I feel that UCSF Stanford Health Care is giving us the conditions, tools and playing field to allow for success in our changing world.

Brown & Toland Physician Services Organization Restructures in Response to Market Downtown

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