Time Believed Key to Healthier UCI Medical Center
When Dr. Edward J. Quilligan became dean of UC Irvine’s College of Medicine in May, he took on the formidable tasks of trying to guide the college to national prominence while making its main teaching hospital, the UCI Medical Center in Orange, financially self-sustaining.
Quilligan, 61, a member of England’s prestigious Royal College of Obstetricians and Gynecologists and editor of the American Journal of Obstetrics and Gynecology, earned his medical degree at Ohio State University and has taught and chaired OB-GYN departments of various medical schools across the nation.
He first came to UC Irvine in 1980 as a professor in the division of maternal fetal medicine and left three years later to chair the obstetrics and gynecology department at the University of Wisconsin Center for Health Sciences. He later was head of the obstetrics and gynecology department at the University of California, Davis.
Quilligan returned to UCI as vice chancellor of health sciences and dean of a 400-student school of medicine that he is trying to nurture to greater eminence. He acknowledges that the school is handicapped by insufficient clinical facilities on campus to complement its research capabilities.
As a remedy, Quilligan is building some health care facilities adjacent to the medical school as a first step toward his ultimate dream of developing a teaching and research hospital--a goal he does not expect to achieve during his tenure.
Quilligan oversees the 493-bed UCI Medical Center in Orange, which the UCI College of Medicine acquired from the County of Orange in 1976.
While the medical center long has been the county’s primary provider of medical care to the indigent, Quilligan says he is striving to increase the hospital’s private patient population, in part because of Medi-Cal’s more restrictive reimbursement policies. The hospital, which has an operating budget of $150.8 million, showed a $748,000 profit during its last fiscal year, ended June 30. But Quilligan is anticipating a hefty loss for the hospital in its current fiscal year.
Quilligan discussed some of the major issues facing UCI Medical Center and the UCI College of Medicine in a recent interview with Times staff writer Leslie Berkman. Q: What is the financial status of UC Irvine Medical Center?
A: Our model anticipates roughly a $9.5-million deficit. . . . Four or five years ago, the deficit was somewhere in that magnitude. Then the hospital took rather drastic steps in terms of cutting back personnel and all sorts of things to try to reduce the expenditures, and over the course of time, the state came in with some rescue money to allow the deficit to be retired. And then we made a small profit for a couple of years.
Q: What is causing the hospital to slip back into the red?
A. Well, what has happened is that each year our built-in expenses go up, including the cost of contracts we have with nurses and all sorts of employees, the cost of medication, the cost of buying new equipment, et cetera. And our revenue is capped because of a set reimbursement for Medi-Cal patients, who constitute a significant portion of our hospital population.
Q. What percentage would that be?
A. Roughly 35% of our patients are fully funded through insurance or HMOs or through Medicare or pay out of pocket. The rest are all either Medi-Cal recipients or medically indigent adults (a category of patients whose medical bills are partially paid by the county).
Q. Why do you put Medicare in a different category than Medi-Cal?
A. Because they pay better than Medi-Cal. We have a shortfall from Medi-Cal of roughly $20 million a year. It is growing because Medi-Cal payment rates haven’t increased and our expenses have. We have a shortfall from the county, too, of about $9 million a year.
Q. If you have a $29-million annual shortfall, why are you projecting only about a $9.5-million deficit this year?
A. By scrimping and saving and cutting every conceivable corner, we can make up the money on the 35% of our hospital population who are private patients.
Q. Do the private patients subsidize the Medi-Cal patients?
A. Yes, they do.
Q. So what can you do now to improve the hospital’s financial picture? Do you have a plan of action for the year?
A. Well, our plan of action is to continue the service to the public patients, which we feel an obligation to do, and to open up as many private patient beds as we can. . . . We’re trying to develop the private patient population, and we have some very good programs that are attracting private patients . . . such as our orthopedic, neurosurgical, cardiology and neonatal intensive care programs. And we will be opening two new ambulatory care facilities for private patients in May.
Q. Is there difficulty getting private patients if UCIMC has the stigma of being the place where poor people go?
A. I think that obviously it was a county hospital for years and years, and there still are many people in Orange County who probably think of it as a county hospital.
Q. And for years the facility was outdated?
A. Right. And we think that we’re turning that image around, but you don’t do that in a day. The state has put roughly $40 million into improving the hospital, and they are putting another $40 million in.
Q. In the past, the administration of UCI College of Medicine has taken the position that you can’t have a top-notch medical school unless there is a teaching hospital adjacent to it right on campus. Do you hold the same opinion? Or have you given up hope of an on-campus hospital?
A. Our long-range plans call for us to have a hospital right on the campus.
Q. How “long range” are your plans for a campus hospital?
A. I honestly don’t know the answer to that question. We have the first step in that long-range plan, which is the clinic right out there (under construction near the medical school) where we will be seeing patients. Next we would like to develop a neuroscience institute where basic research is done and translated into patient care.
Q. Why are you interested in an institute specializing in neuroscience?
A. Because we have such strength in neuroscience already here. We have a lot of strength in the basic science areas, both on the main campus and at the medical school, and we have a lot of exciting people in the clinical areas such as the neurosurgical group.
Q. What is the next step you take to achieve such an institute?
A. I think we have to get realistic about developing funding for planning. It’s going to take a lot of planning to pull something like this off.
Q. Will other clinical facilities follow the institute? Will UCI ever have a medical center comparable to the one at UCLA?
A. Absolutely. But that undoubtedly will arrive after I retire. . . . We plan to develop each step of the way as we go, looking toward a whole. It is very difficult today to get funding to develop a medical center. I mean, we could easily spend $300 million developing a medical center. And I don’t think anybody that I know at the moment has the $300 million to give us to do that.
Q. How would you evaluate the UCI College of Medicine right now, compared to other schools in the country?
A. I think it is a good medical school looking for excellence. And I would say my initial impression is that the basic sciences are very strong, while the clinical sciences have areas that are very strong and some areas that need strengthening.
We have figures that show in terms of research dollars we’re in the top third in the United States. And that’s an indication of a lot of work and a very good faculty. We’d like to make the top 10. I also would like to encourage joint projects between the medical school’s basic science and clinical departments so that within our own institution we can perhaps develop technology transfers.
Q. Are federal research dollars drying up?
A. Federal dollars are getting very difficult to obtain. The actual money that the National Institutes of Health has available has not contracted. It’s still expanding. But the number of investigators applying for that money has increased tremendously.
Q. So will you be seeking more private funding?
A. We have been and will continue to. There’s private industry and there’s private donations, and we have an active program of trying to support young investigators through private donations from individuals. This is not the big type of dollar that you get from the NIH, but it is perhaps a small grant that can get a young investigator started on a project.
Q. Do the changes in way of providing medicine, such as the growing use of health maintenance organizations, affect what students have to learn in medical school?
A. I think the whole tenor of medicine has shifted from inpatient care to more outpatient care, and so we need to have a great deal of emphasis on outpatient medicine.
Q. Are you changing your curriculum to stress the need for doctors to educate their patients more about preventive medicine?
A. Well, we think doctors should be educators because they have to educate their patients. We have not significantly modified the curriculum and do not plan to do so in the next short space of time. But we are looking at our curriculum now, trying to gather information on its strengths and weaknesses, so that within the next two years we can have information as to whether or not we need to make significant modifications.
One of the areas that I’m interested in is bioethics, so that the student residents would be exposed to bioethical dilemmas of the practice of medicine. I think it’s an area that is not hard science, an area where there will be marked differences of opinion. But it’s an area in which you’d like to give students concepts on which to build their own opinions or, better yet, concepts they can use to work within the society they are serving.
Q. I understand that the UCI Medical School, as other medical schools nationwide, has been experiencing a decline in enrollment applications. What is the situation?
A. Nationally the decline has averaged 10% per year since 1984. Nationally there were 35,000 applicants in the 1983-84 academic year and 28,000 applicants in the ‘86-’87 academic year. In California there has been less of a decline, approximately 9%. In California there are 3 applicants for each student opening, compared to 1.6 applicants per position nationally. At UCI we accepted 92 new students this fall and had approximately 3,000 applicants, which is about 500 fewer than last year.
How do you account for the declining applications?
A. The reduction in applications seems to be due to a feeling that medical practice is less prestigious in the eyes of prospective new doctors. There seem to be more problems involved with the business of being a doctor. The issues involve the exorbitant cost of malpractice insurance and the threat of being sued by patients who feel they have been mistreated. These are constraints doctors 15 years ago didn’t really experience.
Doctors are being scrutinized more by the public, and that seems to eliminate the chance of a doctor being viewed as a local healing hero. And the financial return from being a doctor seems to be less in the students’ eyes than it used to be, compared to the cost of a medical education. It now costs $23,000 a year tuition at Georgetown Medical school and $1,500 in annual fees at UCI College of Medicine.
