Rochester Model for Health Care

It was with considerable interest and nostalgia that I read your article (March 28) on health care in Rochester, N.Y., and its possible role as a model for national health-care reform. Having spent eight years at the University of Rochester as an undergraduate and medical student, I feel that I can cast some additional perspective on that community and its health-care system.

There are multiple reasons why such a system may be difficult to emulate. The University of Rochester has among the finest medical and nursing schools in the nation, and ones in which the community medicine department has had an unusually long, special and active role in the community. Thus, an almost unlimited supply of excellent physicians and nurses is guaranteed as in few communities in this nation.

The relatively high status enjoyed by the department of community and preventive medicine in both the community and the medical school is similarly unique. Preventive medicine and cost efficacy held greater clout in the medical school curriculum. Community medicine programs were well conceived and received.

Political and economic factors were involved as well. The managed-care system there was heavily subsidized by the government, helping to drive out many excellent private practitioners. Limitation of physician choice ensued early on in such a system. A close relationship between the university and the corporate community is similarly unique.

That the cost of housing is low, the public educational system frequently excellent and the overall quality of life high help to retain the well-trained medical professionals. The terrible weather in the community also helped to keep other influences out of the community. Despite being in New York state, the malpractice risks of the community are low.

Surely there are lessons to be learned from the Rochester experience. These lessons may need to be learned as much by our nation’s communities, corporations, universities and politicians as by the nation’s health-care providers who operate in the confines of and conflicting interests of these institutions.

PATRICK FARRELL MD

Huntington Beach