Greater New York’s Top Hospitals
The World’s Leading Healthcare Community
By Judith L. Turnock

Healthcare in America is at a tipping point. Technology and medical science are evolving at breakneck speed, requiring our nation’s hospitals to continually update equipment and training. Patients are living longer with complicated chronic diseases, necessitating careful health management. Millions of Americans lack health insurance, and even more are underinsured, leaving our hospitals to pick up the tab for the critical care patients desperately need but can’t afford. Hospitals are being pushed to increase transparency, data reporting and efficiency in an era of declining revenues, rising costs and rapidly changing patient demographics. Nowhere are these challenges more profound — or being addressed more powerfully — than in the Greater New York healthcare community.

IThe Greater New York metropolitan area — most commonly recognized as New York-Northern New Jersey-Long Island-Connecticut — is home to nearly 19 million people, making it the largest urbanized area in the U.S. Economists, city planners and social theorists have long known that urban density promotes vitality, creativity and innovation, and hospitals in the Greater New York area are among the best examples of that dynamic. As Jane Jacobs, one of the 20th century’s most original urban enthusiasts, observed, “The sight of people attracts still other people.”

Like other highly educated, motivated, thoughtful and dedicated men and women, medical professionals like to be part of a community, so they quite naturally congregate at hospitals in the vibrant New York metropolitan region. It’s no surprise that the world’s best and most passionate medical minds — current practitioners and the next generation — along with committed nurses, quality-driven healthcare workers and patients from all over the world, come here.

Greater New York area hospitals:

• train more new physicians than hospitals anywhere else in the world;

• contribute significantly to the region’s economy;

• push the theoretical limits of high quality and safe performance;

• inspire others in their culturally sensitive outreach to underserved communities;

• raise the bar in seeking and valuing the contributions of everyone in their pursuit of excellence;

• and are the gold standard for emergency preparedness.

More significantly, the unparalleled partnership and unprecedented unity of purpose among hospitals, despite being business competitors, makes the Greater New York healthcare community stand out as the national leader in healthcare teaching, research and patient care.

The Medical Training Capital of The World
The New York metropolitan area is the international center for physician training. New York and New Jersey provide graduate medical education (GME) for more than 20,000 physicians annually, twice as many as any other location or state in the nation, and one-fifth of all physicians trained in the U.S. No other place in the world trains more doctors in more specialties.

“Physician training is as vital to New York as cars are to Detroit and oil is to Texas,” says Kenneth E. Raske, president of the Greater New York Hospital Association (GNYHA), which represents nearly 250 hospitals and continuing-care facilities throughout the region.

Many consider physicians the most respected professionals in the world, perhaps because they deal daily with life and death, but also because of extensive training requirements and special ethical and legal obligations. The path to this learned profession is long, both academic and clinical, during which student physicians practice with experienced physicians in a hospital setting. And the rigorous training process ensures that every practicing physician has the proven ability to provide the highest-quality, state-of-the-art care that patients expect. As a society we demand no less of them.

Rigorous Education and Training Required
Physician training and education is a long process, taking anywhere from seven to 11 years following completion of a traditional four-year college degree. Future doctors start with four years of medical school. New York and New Jersey’s 15 medical schools launch more than 8% of the nation’s physician careers. To obtain a medical license, however, all physicians must serve as residents in teaching hospitals under the supervision of experienced physicians. Residencies typically last a minimum of three years for general internal medicine practitioners, but additional specialization in fields like cardiology or neurology require fellowship training of at least three or more years, depending on the specialty.

The periods of residency and fellowship together comprise GME. The 165 teaching hospitals, 13 medical schools and more than 216 research institutions located in the Greater New York area testify to the region’s strong commitment to high-quality GME and, more importantly, to developing the healthcare practitioners of the future.

“Academic medical centers were created by design almost 100 years ago because of a need in the U.S. to adequately train new doctors, advance medical research and provide quality care,” explains Dr. Herbert Pardes, president and chief executive officer of New York-Presbyterian Hospital. “New York hospitals have been at the forefront of this movement, training many physicians who move on to provide medical care across the country and around the world. The mission of academic medical centers is just as important today.”

Tim Johnson, executive director of GNYHA’s Center for GME Policy and Services, adds, “As America’s elderly population continues to grow, so does the need for more doctors to address the increasing medical needs of today and to develop the treatments of tomorrow.”

Outstanding Educational Infrastructure
Taken together, Greater New York’s medical schools, teaching hospitals and research centers create a regionwide laboratory for innovative research breakthroughs, educational activities and quality patient care. The concentration of institutions fosters the ideal environment for invention and possibility, making medical advances more likely. As a testament to those advances, the National Institutes of Health (NIH) has granted New York and New Jersey $2.25 billion annually on average in this decade. Augmenting the superior healthcare infrastructure, the learned, intense and collaborative environment of the Greater New York region’s teaching hospitals also ensures that innovations will be applied and mastered.

“Our academic medical centers therefore provide a higher quality of care and better treatments and cures,” says Kenneth L. Davis, M.D., president and chief executive officer of the Mount Sinai Medical Center.

But the infrastructure to support this level of excellence is not without cost. Unlike medical students, residents and fellows actually provide supervised patient care and receive salaries. The principal sources of funding for these salaries are Medicare and Medicaid, but they do not sufficiently cover costs. Applying its spirit of innovation to financial matters, New York is the only state to have developed another GME funding source: A pool of funds is distributed to teaching hospitals using a formula based on the number of residents and fellows trained. Even so, despite their importance

to the medical infrastructure and the future of healthcare innovation, the Greater New York region’s teaching hospitals are constantly threatened with cuts to GME and other funding. Ensuring adequate support for teaching hospitals and GME requires constant vigilance.

Significant Contribution to The Economy
A second powerful argument for adequately funding the healthcare industry is its positive impact on the greater New York region’s economy. Already the number-one employer in the New York City area, healthcare drives the economy in other significant ways, even during down periods. The region’s dominance in the field of medical education and research is a well-documented example of that powerful economic impact. In 2006, the Association of American Medical Colleges (AAMC), which represents all 125 allopathic U.S. medical schools and 400 major teaching hospitals across the country, concluded that medical schools and teaching hospitals directly contributed $29 billion and 250,000 jobs in New York and $5.5 billion and 44,000 jobs in New Jersey.

What does that mean in the context of the overall regional economy? After calculating the multiplier effect of that investment, AAMC estimated that GME contributes $66 billion (55% more than in the next closest state, Pennsylvania) and 450,000 jobs to the New York economy, creating a state tax benefit of $3.2 billion (53% more than in the next closest state, California). The economic impact of medical education in New York State alone is greater than the total GDP of 14 other states. Every dollar New York State spends on medical education yields a $5 benefit, and upstate, where the economy lags the most, the benefit is eight-fold. For New Jersey, the medical education and research infrastructure generates $12.5 billion in economic output, 77,000 jobs and a state tax benefit of nearly $500 million.

Other significant revenues accrue from outside the state and are not even calculated in the statistics presented here. Patients and their families and friends from outside the Greater New York metro area contribute millions of dollars through spending on hotels, restaurants and transportation, as do attendees of health-related conferences and seminars. In addition, the living expenses of nearly 45% of out-of-state medical students, residents and fellows further boost the economy.

Preparing for the Future

All projections confirm that the healthcare industry’s economic engine will only continue to power ahead, and the only thing holding it back is lack of manpower. America’s elderly population is expected to double by 2030, which should increase physician visits by 53% between 2000 and 2020. However, at current training rates, the physician supply will not be able to keep pace with demand. The AAMC has called for a 30% increase in medical school enrollment in order to create a pipeline of medical students and residents prepared to meet the nation’s rapidly aging population.

Linda Brady, M.D., president and chief executive officer of Kingsbrook Jewish Medical Center in Brooklyn, urges quick action: “Given the long physician training process, we have to act immediately. We can’t delay until the crunch is actually here and expect to serve all the patients who need us.”

Demographic changes will also increase demand for other essential professionals in healthcare, increasingly outside the hospital setting. Employment in long-term care facilities and for at-home health services and clinics, already experiencing significant growth, will continue on that trajectory as the population ages. The U.S. Bureau of Labor Statistics, for example, estimates that over the next decade or so, the need for home health aides will increase by 56%, medical assistants by 52%, physician assistants by 50% and physical therapist assistants by 44%.

Addressing the Nursing Shortage
While growing healthcare demands threaten to create future shortages of physicians and other healthcare providers, the national healthcare community continues to struggle with the enormous public health threat caused by the escalating shortage of nurses. The shortage is compounded by the fact that nursing schools also face a clinical faculty shortage, so most are not in a position to increase enrollment. Hospitals in the Greater New York region uniquely are tackling this issue head-on through the Gap Program, launched by GNYHA and its member hospitals in 2006.

“Given the long physician training process, we have to act immediately. We can’t delay
until the crunch is actually here and expect to serve all the patients who need us.”
Linda Brady, M.D., President and Chief Executive Officer,
Kingsbrook Jewish Medical Center, Brooklyn

In Phase 1 of the Gap Program, experienced and practicing nurses from Greater New York teaching hospitals complete a 12-week educational program to become clinical faculty at nursing schools, earning 12 credits toward a master’s degree in nursing education. In Phase 2 of the program, nursing students are matched with the newly trained clinical faculty for a more robust practicum experience. Having trained nearly 70 nursing faculty to date, the Gap Program should improve both clinical nurse training and the recruitment and retention of nurses.

Given that America has faced a severe shortage of nurses and pharmacists for the past two decades and must address an impending physician shortage, it is absolutely critical that hospitals find innovative ways to fulfill the mission of training the healthcare providers of the future. As a national leader in this field, the Greater New York region is committed to working locally and with national policy makers to ensure that medical training and education is properly supported today to meet the patient care demands of tomorrow.

Redefining Quality Care Through a Patient-Centered Culture of Safety

Like many industries in the region, the healthcare environment is intense and complicated, with hospitals competing for patients, staff, faculty and breakthroughs. What sets the Greater New York region apart, however, is its history of successful collaboration among hospitals to improve quality and patient safety. When every activity in the healthcare setting is viewed as a patient care issue, and all staff members, from CEOs to housekeepers, view quality and patient safety as part of their jobs, collaboration among hospitals can bring about across-the-board cultural changes that approach the theoretical limit of performance: perfection. “By working together, New York area hospitals are not only providing the highest quality care possible,” states GNYHA’s Raske, “they are forging a new, patient-centered culture of care, which will save lives everywhere.”

And Greater New York area hospital executives are leading the way, committing their staffs and resources to building a regional infrastructure based on the collaborative model, a specific, structured process adopted by GNYHA and its partner, the United Hospital Fund. Through the collaborative model, hospitals work together to create an entirely new culture focused on patient-centered care, a culture that builds quality and safety assurances into every touch of the patient from intake to release and that encourages transparency among hospitals to standardize practices across healthcare settings.

“No one hospital has all the resources,” explains James Foy, chief executive officer of St. John’s Riverside Hospital in Westchester County, “but by bringing the best experts to bear and sharing the results, we all benefit. Working collaboratively with other hospitals in the greater New York area has allowed all of us to approach ‘best in class’ in quality and patient care.”

The Greater New York region’s approach for improving patient care embodies this philosophy, with a five-part structured process applicable to any and all issues that impact patient care: Hospital executives spearhead the initiative by committing the resources for full staff participation in training; the participants identify and adopt “bundles” of best-practice strategies to effect and sustain change; multidisciplinary teams participate in team building and other educational programs; the participants collect and act upon data to drive improvement; and the participants share effective strategies and procedures. Multidisciplinary team development is crucial to success so that staff members will be able to communicate with common nomenclature and provide a successful continuum of care for patients.

“The collaborative model is a true catalyst for change, and our area hospital leaders are true visionaries for championing this approach,” states Terri Straub, vice president for quality and patient safety at GNYHA.

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