The Price of Performing a Mitzvah at Temple University:
The Cost of Caring for One’s Fellow Human Beings in the 21st Century
By Michael Sirover, Professor of Pharmacology
“No good deed goes unpunished” - Oscar Wilde
In the Jewish faith, the Rabbis teach that one must study Torah (the Hebrew Bible) and perform mitzvahs (good deeds). The former is insufficient by itself. It must be accompanied by the latter. The necessity of both is further emphasized on Yom Kippur, the Day of Atonement, when the phrase, “Teshuvah, Tefilla vi Tzedakah” (repentance, prayer and charity) is a constant refrain chanted throughout the holiday as one seeks forgiveness for the sins committed during the course of the year.
In Christianity, the parable of the Good Samaritan is well recognized as a means of underlining the role of good deeds and charitable acts as fundamental tenets of the Christian faith. Similarly, in Islam, its Third Pillar, zakat, emphasizes the role of charity as a major tenet of a virtuous life.
For almost a century now, Temple University has practiced admirably what each of these faiths and many others preach. Through its hospital, Temple has cared for the less privileged and the less fortunate among us. It has opened its arms dispensing care, consideration and courtesy seeking to make hard lives easier, ameliorating the pain and suffering of the less favored generations of Philadelphia residents and those of the surrounding community. From generation to generation of Temple administrations and faculty, through each of their tenures, through successive Presidents, Hospital Chiefs, Deans, Provosts and the faculty at large, Temple University’s commitment to the health care of those who seek its aid has remained constant.
Temple University’s acts of compassion have not been without cost. In the 35 some years that the author has been on the faculty, it seems that there hasn’t been a year in which the financial difficulties of the Hospital (and the Medical School) have not been a major concern not only on the Health Sciences Campus but for the University in general. There was the “hole in the ground” when funds were insufficient to build the new Hospital and one walked around that fenced-in area with an air of sadness; the time when the Main Campus needed to loan the Hospital some $30 million or so to make ends meet; the mergers and acquisitions phase where the Hospital purchased physician practices and other hospitals which regrettably did not yield the anticipated financial revenues; when funds intended for basic science faculty raises were diverted to meet hospital needs; and lastly, the protracted and ultimately unsuccessful bid to move St. Christopher’s Hospital for Children to Broad Street. This resulted in the dissolution of our ties with St. Chris, the formation of the Temple University Children’s Hospital followed by the considerable financial losses incurred when that hospital failed.
Now, as we traverse the 21st century, we have witnessed not only the arrival of Dr. Larry Kaiser as the Head of the Health Sciences Center but also that of Dr. Neil Theobald as our 10th President. (Full disclosure-the author has now served under 5 of Temple’s 10 Presidents. Yipes!) Accordingly, as a means to inform the faculty, the author was requested by the Herald Editor and the Herald Advisory Board to provide a global overview of the Hospital, presenting his views of the old concerns we continue to face, new concerns which have arisen, and, intriguingly, potentially novel ways in which the new Administration seeks to change the paradigm which has guided us these many years. As such, the author hopes this discussion will provide faculty on the Main Campus relevant information which may prove useful as questions arise with respect to Hospital and Medical School financial support in relation to University economic planning.¹
There is an old saying which states, “The more things change, the more they remain the same.” As such, from generation to generation, the core patient population served by the Main Hospital at Broad and Ontario has remained relatively constant. It comprises a lower socioeconomic and, at times, underprivileged, group of individuals. Their insurance coverage is restricted and, at times, completely lacking. Further, they present not only with the problems characteristic of each age group (children with their illnesses, adults with their maladies, and seniors with the afflictions of old age) but also with those which characterize individuals at that economic level living in a less than optimal environment.
Similarly, the level of reimbursement received by the Hospital from third party sources has remained insufficient. Indeed, one can reasonably argue that the reimbursement level has decreased in the last few years as economic conditions worsened and as governments at all levels sought to reduce discretionary expenditures. Temple’s state appropriation has been diminished, and, with the Sandusky scandal, may prove more difficult to obtain as time progresses. Further, an unrecognized factor today with respect to Temple’s financial status is the apparent lack of a budget line in the Philadelphia City Budget. With the closing of Philadelphia General Hospital (PGH), our only municipal hospital, many of those patients sought assistance at Temple.² As is its custom, the Hospital accepted this new responsibility without reservation and has continued to care for those patients formerly served by PGH. (The standing joke at the time was that, when individuals who used to be treated at PGH presented for treatment at certain center city hospitals, they were given cab fare to get to Temple.)
There is another old saying (diametrically opposed to that stated above) which states, “The only thing constant about life is that it changes.” In particular, the cost of medical care has dramatically increased based on the new technologies which have revolutionized the manner in which we treat patients. In the late 1960’s and early 1970’s, the death rate from childhood cancer was 3 out of 4. Today the cure rate from childhood cancer is 4 out of 5 (National Cancer Institute SEER data base). New technologies in coronary care ranging from “clot busters” to open heart surgery to heart transplants have enabled hundreds of thousands of patients to recover from their illnesses. In vitro fertilization has enabled many barren individuals to know the joy of holding their offspring in their arms.
For those reasons (and so many more), the costs inherent in the care that Temple Hospital needs to offer its patient population have exponentially increased as have the financial constraints described briefly above. Thus, these new technologies represent a two-edged sword for the Hospital and for the University. To offer the care that any responsible physician would deem appropriate, funds need to be found to provide the resources for that care. This is a fundamental conundrum Temple faces in the 21st century.
Another factor that has impacted patient care and its financial foundation at Temple is the development of an extensive network of suburban regional hospitals that offer state-of-the-art care in a user friendly location. When the author arrived here in 1973 as a postdoctoral fellow at the Institute for Cancer Research (which became the Fox Chase Cancer Center), Abington Hospital was perhaps 1/5 its current size. It comprised a single red brick building and offered services commensurate with that size. St. Mary’s Hospital in Bucks County was a hospital, which, in all candor, you only took your child to when he/she was injured in a soccer game and needed an ankle or shin treated. Similarly, Doylestown Hospital in Bucks County, Paoli Hospital in Chester County, Cooper Hospital in Camden and even Lankaneau on the Main Line were far smaller than they are today. For serious illnesses one went “downtown.”
Now, each of these hospitals qualifies as an impressive regional hospital center offering the most modern treatments in a neighborhood setting. Further, Einstein has just expanded, opening an extensive facility in Montgomery County. Even Aria Health Systems (a.k.a. Frankford Hospital) is expanding its services. Most notably, this has included the recruitment of the orthopedic specialists known as the “Three B’s” (Booth, Balderston and Bartolozzi), from Pennsylvania Hospital, ensconcing them in their Bucks County campus right across from Sesame Place. For Temple Hospital, these changes have proven to be a problem of sorts as the presence of these excellent health centers obviates the need to travel here.
Yet the old Temple Hospital paradigm of surviving from fiscal stress to financial calamity may be now yielding to a new approach whose dividends may not be evident at present. In the early 1960’s, Bob Dylan (né Robert Zimmerman-sorry-Jewish pride) wrote, “The Times They Are A Changing,” the anthem for the Baby Boomer generation as it came of age. That phrase may be applicable to the here and now at the Health Sciences Center. Apart from the new Hospital and the technologies contained therein, we have seen the building of Shriner’s Hospital with its notable contributions to the Health Sciences Center, the new Medical Education and Research building, and, most recently, the purchase of the Fox Chase Cancer Center which now joins Jeannes Hospital as part of the Temple Health System in Burholme Park in Northeast Philadelphia. In addition, there has been the recruitment of new basic science and clinical faculty who represent a generational change in both the Medical School and in the Hospital.
Each represents the next phase of Temple history with the expectation and hope that the patterns of the past may be discontinued. Indeed, the purchase of Fox Chase may be especially intriguing for a number of reasons. As noted above, the emergence of regional centers of excellence in the Philadelphia metropolitan area reduces the patient base from which Temple may draw. Considering this “friendly” encirclement of Temple by our Hospital colleagues, the purchase of Fox Chase may have the intended or unintended consequence of providing a mechanism to pierce that circle providing a means for expansion of our patient base.
In the movie, Dr. Doolittle, there was an animal called the pushmi-pullyu. It had two heads which faced in opposite directions. At Temple, in 2013, we may face two contradictory goals, i.e., the need to establish a firm economic foundation as we go forward in the 21st century and our commitment to our fellow human beings as evidenced by the care our hospital has provided over these many years. How we deal with this challenge may reveal the nature of our character and the strength of our convictions. •
¹ This article was not intended to provide a financial analysis of the Hospital and the Medical School which is beyond the author’s expertise. That being said, historically, in discussions of said finances, one tended to overlook the teaching contributions of the clinical faculty who participates in medical school instruction in each of the students four years. If one presumes a class of 200 students each paying $40,000 in tuition, the basic science and clinical faculty contribute to the provision of some $8,000,000/class/year or $32,000,000 annually. The fate of the latter is unclear.
² It appears that of the 5 largest cities in the United States, Philadelphia is the only one without a municipal hospital.