The Future of Internal Medicine at HRRMC: A message from CEO Ken Leisher

November 30, 2012

HRRMC recently notified patients of HRRMC Internal Medicine that the hospital's Internal Medicine clinic would be closing at the end of March 2013.

The decision to close the clinic portion of HRRMC Internal Medicine has not been an easy or a quick one. We have been very fortunate to have the expertise of excellent internal medicine physicians in our community over the past several years both for our patients and as a resource for our local physicians, who can consult with our internists on complex care issues. Maintaining this resource in our community has been, and will continue to be, a priority of HRRMC.

With the retirement of Dr. John Ellis at the end of this year, and Dr. Laura Donigan's plans to relocate to Denver at the end of August 2013, the hospital was faced with the prospect of recruiting new physicians to the practice. Internists have traditionally practiced in both the hospital and outpatient settings, but over the past decade there has been a growing trend for hospitals to hire internists to work solely in the hospital. As a result, fewer and fewer internists want to work in a traditional practice like HRRMC Internal Medicine. Instead, they choose the hospitalist role, the clinic setting or to further their training in a subspecialty such as cardiology.

In addition to the recruitment challenges, the hospital's administrative team also considered the financial viability of a traditional internal medicine practice. When Intermountain Internal Medicine decided to close its doors in 2005, HRRMC hired Dr. Paul Ammatelli and Dr. Susan Blakely to continue the practice as an HRRMC clinic. Over the years there have been a number of providers at the clinic, but the one constant has been that the clinic has continued to lose a great deal of money.

We do realize that we are a Hospital District and as such have a fiduciary duty to the taxpayers of the district. Certainly the decision to provide services is not based solely on the ability to realize a positive bottom line. HRRMC has provided certain services to our community, such as childbirth services, at a loss for years. We continue to provide this vital service, keeping in mind that every decision is a balance of community needs, our ability to maintain the service and its impact on the long-term viability of the hospital.

Looking to the future and the need to create a sustainable model for internal medicine in our valley, the administrative team and hospital board determined it was most important to have an internist based in the hospital, focused on treating complex hospital patients while retaining the position as a resource for our local physician community. Dr. Donigan will be working as a hospitalist at HRRMC from April through August. The hospital is currently recruiting for a hospitalist to begin after her departure.

The hospitalist will be available to follow hospitalized patients who do not have a local primary care provider and to follow inpatients admitted after surgery. The hospitalist would also continue to serve as a valuable resource for local family medicine physicians to consult.

We know that change can be difficult and to ease the transition to a new primary care provider, the hospital supplied all Internal Medicine patients with information about the four family medicine practices in our valley and how to request the release of their medical records to their new physician. We have complete confidence that our local family physicians will continue to provide the Internal Medicine patients with high quality care.

With the addition of a hospitalist, HRRMC will be able to continue offering internal medicine locally but in a new form. We hope the community will understand that this was a difficult decision but one made to ensure the long-term viability of internal medicine in the Salida Hospital District.

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