Word: ucla
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Cole, 39, owns a set of credentials that have aided him in reporting on Oklahoma City and its aftermath. A Notre Dame graduate, he went on to earn a law degree at UCLA. But the lure of journalism, which he had felt as a teenager, reasserted itself, and he took a job 10 years ago at the Akron (Ohio) Beacon Journal as a staff writer. Stints at Business Week and Bloomberg's Business News followed before he joined Time in 1992 as a correspondent in the Los Angeles bureau...
This is the sort of high-tech wizardry that has earned ucla and other teaching hospitals a crucial role in the U.S. medical system. They are the places where patients find specialized care that is unavailable elsewhere, young doctors learn their art and researchers develop the equipment and techniques that will save lives tomorrow. But all this comes at a fearfully high price-so high that many buyers in today's medical marketplace cannot or will not pay it. As a result, for all their supermodern machinery and fine medical pedigrees, the teaching hospitals are increasingly looking like institutional dinosaurs...
Managed care originated in Southern California, so UCLA has been especially hard hit. Some 40% of its patients are under some kind of plan. Not long ago, UCLA cardiologists routinely charged $400 for an appointment and electrocardiogram. Now they are lucky to get $160 from managed care. In response, UCLA has been forced to cut staff from 4,200 in 1990 to 3,200 today. It has instituted productivity standards for doctors and shortened hospital stays. Unlicensed "care partners" have been hired to take over some of the more routine duties of higher-paid registered nurses. And in a kind...
...what is clearly the most violent cultural wrench for UCLA is its decision to train fewer specialists and more medical generalists. Late last year, an audience of UCLA specialists listened in shocked silence as Alan Fogelman, chairman of the School of Medicine, outlined a vision of the future: "A tertiary cardiology specialist will be waiting for the phone to ring, but it won't." While it still emphasizes training medical scientists and, in fact, has a new program to attract top-notch students who will commit themselves to research but not practice, UCLA will no longer train students to practice...
Meanwhile, substantial reductions in Medicare and NIH subsidies for teaching and research could wipe out much of the benefit from these economies so painfully achieved. "We look at cuts as unfunded mandates,'' says Mark Laret, deputy director of the Medical Center at ucla, which stands to lose some $16 million. "We are supposed to provide all the same services and do it with less. Medicare, to its credit, is the only payer that contributes anything to the cost of medical education, and that has got to change.'' UCLA has already talked with several local hmos about a premium...