Effect of Closure of a Local Safety-Net Hospital on Primary Care Physicians’ Perceptions of Their Role in Patient Care

The article by Walker et al in this month's Annals of Family Medicine provides a cautionary tale from primary care clinicians on the closure of a safety net hospital. With health reform emphasizing systems of care that treat ambulatory sensitive conditions more effectively in primary care settings thereby reducing emergency department and hospital utilization, one wonders if the stories told are a harbinger of the possible dark side of system change. Indeed, closure of safety net hospitals without the simultaneous investment in primary care in communities of high need may have the potential of yielding just the opposite of what healthcare reform purports to achieve. As we learned in many locations in the 1960's with the deinstitutionalization of people with mental illness, access to culturally appropriate and comprehensive ambulatory services needs to be in place and supported to avoid unintended consequences for populations of special needs. While no one should argue with shifting of today's acute care focused health system to a more effective primary care based disease management and preventive services orientation, we must ask if the existing primary care resources are present and adequate for communities of need. Proposals for closure of safety net hospitals must be coupled with proposals to support and promote primary care and other ambulatory resources in the community; otherwise the unintended consequences will quickly become all too apparent to providers and communities alike.

Competing interests:   None declared