Longtime physicians at the Maryland Shock Trauma Center, one of the nation's premier hospitals for accident victims, say they will resign en masse if proposals giving the affiliated University of Maryland Hospital a greater role in its operations are adopted.
"This place is widely regarded as the model for trauma care in the United States," said Dr. Howard Belzberg, a Shock Trauma internist who is one of many doctors who predict wide-scale defections if their independence is compromised. "It's a unique and delicate thing. If the system should be broken apart, there would be no longer any reason for us to remain here."
Top officials with the University of Maryland Medical System (UMMS), the umbrella corporation that includes Shock Trauma and University Hospital, acknowledged that the issue has aroused intense emotions based on long-standing rivalries between the two institutions.
"You know there's a fair amount of conflict, ego, jealousy," said Dr. Morton I. Rapoport, president and chief executive of the medical system. "But we're trying to stabilize it, resolve it."
Dr. Rapoport said the trauma doctors' worst fears -- outright absorption of Shock Trauma into the hospital and medical school -- are unfounded. While refusing to discuss proposals now on the table, Dr. Rapoport and other top officials said they amounted to subtle changes that would do little to alter the face of either institution or compromise the ability of the Shock Trauma staff to set its own direction.
Doctors at Shock Trauma, however, insisted angrily that the hospital has wanted greater control over Shock Trauma for many years -- in part to enhance its own prestige, which has suffered through much high-profile turmoil in its department of surgery.
"We don't need the department of surgery," said Dr. Philip Militello, Shock Trauma's clinical director. "It's a game. They're hurting bad." Said another doctor: "You don't think that Iraq invaded Kuwait to help Kuwait, do you?"
They said proposals that, for instance, would give department chairmen at University Hospital a greater role in the hiring of new trauma doctors would tarnish Shock Trauma's reputation, inject a greater emphasis on research at the expense of patient care and make it difficult to recruit top-flight physicians.
"There's an attempt here to pull us down to the lowest common denominator, to pay back past grudges," said Dr. John H. Siegel, chairman of surgery at Shock Trauma.
Negotiations over the delicate relationship between Shock Trauma and University Hospital have been in progress for months.
In April, the Board of Regents designated one of its own -- attorney Richard Berndt -- to negotiate an arrangement between the Maryland Institute for Emergency Medical Services Systems (MIEMSS), the University of Maryland at Baltimore and the University of Maryland Medical System.
All three have a stake in Shock Trauma: MIEMSS is the statewide network for trauma care that runs Shock Trauma. The University of Maryland at Baltimore includes the medical school, whose department chairmen must award a faculty position to anyone wishing to practice at Shock Trauma. And the medical system is the larger corporation consisting largely of the hospital, a cancer center and Shock Trauma.
The need to clarify relationships within the corporation grew out of the retirement last year of Dr. R Adams Cowley, the strong-willed founder and guiding spirit of Shock Trauma. By force of will, Dr. Cowley gave Shock Trauma an independence rarely seen within a university medical system.
His departure left a power vacuum recognized by Dr. Rapoport, other top medical system officials and the trauma doctors.
Ironically, many of the same trauma doctors who now miss Dr. Cowley's powerful presence were instrumental in forcing his resignation, saying at the time that he had grown old and prone to administrative mistakes.
Tensions between Shock Trauma and the hospital's department of surgery have long simmered.
Dr. Anthony Imbembo, chief of surgery at University Hospital, recently charged in a position paper that the trauma doctors have fine reputations for patient care but "borderline" reputations in academic circles.
At one point, Dr. Imbembo proposed that the MIEMSS director -- currently Dr. James P. G. Flynn -- become second-in-command within his own department of surgery. The proposal is not under serious discussion, top officials have said.
Angry trauma doctors cited a long list of published articles as evidence of their academic credentials. They insisted their primary mission -- patient care -- would suffer if they were held to the publish-or-perish demands of academic medicine.
And they said their program could only suffer if brought closer to the department of surgery, which has experienced brisk turnover, a sluggish heart-transplant service and the "probationary accreditation" of its program to train orthopedic surgeons.
Mr. Berndt has issued a series of proposals and appears close to making a final recommendation. The latest would, among other things, give the medical school a role in recruiting new physicians for Shock Trauma.
The concept rankled trauma physicians who believed it would result in hiring doctors known more for their academic prowess than clinical abilities.
Not everyone agreed that Shock Trauma's success depended so strongly on independence.
Dr. Alexander Keuhl, a Cornell University physician who held a top position with MIEMSS between 1979 and 1981, said Shock Trauma has passed the point where its quality depends on independence.
"A closer linkage of trauma to the medical school couldn't help but make the medical school stronger," he added. "At this point, I don't think patient care would suffer."