Teaching Hospitals

Black women who give birth to extremely small babies are nearly three times as likely as white women to have had medical conditions that led to the premature delivery, according to a study released today.The finding may help explain why the black infant mortality rate is about twice the rate for whites in this country and underscores the need for better health care for women before and during pregnancy, researchers said."In some measure, our very low birth weight problem is a legacy of poor women's health, period," said Dr. Paul Wise of the Harvard Medical School, one of the authors of the study appearing in today's New England Journal of Medicine.

The Greater Baltimore Medical Center's 8-year-old in vitro fertilization program hopes to expand by at least 20 percent with the recent hiring of two well-known infertility specialists from Baltimore-area universities.The program is already one of the largest and most successful in the world.The hospital said yesterday that it has hired Dr. Marian Damewood, former director of the in vitro program at the Johns Hopkins School of Medicine, who becomes associate director of the GBMC program, and Dr. Eugene Katz, past director of in vitro programs at the University of Maryland.

SEATTLE -- Future doctors may find themselves standing in the unemployment line instead of at the bedside, if some projections of doctor supply and demand turn out to be true, according to an American Medical Association official who spoke here this week.By 2000, the United States will have 163,000 more doctors than it needs, possibly even too many primary-care physicians, said Dr. M. Roy Schwarz, group vice president of medical education and sciences for the AMA.In addition to a large number of students entering medical school and the many residents being trained at teaching hospitals, nurses and physician's assistants are taking on a greater role in delivering basic care, Dr. Schwarz said.

Labor unions that represent government workers — and some Maryland Democrats — criticized the budget President Barack Obama unveiled Monday for cutting $27 billion in federal employee pensions while offering what they called a modest, half-percent raise. The $3.8 trillion spending plan for 2013 would trim $4 trillion from the national debt over a decade through a combination of tax increases on the wealthy and spending cuts. Many of those reductions would affect Maryland, including funding for Chesapeake Bay cleanup, teaching hospitals such as Johns Hopkins and research grants awarded by the Bethesda-based National Institutes of Health.

Proposals this week by the Clinton administration to trim federal Medicare reimbursement rates have area HMOs and hospitals worried, but teaching hospitals were encouraged by another element in the plan.If approved by Congress, the cuts could deflate profits in Medicare HMOs, which have been competing aggressively to sign up seniors. Medicare HMO enrollment in the state has quadrupled from about 10,000 in December 1995 to about 42,000 as of Jan. 1.Although Maryland hospitals are not directly affected by proposals to tighten Medicare hospital rates -- under Maryland's unique regulatory system, Medicare pays the rates set by a state commission rather than those set nationally -- hospitals still fear an effect.

Lawyers who sue Maryland's elite hospitals for alleged medical mistakes often don't target the physicians involved, a practice that expedites such cases but can shield doctors from government regulators and the public. The practice involves doctors employed by Johns Hopkins Medicine or the University of Maryland Medical System. When doctors are not defendants, it is easier to reach agreement, Hopkins and lawyers say. In the process, the identities of doctors associated with malpractice claims can be obscured, an investigation by The Sun has found.

FOR MORE than two decades, Maryland's Health Services Cost Review Commission has been one of those non-glamorous government success stories -- regulation that works.By controlling the rates hospitals charge patients, the commission has helped keep the growth in hospital costs below the national average. It has done so while ensuring that hospitals caring for uninsured patients get compensation for that care and that teaching hospitals are not unfairly penalized by an increasingly competitive marketplace.

With the exception of James Levine, the music director of the Metropolitan Opera, each of the most sought-after contenders for the music directorships in Boston, New York and Philadelphia is a European.This is always the case in such high-level searches, and for years many voices in the classical music world -- mostly those of American critics and conductors -- have decried this state of affairs. They have maintained that American orchestra boards continue to shortchange home-grown talent for what they perceive as "foreign glamour."

THE EARTH HAS been turned, and construction begins on the next big spoke in downtown's west-side economic wheel. The groundbreaking for the University of Maryland, Baltimore's biotech park project Thursday morning adds to the area's continuing transformation from near-death to cultural and fiscal vibrancy. Baltimore is banking on the long-term success of the UMB BioPark, which is to start housing tech-related firms by year's end, and the east-side's mammoth biotech and housing project, which has just started demolition work.

IF CONGRESS shied away from addressing long-term questions about the solvency of Medicare, it at least took a step toward alleviating the financial pressures that are threatening graduate medical education.Currently, when Medicare patients move into HMOs or other managed care arrangements, the government pays the managed care organization a fee that includes money intended to compensate institutions for their role in providing graduate medical education.When that money is paid to an HMO, rather than to a hospital, it deprives academic teaching centers like Johns Hopkins Hospital and the University of Maryland Medical Center of an important source of funding.