Mini-Medical Center

By all odds, the 2,600 citizens of Cooperstown. N.Y., ought to be getting some of the worst health care in the nation. Every statistic shows that rural medicine lags far behind what is available in urban areas. Good city hospitals lure the best doctors from nearby medical schools; they get the most research money, clinical practice and high-fee patients. But Cooperstown, a dairy-and poultry-farming community 200 miles northwest of New York City, is a remarkable exception. Reason: it has the Mary Imogene Bassett Hospital, a mini-medical center that ranks among the best in the U.S.

As unique as it is unexpected, the Bassett Hospital is a 183-bed facility only a long fly ball away from Cooperstown's Baseball Hall of Fame. Its secret is superb organization. Named for its first chief of staff, the hospital opened its doors in 1922, only to close them three years later without raising the level of medical care in the community. In 1927, the hospital opened again, this time under a then radically new concept: group practice designed to provide full medical care for the entire community.

Medical Middlemen. Even today, most U.S. hospitals follow the practice of extending staff privileges to private physicians, who may then admit their own patients or refer them to other private specialists on the staff. But the Bassett set out to be more than a medicine middleman for private practice. The hospital put its staff members on the payroll and became the primary provider of health care in Cooperstown. Now patients seeking attention can go directly to one of the hospital's seven specialty clinics or be referred from the general services department. Doctors treating patients in one department can simply refer them to another without fear of losing their business. No longer forced to compete for patients, local doctors share their skills for the entire community's benefit, but retain their individuality. "We are more a group of solo practitioners with pooled resources and supporting personnel than anything else," says Dr. Charles Ashley, the hospital director.

At first, many townspeople were openly suspicious of group medicine. Some disliked the extensive examinations that such a system encourages. "They did not want to be examined from head to toe, nor did they want a host of mysterious tests," recalls Dr. James Bordley III, who retired in 1967 after serving 20 years as the hospital's second director. "All they wanted was to get their medicine and get back to farming."

Today the old skepticism has virtually disappeared. Because there are no private physicians in Cooperstown and few in surrounding communities, most residents see themselves as the personal patients of the Bassett's 32 full-time physicians. They drop in at the hospital at the first sign of illness, and as a result, the doctors spot many medical problems in their earliest stages. Often they are able to head off the kind of serious illness that other Americans discover too late for proper care.

Last year the Bassett's out-patient department recorded 68,000 visits; the average cost of treatment was $15. Nearly 4,000 patients were admitted to the hospital, paying $65 a day for semiprivate accommodations, about half the average rate charged by New York City hospitals. Nor was all medical care confined to the hospital. Hospital staffers made more than 500 house calls on those too old or too ill to travel to the hospital themselves.

National Prototype. Unlike many community hospitals, the Bassett does not have to struggle for money or personnel. The hospital has an endowment income of $1,000,000 a year and offers excellent opportunities for research, plus first-class training for young doctors. A 1947 agreement gives many members of the staff a faculty appointment at Columbia University's College of Physicians and Surgeons. In turn, the hospital has established strong training programs for interns, nurses and medical students, along with residencies in the major specialties. "We are better off training here than in the city," says Third Year Surgical Resident Roger Spier. "We learn how to deal with patients as people as well as people as patients." Attracted by the opportunities and an average staff salary of $30,000 a year, many former residents seek to stay on after they complete their training.

They are not alone in their approval. When the Carnegie Commission called for drastic improvements in the quality of U.S. rural medicine last fall, it recommended that this be accomplished by the creation of a nationwide network of 126 regional health centers, combining schools and hospitals, and located within an hour's drive of 95% of the population. As the ideal prototype for such institutions, the Carnegie report pinpointed one existing hospital: Cooperstown's Mary Imogene Bassett.

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