Northwestern University and Evanston Northwestern Healthcare (ENH) have agreed to terminate the affiliation agreement between Northwestern’s Feinberg School of Medicine and Evanston Northwestern Healthcare, the two institutions’ leaders announced recently.

The year-long transition will be completed next June, allowing most of the 200 Northwestern University interns, fellows and residents to be phased out of rotations at the three hospitals owned by ENH – Evanston Hospital, Glenbrook Hospital and Highland Park Hospital. Most physicians and researchers at those hospitals – about 700 in all – will no longer be on the faculty of the Feinberg School of Medicine, according to the joint announcement. Evanston Northwestern Healthcare also includes ENH Medical Group (comprising 65 medical offices and facilities), ENH Home Services, ENH Research Institute and ENH Foundation. 

Differing Visions

The termination of the agreement stems from different visions by Northwestern and ENH regarding future directions for the respective institutions. Alan Cubbage, vice president for university relations at Northwestern told the RoundTable, “Northwestern University is very much committed to all of the facets of a strong academic medical center – teaching and research as well as the clinical-care component. We have a very good partnership with Northwestern Memorial Hospital, Children’s Memorial Hospital, the Rehabilitation Institute of Chicago and the Jesse Brown Veterans Administration Medical Center, just as we had in the partnership with ENH.”

Mark Neaman, president and chief executive officer of ENH, said, “We recognize the importance of medical education and clinical research in support of our patient-care mission. You can be assured that we will develop a strong academic relationship going forward in support of our steadfast commitment to offer outstanding teaching programs in an academic setting that promotes the clinical teaching and research interests of our physician faculty.”

ENH is ranked among the top 50 hospitals in the country by U.S. News & World Report.

Although it wishes to acquire Rush North Shore, ENH says it will not have an academic affiliation with Rush Medical School in Chicago. It is, however, in negotiations with University of Chicago to secure academic affiliation. In addition, Mr. Schroeder said ENH will likely change its name next year.

Differences About Money and Power

The differences appear to be about power and money. Mark Schroeder, director of communications for ENH, told the RoundTable, “NU has increasingly focused their activities on [their] Chicago campuses, with Northwestern Memorial Hospital and then the Children’s Memorial Hospital move. They needed agreements to fit with their plans. Despite efforts to come to an understanding for the future, we have been unable to achieve a mutually satisfactory resolution. … Northwestern’s growth and focus downtown over the last few years at the Chicago campuses has made ENH a geographic ‘outlier.’”

Mr. Cubbage said the differences were on “the appointment of chairs of departments and who controls tenure.” The power to make such appointments is a factor in the strength and direction of a hospital. Northwestern apparently wished to have greater power in those choices.

Mr. Cubbage added there were “some” financial considerations as well. ENH’s Mr. Neaman said Northwestern demanded an additional $20 million for “research and development.” The funds would have come from the medical group rather than the hospital, an ENH doctor told the RoundTable.

Impact on the Evanston Community

Evaluation of the impact of this separation on the community of Evanston is ongoing. Evonda Thomas, director of health and human services for the City, told the RoundTable that was one topic of discussion when the Evanston Community Health Task Force met last week.

With the closing of the Evanston Health Department’s clinical services last year, City officials said they believed the two hospitals would provide some of the services being discontinued at the City. However, Evanston Hospital officials made no promises other than helping with school services (see other stories in the June 11 RoundTable).

One criticism of Evanston Hospital has been that, although it does not pay property taxes on its Evanston property, it does not provide community services proportional to that subsidy. When asked whether Evanston Hospital would offer “more community-based services to Evanston,” Mr. Schroeder said, “Each year we expand our community benefits to provide a wider variety of health and education programs. We also broaden our efforts to provide care to the uninsured and underinsured populations we serve. We will continue to take a leadership role in the community by offering resources and support to achieve our mission.”