The Emperor Has No Health Care

Author Hans Christian Andersen wrote many short stories – adapted parables (think “The Little Mermaid”) that often stand the test of time in terms of the messages they are meant to convey. One such story involved an emperor, his vanity and an obsession with new fancy clothes that ultimately led to his being hoodwinked into ignoring the most obvious of truths: His new clothes were not clothes at all, and he was, in fact, naked.

Today, we tend to use the expression “the emperor has no clothes” when many people believe something that is not true, and others are too often afraid to criticize or be seen as going against popular opinion. This is not an uncommon response as we try to get on with our daily lives – call it human nature. Well, respectfully, I’m going to push back against that human tendency here and say that in the state of South Carolina, “the emperor has no health care.”

Take, for instance, some recent health data from the Centers for Disease Control and Prevention, ranking infant mortality in developing countries. The United States is tied for last place out of 24 industrialized nations. From there, if we look only at the U.S., we see that South Carolina sits in the bottom quartile, meaning we have rates of infant mortality that are beyond unacceptable. In data available through the Department of Health and Environmental Control and other sources, including research teams here at MUSC, we quickly understand that when it comes to chronic diseases, South Carolina continues to rank at the bottom of the scale. Opioid deaths are on the rise, too. These are just a few of many examples. Health care access, delivery and outcomes are far from optimal in South Carolina, as the evidence and data consistently tell us.

I don’t have to tell you that South Carolina and its citizens, myself included, are a very proud bunch. We have a lot of great things going for us all over the state, and as evidenced by our economic growth, influx of new citizens and great quality of life that’s not a surprise. But I will share with you a fact that we never discuss – health, or lack thereof, is the great equalizer. If we do not come together to address the chronic and increasing health care issues that hold us back as individuals and communities, we will never be able to reach our full potential.

In recent months I’ve been receiving feedback, questions and just to state it candidly, some concerns, from external stakeholders about MUSC’s strategic moves related to the subject of partnership and our physical presence around the state. Typically, they want to know why MUSC is “trying to take over the world,” or why we don’t just “stay where you belong in the Lowcountry.”

I struggle with this feedback for three reasons: One, their statements don’t account for our statewide mission and charge from the legislature – we are the Medical University of South Carolina, not the Medical University of Charleston. Two, they operate under the false premise that unbridled competition, rather than partnership, is the only path forward. And three, they assume that all is well with health care across the state of South Carolina, and, therefore, any change to the status quo could only be detrimental, and statewide approaches to longstanding issues aren’t needed. That last reason, in my mind, is the equivalent to the emperor wearing no clothes.

For MUSC, more of the same is not acceptable. We’re innovators, collaborators and fellow humans, yes, but ultimately, we’ve also been charged with taking on this hard, and at times, seemingly insurmountable set of health problems that plague us – yet we are willing to accept this challenge. But to be clear, MUSC cannot solve these many issues alone; we require partnership, community and a willingness for individuals and entities to look beyond their own backyards. The key to moving the earlier stats in a positive direction and maintaining them in a place that we can all be proud of requires different thinking.

This starts with a systematic, strategic approach to partnership and presence across the state – acknowledging the basic truth that best care is local as a cornerstone of what we seek to do. We need to enable and strengthen access to high-quality care as close to home as possible. Why? Because enabling other providers and systems increases the quality and access of available health care while enabling the right care to actually happen at the right place and time. Because we know that being a catalyst for transformative and translational research around the state spurs necessary progress. Because we know that there are not enough training and educational opportunities in our state – a fact that has only become more evident by all things COVID.

So, where are we beginning to have impact?

Our work and leadership via the South Carolina Telehealth Alliance and the South Carolina Stroke System of Care are excellent examples to date. Today, you can present at any hospital emergency room anywhere across the state, and that ER physician and care team will have access to a stroke expert at one of five comprehensive stroke centers in South Carolina, which includes MUSC. This saves time and brain, leading to much better and different outcomes for thousands of South Carolinians. Further, as a National Center for Telehealth Excellence (one of only two nationwide), we’re connecting with smaller, rural, underserved and community health centers and hospitals so that we can deliver on the best care is closest to home concept for patients, yet ensure better outcomes and support for our health care colleagues across the state.

Another example involves the growth in clinical rotations for students across multiple MUSC colleges as a result of our acquisitions in the Florence and Lancaster regions of the state. We’re also working on graduate medical education (GME) consortiums with health care affiliates and colleagues to keep more physicians training and then, ultimately, staying to practice in South Carolina.
And, briefly, I’m particularly excited about how we are growing our community and underserved populations outreach, from our work with Healthy Me – Healthy SC to our leadership and crucial lessons learned during our statewide rollout of COVID-19 testing and vaccination.

Here are some more facts to consider:

• MUSC serves a critical role for South Carolina as the only health system able to provide the highest level of specialized, complex care and expertise, meaning we have the broadest range of specialties in South Carolina, with more than 15 offered exclusively at MUSC. Because of the focus on specialized care, MUSC sees patients from every county in South Carolina and every state in the nation.
• MUSC provides more than 50% of the state’s GME, making the institution the largest GME provider in South Carolina, with a total of 850+ positions across 77 specialties. Approximately 75% of physicians who complete medical school/GME in South Carolina remain in the state to practice.
• MUSC is the only health care system in the state that has a $328 million translational and basic science research enterprise capable of defining state-of-the-art care.
• MUSC has developed productive health care system partners or clinical affiliates in all 46 counties in South Carolina because providers, hospitals and health systems across the state are looking for partnerships that deliver the highest-quality, comprehensive care closest to their patients’ homes.
• Partnering to increase clinical- and outcomes-research capabilities elevates the level of care available and the quality of care provided in the local communities.
• Approximately 11% of South Carolinians requiring hospitalization (57,938 people) leave South Carolina for care. By partnering locally, we accomplish what is most appropriate, which is providing health care in South Carolina for South Carolinians.
• Rural hospitals in South Carolina are under significant financial pressure, with some facing closure, worsening the challenge of health care access/disparities. MUSC is investing and innovating in numerous smaller and rural South Carolina hospitals through partnership or presence, providing underrepresented minority and rural populations with better access to the highest level of patient care.

Given who we are – our mission, our momentum, the fact that we are blessed with so many talented providers, researchers, faculty, staff and students who work daily to make a meaningful difference in people’s lives – contrasted with the current state of health affairs in our South Carolina, my response to those who have concerns is “if not MUSC, then who?”