“I don’t really remember. Atorvastatin, or something. It’s in the computer.”
I nodded, making a mental note to track down my patient’s dose, as I knew full well it was not in the computer. As one of Northeast Ohio’s few remaining independent primary care doctors not employed by a major health system, I’m no stranger to the challenges of not being on the same EMR as everyone else.
Mention healthcare in the Cleveland area, and there’s at least one obvious name that comes to mind. It is almost certainly not Western Reserve Hospital, the small, physician-owned hospital where I’m on staff. In a small suburb adjacent to Akron, Western Reserve sits sandwiched between the larger, more familiar names of the Cleveland Clinic, University Hospitals, and Summa Health System. While the dominoes of independent hospitals in the Northeast Ohio region have fallen one by one under the banner of these dominant three systems, the 89-bed hospital formerly known as Falls General, and before that as Green Cross, still stands as the only remaining full-service physician-owned hospital in Northeast Ohio.
For those who have never worked outside the confines of a large, quasi-academic health system, the story of Western Reserve Hospital is one worth telling. Although I was not there to verify, the “legend” as I've been told it goes like this: Western Reserve was one of the last hospitals allowed to be acquired by a physician group before the passage of the Affordable Care Act (ACA), which imposed highly restrictive limits on physician ownership of hospitals. Depending on who you ask, frustrated by a decline in the quality of care, the local physicians in the Falls area banded together to attempt to purchase the hospital and run it, to preserve community access to care. In Cinderella-esque tellings, the paperwork to acquire Western Reserve was either signed or submitted just before the stroke of midnight the night before the ACA became law. The city of Cuyahoga Falls kept its community hospital, and the physician ownership has kept it running to this day.
During business hours at Western Reserve, music wafts across the parking lot, beckoning patients inside. And it is inside that the magic of a small, physician-run hospital becomes readily apparent. There are excellent cardiologists, surgeons, intensivists, and proceduralists, ranging from freshly minted residency graduates to distinguished senior attendings with impressive academic pedigrees. ORs hum and residents walk the floors, bits of paper overflowing out of the pockets of their white coats as they flip through paper charts. A handful of intrepid community PCPs still admit their own patients, and the ER docs somehow still manage to find the time for courtesy calls to the PCPs who don’t. And of course, patients are sent home with a bowl of the hospital’s “famous” chicken soup — because the last thing you want to worry about when you get out of the hospital is your next meal. The focus is undeniably on the patient experience, not by initiative, but by design.
Most people are surprised to hear that such a place still exists in the modern age. I think the element that keeps my hospital alive is also the most important one missing in modern medicine: a shared desire to put the patient, rather than the system, at the center. To be sure, working outside the area's major health systems has its challenges. Patients often assume I can see everything easily from other hospitals, but it’s not as simple as it might seem. The lack of interoperability and the adoption of EMR among local health systems mean plenty of record-chasing and begging for cooperation when referrals are sent to outside specialists. Some systems share information readily, while others don’t share at all. Many local hospitals won’t allow staff positions for non-employed doctors, regardless of their skill level or experience. Some will disregard orders from an “outside” physician, only to have an employed physician within their own organization enter the same order and follow up on it to capture more market share under the guise of “patient safety.” What those who have never worked at a place like mine do not realize is that many of these “barriers” are artificial and come at the patient's expense.
Places like Western Reserve for me highlight what’s lost when physicians are reduced to cogs in the machine rather than servants of their community. Private practice ownership is rare, and physician ownership of a hospital is even rarer. I came to work here by a combination of preparation and good fortune. Like many who work there, I am a firm believer in the value of strong, independent, physician-led healthcare. Following a stint with a major system during residency, I found myself increasingly interested in private practice. My father, a family medicine physician, had helped found a successful primary care group in my hometown, so I knew that an alternative to the big systems existed. Once I found one nearby, it was a natural fit, and unlike most of my residency colleagues, I’ve been with the same group since I graduated. Had I not had this background, though, and not known that things could be different, I think, like many of my colleagues, I would have found myself another cog in the machine.
Many physicians now go through training never having known anything other than working for a large corporate health system. I think this is a massive disservice to the profession, and I fear what the future of healthcare will look like if physicians in training aren’t exposed to places like Western Reserve. In many ways, places like this serve as a rebuke to the current trend of consolidation and corporatism that has eroded physician satisfaction and trust in healthcare as a whole. Its continued existence proves to me that we can trust physicians to do what’s right for patients. If we train physicians only within large corporate systems, we risk raising a generation of clinicians who believe there is no alternative. The future of our profession depends on remembering — and preserving — the places that prove otherwise.
It might mean more work when it comes to chasing down the records of someone who isn’t in our little hospital. But for me, and for my patients, I think it’s all worth it.
Dr. Brennan Kruszewski is an internal medicine physician in Hudson, Ohio. He is passionate about transforming primary care. He enjoys spending time outdoors, especially biking the trails of Northeast Ohio. He is active on social media, and blogs at his personal website. Dr. Kruszewski was a 2024-2025 Doximity Op-Med Fellow and is a 2025-2026 Doximity Op-Med Fellow. Opinions expressed here are his own and not the opinions of his employer.
Illustration by Diana Connolly
