The health care crisis: impact on surgery in the community hospital setting.

Hospitals and health systems across the United States are in crisis. The causes of this crisis are multiple, and they reflect the interplay among reduced operating margins, workforce issues, the technology explosion, consumerism, and leadership. They affect hospitals of every type and location. In aggregate, they profoundly influence our trifold mission of patient care, education, and research. Departments of surgery have a disproportionate effect on hospital financial viability, and therefore, surgical leaders must work with other clinical and administrative leaders to manage these issues. This article is a personal view of how this crisis has affected our community-based academic medical center, William Beaumont Hospital, Royal Oak, Mich.