Dee Dixon left her appointment with the doctor who guides her care for diabetes shaken. It was mid-November, and Wellstar Health System was about to move the doctor’s downtown Atlanta office to Austell, in Cobb County, 20 miles and two bus systems away.
“I live five minutes away,” she said to a reporter, her eyes wide and glistening. “Now I have to travel to Austell?”
When Wellstar Health System announced on Aug. 31 the impending closure of Atlanta Medical Center, the first thoughts went to the loss of its emergency room and rare Level 1 trauma center to treat the most serious injuries. But the loss of nearby medical practices and routine, preventative care could have an equal impact on patients left behind.
When Wellstar closed AMC on Nov. 1, it effectively deprived an entire network of doctor’s offices — practices owned by Wellstar as well as independents — of a nearby hospital that could provide services or in-patient treatment. Many of those doctors, who cared for thousands, have now closed their offices, often moving closer to hospitals elsewhere.
Wellstar itself closed or moved 12 of those practices, like Wellstar Internal Medicine where Dixon’s doctor worked. Other practices that were lost were independent providers, like a pulmonologist who retired early because of the hospital closure.
Patients and doctors interviewed over the past two months repeated the expectation that the lower-income and Black communities would be the most harmed by the closures. They worry many will drop regular visits or never find a new doctor.
Credit: Christina Matacotta
Credit: Christina Matacotta
The routine care that the clinics provided may not be as dramatic as trauma surgery, but it saved lives too, doctors and researchers say. Chronic conditions like diabetes were caught and managed early. Breast lumps were found and biopsied. Conversations led to lung scans. Mental health crises were calmed.
The loss of this type of care will be felt for years.
And it is likely to fall once again more heavily on underserved populations: those without cars, flexible work schedules, or good health insurance. The fallout will likely affect Black patients disproportionately, as they made up nearly 70% of AMC’s patients at its facilities in Atlanta and East Point, which also closed earlier this year.
Black patients also have some of the worst outcomes for chronic conditions such as hypertension and diabetes and for other dangerous diseases that are caught through regular primary care. On average, Georgia’s closed hospitals, both urban and rural, reported more than one-third of their admissions were Black patients.
The ripple effects for the health of Atlanta patients will be significant, said Dr. Rabih Bechara, an official with the American Lung Association and a professor at the Medical College of Georgia.
“The closure of any health care institution, especially, sadly, in our city with Atlanta Medical Center, it definitely does affect the acute care as well as not just the long term care, but preventative care,” Bechara said. “The sad part also is that it affects among the most vulnerable population in the city.”
“Out on an island”
The offices and clinics that Wellstar closed near AMC included family medicine, internal medicine, surgeons, heart doctors, ob/gyns, urologists and rheumatologists.
Many were in office buildings next door to AMC, but others occupied strip malls or office parks in neighborhoods across the southern part of metro Atlanta. Photocopied notices reading “Our medical office will be closing” or “OUR OFFICE IS PERMANENTLY CLOSED” now dot glass doors from the Old Fourth Ward to Cascade.
Credit: Christina Matacotta
Credit: Christina Matacotta
Wellstar estimates that the removal of those offices will affect 10,000 patients.
Only three of Wellstar’s offices were relocated, at least two to Cobb County, closer to its flagship Wellstar Kennestone Hospital in Marietta.
In interviews, Wellstar’s executive vice president for ambulatory and business development, Kem Mullins, and Dr. Sophia McIntyre, senior vice president of Wellstar’s ambulatory division, said that the Wellstar practices that closed or moved were bound to hospital-based programs or required hospital-based services like laboratory hubs, and couldn’t remain untethered.
“We just don’t feel we can support those,” Mullins said. “A physician practice out on an island is really not a good functioning practice.”
But they noted that Wellstar kept a handful of Atlanta practices open as well, at least one of which is an experiment to see if it can work without a hospital nearby. And they said patients were being given electronic records notifications about alternative practices they could use, as Wellstar worked with other organizations to transition patients where they needed to go.
“Health care is a team sport,” McIntyre said.
Wellstar assured the public in October that it had a plan in place to transition non-emergency patients to new clinics and doctors. It included distribution of thousands of fliers and mailers and notification in patients’ online portals.
For the neediest, the plan included partnering with Grady Health System and the large Atlanta charity clinic Mercy Care. However, Mercy Care officials say Wellstar held just one meeting with them to strategize, and it focused only on a handful of specific patients.
“That process wasn’t well thought out,” said Anitra Walker, vice president of operations at Mercy Care. “It was just kind of, ‘Good luck.’”
Before AMC’s closure was announced, Mercy Care had to close one of its own locations on Pryor Street in downtown Atlanta for lack of staffing. Now, Mercy Care’s main location one mile from AMC downtown is seeing more patients than the same time last year, but they’re unsure how many came from AMC.
Credit: Christina Matacotta
Credit: Christina Matacotta
More vulnerable, yet more barriers
Rural hospital closures have become commonplace around Georgia, but the loss of an urban hospital like AMC is still rare. The Atlanta Journal-Constitution found that whether in town or in the country, the same people were disproportionately harmed by the closure of hospitals in Georgia: those who are poor and people of color.
An AJC examination of the last dozen hospitals that closed their doors in Georgia before AMC shows that more often than not, they were in counties with a household income lower than the state’s average. For example, Randolph County, where Southwest Georgia Regional Medical Center closed in 2020, had a median income of $29,400 compared to the statewide median of $61,200.
In addition, the closed hospitals had an inpatient population that was disproportionately Black compared to the county in which it was located. For example, In 2020, its final year of operation, Black patients made up 24% of admissions at Northridge Medical Center in Jackson County, where less than 7% of county residents are Black.
Closing in underserved areas throws up significant barriers to getting treatment for those who already struggle to find equitable care.
Georgia already trails in most significant health care markers, according to national studies. Georgia ranks below average for early diagnosis and survival rate of lung cancer; for incidence of cancer generally; for diabetes, which can lead to organ failure, blindness, amputations or death. Georgia ranks among the worst states in the nation for maternal mortality.
Black patients bear the brunt of all those outcomes, with worse outcomes than their equally situated white counterparts. With breast cancer, for example, a Black woman nationwide is 40% more likely to die of the cancer than their white counterparts. In Atlanta it’s about twofold: Black women are twice as likely to die of breast cancer than their white counterparts, said Lauren McCullough, an assistant professor and cancer researcher at Emory University.
“The fact that we are worse than the national average is pretty pitiful,” McCullough said.
Four major factors are at play increasing the burden on Black patients, she said: health insurance status; their personal preferences, which may include not trusting doctors; low-income neighborhood factors; and distance from health facilities. White and Black women both get mammograms equally, she said, but Black women face more delays getting the follow-up care after suspicious results.
A valued connection
“It’s a very heartbreaking situation,” said Dr. Carla Crawford, an ob/gyn who used to work in tandem with AMC. She’s concerned about the impact of the closures on her downtown patients for whom time off work and transportation are barriers.
She has been treating some long-term patients at her office next to AMC for 10 or 15 years. “The patients are not going to travel up to (Marietta). Most of them don’t even have a car.”
“Just because of the population that’s there,” she said. “If they made the trip to come down to see me and they were expecting to get, for example, their yearly gynecological exam, their pap smear and their mammogram; they paid the bus fare ... and they cannot get it that same day? Then they may not get it for a good while.”
Though Crawford does surgeries, her home base is her private office where she sees patients. She had two offices, but closed her downtown location because she couldn’t justify keeping it open without a hospital nearby to do scans and procedures. Now she has just one, in Johns Creek, an affluent area of north Fulton County.
Several miles away from AMC, Timothy Henry was seeing another Wellstar doctor. Henry has a pickup truck to get there. But he doesn’t find it easy to trust people, including doctors.
Like Dixon, Henry is Black. Studies have documented how a history of abuse of Black patients in the U.S. led to mistrust of the medical system. That distrust in turn interferes with patient health now.
But Henry said he grew to trust his doctor, Dr. Jennifer Francois, and that doesn’t happen very often. She ran an office on Cascade Road that Wellstar Family Medicine has now shut down.
Francois’ office would not confirm her plans, but Henry said he would follow her if she opens a new location. For him, the trust is everything: she discovered his diabetes. And now she helps him keep it under control.
“I didn’t even recognize it,” he said.
Ariel Hart’s reporting on gaps in medical services in Georgia was undertaken as a USC Annenberg Center for Health Journalism 2022 National Fellowship Grantee.
