On our way from Detroit to Bloomington, Indiana, we stopped in Bryan, Ohio (pop: 8,434) to meet with Phil Ennen, president and CEO of Community Hospitals and Wellness Centers’ Bryan (Ohio) Hospital, and former chair of the board of trustees of the Ohio Hospital Association. Ennen is also on a statewide task force on the opioid epidemic. We had a long, fascinating conversation with him, on topics ranging from history and the state of society in the Rust Belt, public health and Medicaid and Medicare for all from a small town hospital’s perspective, and the opioid crisis. We’re going to post pieces of the interview in separate parts.
Below is part 1, covering some Midwest regional history from his family’s perspective, and why the November election happened the way it happened there.
How did you end up becoming president of this hospital system?
First of all, I grew up in this town. My family’s a Michigan family, but my father had a metal stamping factory that he moved down here in the 50’s. Making parts for cars. Had a little factory in Ypsilanti, Michigan. If you’ve been to Ann Arbor, you were right next door to Ypsi. So all of the kids were born there. But people if they do a little history, there was actually a pretty bad recession in the 50’s. He was struggling, couldn’t make a go of it, so he moved the factory to Ohio to try to lower his costs.
That’s interesting, this morning we were at the Packard Automotive plant in Detroit.
So at one point, my grandfather’s company would’ve made parts for the Packards.
And that closed in 1955.
What happened was the UAW was very powerful, especially in the 50s. And so everybody who worked at my dad’s factory were union also. What got him was, whatever agreement they negotiated with General Motors or Ford, Chrysler, they immediately wanted the same exact agreement with my grandfather’s old company. He just couldn’t swing it. So he ended up moving towards Ohio because just that far enough away got him outside the UAW’s purview at that time. UAW really wasn’t out deeper in Ohio, Michigan, Indiana, like they are now – not back then. They had plenty of guys working in Detroit – why do we want to unionize a shop in Chelsea, Michigan, or I-94, Jackson, Michigan kinda thing.
So the family gets down here that way, and then I grow up in this town. My mother was a nurse; she actually had a bachelor’s degree long before it was cool to have a bachelor’s degree.
Or very possible for many women!
So she started working here as a registered nurse, and she was actually appalled at how horrible and careless – this had been in the late 60s – so she quit. Then their director resigned, so they kinda said, well if you think things are so bad… so she took a job as the nursing director. And immediately got into conflict with the doctors. Because at that time, it was a very different time, in lots of ways. But like when a doctor walked down on the floor, all the nurses actually had to stand up. And there was all this deference.
And was it still like men are doctors, women are nurses?
Oh yeah. Although this hospital did have a female radiologist. Typically I would have to say at that time if women were physicians, they were like pathologists, radiologists – not necessarily cardiac surgeons and things like that. Anyways, they complained to the administrator about my mother. But then the hospital was a mess, and the nurses are telling the administration about this lady – so they hire her back. But not as a nursing director, she just kind of did things for him. And that was it until my parents retired in 1981. My father was running the factory; my mom was working at the hospital. And so then, I’m finishing high school right there (points out the window across the street). Well it’s a shell now, the new high school was built – if you came this time next year, the whole thing would be gone. They just sold everything out of it and everybody’s in there tearing everything out, and what’s left over they’re gonna abate the asbestos and knock down.
And what had happened was, I started dating a local girl. And we just didn’t really make a commitment to each other, we just said let’s see what happens, and we ended up staying together. So I came back in 1984 and we got married.
And did you go to med school?
No, I was never gonna do this. I was doing master’s in Public Administration. So I’m at Florida State, in Tallahassee, doing master’s in Public Administration, firmly believing that I was either going the route of city/county management, or working in the legislature. ‘Cause I got an internship in the Florida House of Representatives during my master’s degree, and loved it, and actually they offered me a job to stay on as a staff analyst on the appropriations committee. The problem was, these guys offered me a job to come back. And basically the family pull is why we came back. So I came back here straight out of my master’s program as a VP, specifically to take over after this guy who was gonna retire. So I was succession planning, and then we had 20 years of transition, which was not easy for either of us. Especially about 12, 13, 14 years in, I’m kinda feeling like, “I thought you said you were gonna retire…” So, it ended up just fine, but that’s the reason I ended up back here. And so, I’m the one member of the family who’s still here, and I’ve got one sister in Chelsea, which is near Ann Arbor, in the previous family spot. But everyone else scattered. Starting with Rebecca’s [our friend] father, he moved to Boston.
And is that kind of the typical brain drain thing that’ll happen in these counties?
Yeah, what has been happening in this community for a long time is kids finish school, and they go away. The ones who are going to be professionals and managers and things like this. And they don’t come back anytime soon. They come back, typically once they’re in a committed relationship and they got a couple other human beings about this tall, that’s when they wanna come back. ‘Cause they start looking at the kids, and they’re going, “Where do I want them to go to school? I don’t know that I want them to go to school around here, I think we better head back home, or somewhere near home.” And then what worked for the longest time out here was, for the kids that stayed it was okay because there were actually really strong jobs out here. Good manufacturing jobs, good pay. A combination of union and non-union shops.
It was still kind of auxiliary with the automotive industry?
Yeah, still a massive amount of automotive – making something that went into a car, of some kind. Then, plastics industry started growing up. Plastics industries are really interesting – a company grows up, everybody really happy, a couple people get unhappy, they go down the street and open up a plastics company. It’s kind of like what I’ve noticed about some of the Protestant denominations of churches – you always notice there’s a first, second and third and you kinda find out why.
That’s what they say about Jews too. There’s a joke where there’s a Jewish guy who gets stranded on an island, and there are two synagogues. He’s like, “why did you build two synagogues?” “Well this is the synagogue I go to, and that’s the synagogue I don’t go to.”
Yeah, I get it! I was recruiting a physician one time, and trying to make all the connections for them, and I found out they were Baptist. So I’m making all these arrangements, and someone says to me, you better find out what kind of Baptist! She says, wow you just do not know. So she talked to the candidate and she says, okay I know which one you need to go to now.
Anyway, so the formula worked for the longest time. So if this town in 1950, 1960, just had a whole bunch of companies in the town that actually were owned by people who lived in the town and probably started it, post-World War II. Some companies even older than that, you guys might be familiar with Spangler candy company, which makes the Dum Dum lollipops. That’s a 116-years family owned company from Bryan. So the Dum Dum lollipops is what they’re most well known for, and then candy canes are the other. So if you have candy canes in the United States, pretty much they were made by Spanglers, unless they were red and whites. Red and whites just gets to the point where the US manufacturers can’t compete worldwide because the sugar subsidy that the sugar growers down in Florida get. So they have manufacturing down in Mexico that makes the red and whites, but all the specialty canes and everything are made here in Bryan. The other one that we used to be known for that we can’t say anymore is that this is the home of Ohio Art, which is the home of the Etch-a-Sketch. They bought the Etch-a-Sketch in the 50s from whoever couldn’t figure out how to sell it, and it went off. But they actually stopped making Etch-a-Sketches here in the 90s, late 90s, and finally sold the brand and they just completely got out of the toy business about three years ago.
And what has happened since then, is that all these companies that were owned by somebody who lived in town, they sold. But they weren’t sold to anybody who was in town, they sold to somebody who lived someplace else. And so we went from owners who were really committed to the community, to owners who were really nice people, but they were managers who were here for a certain amount of time to show corporate, you know, we can do this. And then corporate just had charts and graphs and things they looked at that they didn’t think too much about the towns. And corporate started making all the decisions that they make. So in some cases the decision worked for us, something moved here, and in other cases it worked against us, they hauled all the stuff someplace else. But the people who are just here for a period of time, they’re not really committed to the town, they’re just trying to make it work until they can go. And the worst thing that could happen to you in the corporate world was that you stay somewhere too long. Higher ed is kinda that way, you stay too long and they wonder about you. So we just lost that edge that we had in terms of all these people being really committed to the community.
And then the quality of the jobs fell off. And what we got left with was some really really high end work, that we actually have real talent for; we have people in the community that are really gifted tool and die makers, and manufacturing work. But the lower end work wasn’t there anymore, and if it was there, it was at a wage that wasn’t worth it. So people didn’t move back with kids as much as they used to. They stayed in Columbus, they stayed in Cleveland more recently, but definitely in Columbus. Stayed in Cincinatti. Stayed down south. And people who didn’t leave got poorer and poorer.
So now, we’re at the point, I’ve been doing some demographic work with the health department. So there’s this main street that you guys were on, that splits the town in half. If you take two people and they both die on the same day, and one of their residence’s address is on the east side of that street, and one of their addresses is on the west side of the street, the one on the west side of the street lives seven years longer than the one on the east side. So it’s right in this town.
And they’re both probably white.
Oh yeah, 97 point whatever. And then Latinos, and a very small number of black residents. And a little bit of Japanese, because there are Japanese concerns that bought these manufacturing companies, so they have Japanese management in town. And then a little bit of everything else. But the biggest non-English speaking population that we have in town speaks Spanish, by far.
So it’s just, I don’t think that this town is dramatically different from the rest of this rural America that feels left behind. You used to have these pretty good jobs, and you know, as long as I had a good job that I got what I needed, then do whatever you want for the rest for everybody else. But the minute I feel like, you know hey nobody’s paying any attention to me anymore, then you get what we had last November. So, the fascinating thing for somebody like me though is, I have to swim in between all of these people because I have to try to convince people that Medicaid expansion is a good thing, and I have to try to convince people that it’s the right thing to do, and I have to try to explain to people that actually these people you’re upset about that won’t go to work are actually making incredibly rational decisions about life.