In 1988, Bruce Bartels traded a career at university hospitals in bigger cities to become president of what was then York Hospital.
Built in 1880, the hospital was a "unique health-care resource because of its depth in a community the size of York County" by the late 1980s, he said.
There were about 320,000 people living in the county in 1988, according to data from the U.S. Census Bureau.
The local health care options provided to that population by what was then the York Hospital network included one hospital, four laboratory annexes, a physical medicine and rehabilitation center, a nutrition and weight management center, and a radiology facility with a combined 2,500 employees.
Birth of WellSpan: To have all that in a small southcentral Pennsylvania town seemed surprising to Bartels, the first and only CEO of WellSpan.
"Since then, that uniqueness has multiplied," he said.
Bartels, who previously held administrative roles at the Medical Center Hospital of Vermont, Methodist Hospital in Indianapolis and the University of Chicago, said the size of the hospital has also multiplied.
In fact, it's not just a hospital anymore.
During the last 25 years it became a regional, integrated health-care system with more than 9,000 employees, more than 65 locations, three hospitals and an impending merger that will add a fourth hospital to the WellSpan lineup.
In 1999, York Health System and Gettysburg Hospital announced they would form a regional health system. A year later, that system became WellSpan Health.
The health system is the largest employer in York and Adams counties, and it will add 2,000 more employees to its payroll when a merger with a Lancaster County institution is finalized.
WellSpan and Ephrata Community Hospital in October announced plans to proceed with an affiliation process that will likely be completed by the end of spring, Bartels said.
The Ephrata hospital would be the fourth hospital in the regional health care system, which includes WellSpan York Hospital, WellSpan Gettysburg Hospital and WellSpan Surgery and Rehabilitation Hospital in York Township.
It could be one of Bartels' last major deals as CEO of the health system. In October he announced his retirement at the end of this year.
"Because I'm old," Bartels said in a straightforward, yet jovial, way.
He'll be 67 when he retires, and he's ready to enjoy a "different stage of life," he said.
"I have six grandchildren I don't get to see very often," Bartels said.
And after 25 years at the helm of WellSpan, it seems like time to move on, he said.
"There comes a time when you say, 'I've done what I can,'" Bartels said.
Changes: In a quarter of a century, he's been at the helm of a changing industry.
"The hospital component is a minority of our business now," he said.
At the end of the 1990s, residents were going to the hospital for most of their major care needs, but that all started to change in 2000.
Physicians' offices, labs and outpatient care centers were seemingly established on every corner, and most locals had to travel 10 minutes or less for care.
But that growth came with its share of struggles.
At the time of the merger with Gettysburg Hospital, southcentral Pennsylvania was one of the fastest-growing regions as people moved into the area from the Baltimore-Washington, D.C., metroplex, he said.
"Keeping up with that population growth was a challenge, but it's tapered off a bit," Bartels said.
The York County population was 434,972 as of 2010, according to census data.
And that population is growing older, which creates another demand for care, he said.
"The baby boomer generation has transformed contemporary medicine," Bartels said.
Medical care has changed immensely during the last 60 years, he said. For example, decades ago a patient used to walk into a doctor's office and basically do whatever the physician suggested, without asking many questions. Authority was on the side of the physician.
"That's all changed, and that's a good thing," he said.
Now, patients do their own Internet research and go into an office armed with questions and knowledge about their conditions. They don't wait for their doctors to make decisions; they make decisions with their doctors.
"The need for partnered decisions is front and center," Bartels said.
As medical science has advanced, so has the level of care, he said. Advancements in medical technology, combined with patients' needs, have been the impetus for large integrated health systems like WellSpan, he said.
"The growth of hospital systems are driven by the populations they serve and the kinds of needs that need to be met," said Julie Kissinger, vice president of public affairs for The Hospital & Health System Association of Pennsylvania. "The southcentral region of the state has definitely seen a lot of growth, and we're seeing a larger population of people there who will need services over time."
Because of the geography of York County, WellSpan has had to cater to some very urban and very rural populations, she said.
"(WellSpan) has really stepped up to do an effective assessment, ensuring people in their community and region have easy access to care," Kissinger said.
Funding issues: Another challenge WellSpan has had to meet is the role of Medicare and Medicaid, and soon the implementation of the Affordable Care Act, which will fully take effect in 2014, she said.
Patients covered by Medicare and Medicaid represent more than 50 percent of those cared for at WellSpan, Bartels said.
As those patients have grown into the majority, government funding has become a big problem, he said.
"It was obvious something needed to be done," Bartels said, referring to the Affordable Care Act.
Though the political debate raged about whether the problem should be solved by government intervention or the free market, his perspective as a health system administrator was clear.
"Patients who are 65 and older can't afford free-market prices," he said.
In 2012, it cost $26.2 million to provide care to WellSpan patients who did not pay their medical bills or who demonstrated their inability to pay, according to company records.
It's just a part of the costs managed by WellSpan,
Mergers can sometimes help companies better manage expenses for both the health systems and the patients, Bartels said. For example, the entities can combine business practices, such as billing, and eliminate other redundancies.
But after the pending affiliation with Ephrata, the health system has no immediate plans for further growth, he said.
"Ephrata is a special situation. In our organizations, the (values and missions) are very similar," he said.
Core values: They are values and missions Bartels has never lost sight of during his 25 years at WellSpan, according to Jan Herrold, chairwoman of the WellSpan Board of Directors.
"His leadership has held a very steady course relative to the charitable mission of WellSpan," she said.
The company has been lucky to have his leadership for 25 years -- an uncommon length of time for a health system CEO to stay in one place, Herrold said.
"I've uttered the words many times that we're very grateful he's stuck with us all these years. I believe it's because he's terribly committed to the charitable mission and works well with a continuing challenge," she said.
When Bartels retires at the end of the year, he said he'll feel much like he did when he first started with the company.
"It's still unique," he said. "I'll feel good for having been a part of it all."
-- Candy Woodall can also be reached at firstname.lastname@example.org.