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Here is the rock and the hard place. Roswell Park Cancer Institute needs to improve its operations to become more self-reliant. The state is weary of sending it $100 million a year and the hospital is under pressure to produce an alternative.

At the same time, though, the hospital urgently needs to preserve its standing as a comprehensive cancer center and to lead the nation in developing new cancer therapies.

As the hospital pursues the former, Rep. Brian Higgins, D-Buffalo, believes it is threatening the latter. If he is right, the consequences for Buffalo would be severe.

The problem, from Higgins’ perspective, is that in trying to broaden the hospital’s financial base, Roswell Park is talking about collaborations with the University at Buffalo, including – potentially – a full-fledged merger. That would be disastrous, Higgins says, and his argument is compelling.

The idea of a full merger is fraught for a couple of reasons: the standing of the two institutions and the timing, which could hardly be worse. Roswell Park is one of just 41 federally designated comprehensive cancer centers in the nation, a status that provides federal research funding and, in no small part, its reputation. That designation is now up for renewal and a merger with UB could be the kiss of death.

As things stand, Roswell Park would be taking a step down by merging with UB and its medical school, whose reputation doesn’t measure up to Roswell Park’s. The Accreditation Council on Graduate Medical Education recently placed UB’s general surgery and pediatric surgery residency programs on probation, and the university shuttered its dermatology program after that, too, ended up on probation.

That suggests a pervasive problem that needs to be dealt with by UB – whose importance to the region can hardly be overstated, either. A merger would ill-serve Roswell Park, especially as it seeks renewal of its standing as a comprehensive cancer center. Washington wants to see that Roswell Park is worthy of federal funding; merging with UB would send the opposite message.

“They can’t solve the problems of the UB Medical School on the backs of Roswell Park,” Higgins said. “Western New York needs to position Roswell Park to become the best cancer center in the nation.”

Robert Gioia, president of the John R. Oishei Foundation, which is funding a study on how to improve Roswell Park’s business model, says there is less here than meets the eye.

“We’re urging the participants to work through this process to determine if we can come to a combined resolution and what that resolution might look like,” Gioia said. “We are aware of many, many possibilities.”

Translation: It doesn’t have to be a merger. Collaborations and partnerships are also possible, for example, and may provide a safer way for the hospital and university to benefit from each other’s expertise.

No one can fault Roswell Park for seeking to broaden its financial horizons. New York, unwisely if understandably, has been pushing the hospital to become more self-sufficient and at one point threatened to cut off funding altogether. That threat was lifted, but the pressure remains.

The trick will be for Roswell Park to pursue its opportunities in ways that don’t threaten its standing with the federal government or patients who will seek its care.

As Higgins said, Western New York needs Roswell Park not just to thrive, but to excel. A merger could threaten that goal, which is why this process bears close attention.