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BUFFALO, NY - The change in leadership for the Kaleida Health care system may also reflect part of the overall changing landscape and financial issues for hospitals here and across the country. That's according to union officials from the CWA and the SEIU which represent nearly 8,000 employees at Kaleida hospitals.

They say the actual number of patients admitted to hospitals is dropping by three to four percent as doctors and other medical practitioners are offering more outpatient options.

But they also say those patients who are hospitalized may require more care.

"A lot of the volume is moving outpatient," said CWA Local 1168 President Cori Gambini. "You're seeing urgent care centers, endoscopy centers, surgery centers, all over the place and that volume is outside, which does decrease our volume inside the acute care setting. What we're seeing in the hospitals, though, is very ill patients. By the time they land in the hospital or need to remain in the hospital they are much more acutely ill than they have been in the past."

With fewer patients, the unions are bracing for some job cuts at hospitals which Kaleida board members say will be necessary to, as they put it, "right-size" the institutions.

Kaleida Board Chairman John Koelmel told 2 On Your Side's Scott Brown on Friday that lower-than-anticipated patient volume at Kaleida hospitals means that staffing levels will have to be reduced.