Comments on: The Boomerang Effect: Hospital Employment of Physicians Coming Back Around http://www.physiciansnews.com/2009/02/04/the-boomerang-effect-hospital-employment-of-physicians-coming-back-around/ Wed, 06 Jan 2010 06:04:25 -0600 http://wordpress.org/?v=2.8.4 hourly 1 By: Dawn Lipthrott http://www.physiciansnews.com/2009/02/04/the-boomerang-effect-hospital-employment-of-physicians-coming-back-around/comment-page-1/#comment-783 Dawn Lipthrott Wed, 30 Sep 2009 00:14:49 +0000 http://clients.ikodum.com/phynews/?p=2034#comment-783 This trend is deeply disturbing to me. In my area a very large non-profit hospital system has gone on a hiring binge over the past 3 years and now has 200 physicians employed by its wholly owned subsidiary and some directly employed. My concerns are these: 1. While described as a multispecialty group, the physicians are placed in 90 practice loactions in the metro area. Each practice is given a different name and presented and advertised as if they were private practices. Patients have absolutely no idea they are IN the system which refers to itself. To me, that is dishonest and takes away the patients' ability to make an informed choice, both initially and in subsequent referrals. The patient doesn't know they are being referred from one system physician to another. 2. Referring in system bypasses some of the best specialists we have. To test the system, I called the hospital physician referral line where all physicians with staff privileges are listed. I asked for a breast surgeon. I was given 5 names, ALL of whom were employed by the hospital system and all of whom were less experienced than the best know breast specialists in the same building, next door and in-between the two locations. These surgeons have loyally supported the hospital for years and are supposedly part of their consulting breast care team. The referral was made in the interest of the corporation, not in the interest of me, the patient. 3. Statistics from the state show clearly the decline in volume of private surgeons and the rise of employed surgeon volume. Because there is no real need to hire surgeons and many of the other physicians it hires, no increased demand, no increase in population, no wait times for physicians, it is inevitable that as patients are steered to system physicians, it damages private practices. 4. Patient steering of clueless patients allowed a completely unknown surgeon brought from out of state, placed in a building where there was already a successful surgeon, to surpass every breast surgeon in the metro area in volume of outpatient procedures in just 3 months. That was 2 years ago and now she regularly does double what some of our best private practice surgeons do. That kills private practice, the ability of a patient to choose someone outside a self-serving system seeking more revenue and market share, and prohibits new independent surgeons from establishing practices here because they could never compete with the system. I think there are major ethical issues with systems like the one we have and it astonishes me that no one in the medical or legal community seems to blink an eye. It concerns me just as much that the medical and legal community don't seem to see or care. As patients we are having the wool pulled over our eyes, our choice compromised and decisions to send us to physicians in the system instead of those that are truly the best for us. And as for our best surgeons and physicians. . . .it's just a matter of time before we don't have them or much choice anymore. This trend is deeply disturbing to me. In my area a very large non-profit hospital system has gone on a hiring binge over the past 3 years and now has 200 physicians employed by its wholly owned subsidiary and some directly employed. My concerns are these:
1. While described as a multispecialty group, the physicians are placed in 90 practice loactions in the metro area. Each practice is given a different name and presented and advertised as if they were private practices. Patients have absolutely no idea they are IN the system which refers to itself. To me, that is dishonest and takes away the patients’ ability to make an informed choice, both initially and in subsequent referrals. The patient doesn’t know they are being referred from one system physician to another.
2. Referring in system bypasses some of the best specialists we have. To test the system, I called the hospital physician referral line where all physicians with staff privileges are listed. I asked for a breast surgeon. I was given 5 names, ALL of whom were employed by the hospital system and all of whom were less experienced than the best know breast specialists in the same building, next door and in-between the two locations. These surgeons have loyally supported the hospital for years and are supposedly part of their consulting breast care team. The referral was made in the interest of the corporation, not in the interest of me, the patient.
3. Statistics from the state show clearly the decline in volume of private surgeons and the rise of employed surgeon volume. Because there is no real need to hire surgeons and many of the other physicians it hires, no increased demand, no increase in population, no wait times for physicians, it is inevitable that as patients are steered to system physicians, it damages private practices.
4. Patient steering of clueless patients allowed a completely unknown surgeon brought from out of state, placed in a building where there was already a successful surgeon, to surpass every breast surgeon in the metro area in volume of outpatient procedures in just 3 months. That was 2 years ago and now she regularly does double what some of our best private practice surgeons do. That kills private practice, the ability of a patient to choose someone outside a self-serving system seeking more revenue and market share, and prohibits new independent surgeons from establishing practices here because they could never compete with the system.
I think there are major ethical issues with systems like the one we have and it astonishes me that no one in the medical or legal community seems to blink an eye. It concerns me just as much that the medical and legal community don’t seem to see or care. As patients we are having the wool pulled over our eyes, our choice compromised and decisions to send us to physicians in the system instead of those that are truly the best for us. And as for our best surgeons and physicians. . . .it’s just a matter of time before we don’t have them or much choice anymore.

]]> By: richard goldstein http://www.physiciansnews.com/2009/02/04/the-boomerang-effect-hospital-employment-of-physicians-coming-back-around/comment-page-1/#comment-527 richard goldstein Wed, 03 Jun 2009 02:35:00 +0000 http://clients.ikodum.com/phynews/?p=2034#comment-527 If the hospital needs you badly enough, your contract will be negotiable. If they don't need you, then they won't need you in the future either, and you will be expendable. If a physician goes this route, they must understand the hard realities of relocating a medical practice. Their contract must protect them: No restrictive covenants (unless counter-balanced by multiple six-figure severance packages), notification of at least one-year of non-renewal of contract, specified practice setting, benefits package identical to CEO's package, specified grounds for termination with definitions of those grounds, occurrence type malpractice insurance (or an agreement that they will pay for tail-coverage under all circumstances) and unambiguous salary and clearly defined productivity bonus clauses. The contract should not bind the physician to performing any non-remunerative tasks that would serve to degrade her "productivity" and thus adversely affect her chances at a bonus. If the hospital doesn't come close to this, don't go there-you'll only be leaving again in a few years. You will want your contract to specify a minimum level of staffing for your practice. Since the hospital will be biling and coding, but using your name, you must be indemnified against any penalties assessed by CMS or other agencies/organizations. Everybody is happy working for the hospital in the beginning. The bitter divorce rate is high as physicians usually seem to wind up feeling cheated as the hospital gets the authority and the money while the physician is left with the responsibility. If the hospital needs you badly enough, your contract will be negotiable. If they don’t need you, then they won’t need you in the future either, and you will be expendable. If a physician goes this route, they must understand the hard realities of relocating a medical practice. Their contract must protect them: No restrictive covenants (unless counter-balanced by multiple six-figure severance packages), notification of at least one-year of non-renewal of contract, specified practice setting, benefits package identical to CEO’s package, specified grounds for termination with definitions of those grounds, occurrence type malpractice insurance (or an agreement that they will pay for tail-coverage under all circumstances) and unambiguous salary and clearly defined productivity bonus clauses. The contract should not bind the physician to performing any non-remunerative tasks that would serve to degrade her “productivity” and thus adversely affect her chances at a bonus. If the hospital doesn’t come close to this, don’t go there-you’ll only be leaving again in a few years. You will want your contract to specify a minimum level of staffing for your practice. Since the hospital will be biling and coding, but using your name, you must be indemnified against any penalties assessed by CMS or other agencies/organizations. Everybody is happy working for the hospital in the beginning. The bitter divorce rate is high as physicians usually seem to wind up feeling cheated as the hospital gets the authority and the money while the physician is left with the responsibility.

]]> By: John Samsell MD http://www.physiciansnews.com/2009/02/04/the-boomerang-effect-hospital-employment-of-physicians-coming-back-around/comment-page-1/#comment-6 John Samsell MD Fri, 13 Feb 2009 21:03:48 +0000 http://clients.ikodum.com/phynews/?p=2034#comment-6 Sir: I retired from the practice of Orthopaedic Surgery at a relatively young age because of the legal and economic climate that you are describing. Subsequently, I have been serving on a Board with my local not for profit hospitalto build an integrated health care system for the community. Over the last couple of years, I have interviewed many young physicians entering the work environment and almost none of the are interested in the "private practice of medicine" The general trend is to help them relocate, help service their debt-load, and provvide a good working environment. In the long run it creates a better environment in the physician-patient relationship than a practice where the practioners generate income from MRI scans, Physical therapy, facility fee for Amb. Surgery,all of which cause a conflict of interest in the present system and encourage excess utilazation for profit. Sincerely, John SamsellMD Sir:

I retired from the practice of Orthopaedic Surgery at a relatively young age because of the legal and economic climate that you are describing. Subsequently, I have been serving on a Board with my local not for profit hospitalto build an integrated health care system for the community. Over the last couple of years, I have interviewed many young physicians entering the work environment and almost none of the are interested in the “private practice of medicine” The general trend is to help them relocate, help service their debt-load, and provvide a good working environment. In the long run it creates a better environment in the physician-patient relationship than a practice where the practioners generate income from MRI scans, Physical therapy, facility fee for Amb. Surgery,all of which cause a conflict of interest in the present system and encourage excess utilazation for profit.

Sincerely,
John SamsellMD

]]> By: Jeff Angel http://www.physiciansnews.com/2009/02/04/the-boomerang-effect-hospital-employment-of-physicians-coming-back-around/comment-page-1/#comment-4 Jeff Angel Thu, 12 Feb 2009 00:35:51 +0000 http://clients.ikodum.com/phynews/?p=2034#comment-4 The problem is that hospitals have an agenda. There agenda is to make money, even the non-for-profits. As soon as it benefits the hospital to change to another doctor, because of any issue, they will do it and fire the doctor. For people who don't mind moving during their careers, this is a possible option. For people who want to establish long term roots, signing something over as important as your autonomy is short sided for temporary gains. Physicians need to think this through. The younger generation likes this model, because they don't want to take much call or work long hours. The older generation is tired of doing most of the work, and watching hospitals reward the young docs they hire for doing little work. That is why there is a temporary trend in hiring by hospitals. But when hospitals figure out it is very costly to hire young docs, and old docs figure out the hospitals will change the terms at any point, it will cycle back to private practice again...When physicians become employees, they lose the ability to price their time and hospitals control this last bit of autonomy, our time...sure they are singing you on now...one year contact, ha!!!!! The problem is that hospitals have an agenda.
There agenda is to make money, even the non-for-profits.
As soon as it benefits the hospital to change to another doctor, because of any issue, they will do it and fire the doctor.
For people who don’t mind moving during their careers, this is a possible option.
For people who want to establish long term roots, signing something over as important as your autonomy is short sided for temporary gains. Physicians need to think this through. The younger generation likes this model, because they don’t want to take much call or work long hours. The older generation is tired of doing most of the work, and watching hospitals reward the young docs they hire for doing little work. That is why there is a temporary trend in hiring by hospitals. But when hospitals figure out it is very costly to hire young docs, and old docs figure out the hospitals will change the terms at any point, it will cycle back to private practice again…When physicians become employees, they lose the ability to price their time and hospitals control this last bit of autonomy, our time…sure they are singing you on now…one year contact, ha!!!!!

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