Why are Hospital Employed Physicians (and their patients) Quitting? by Steven Mussey, MD


Why are Hospital Employed Physicians (and their patients) Quitting? by Steven Mussey, MD

Even though I am not an employed doctor, I keep in regular communication with hospital-employed doctors in our community.  Doctor-owned practices across the state are quickly being bought by hospital systems.  I have to admit, I am constantly tempted to toss the never-ending turmoil of practice management into someone else’s lap.

In theory, this sounds great.  From all angles, it appears to be a model that places the interests of the patient first.  The care transitions between the hospital and the outpatient world are fraught with repeated mishandling.  When the hospital controls both inpatient and outpatient care, this huge problem theoretically disappears.

Theoretically is the keyword.  In fact, the theory seems sound.  The Electronic Medical Record (EMR) is the same.  Everyone is literally working off the same page.  Hospital follow-ups should be easy.  Efficiency, Convenience, Patient Safety, Good Care…. It all seems hardwired into such a system.

But…. It’s not working.  The efficiency is failing.  The convenience factor is a joke.  It’s a nightmare for patients.  This makes good care more difficult and it throws safety out the window.

It’s a flop.  The doctors soon realize how awful their system has become.  They listen to angry patients.  They see their patients falling through the cracks.

The doctors get a bit “burned out.”  Some of the key doctors turn passive-aggressive, burdening those who have not yet lost all of their enthusiasm.

Notice!  I have not even mentioned doctor salaries.  Does that mean salaries are not an issue?

Oh!  They are definitely an issue.  But, that is for another post.

Ask patients about their doctor who has recently transitioned to a hospital owned practice.  You will hear the same.  As a private practice, we hear it all the time from their former patients:

“I used to love Dr. X.  I still do, but I hate the office.  I hate their system.  No one answers the phone.  No one returns my calls.  I can’t get an appointment.”

A big Orthopedic Group was purchased by the hospital recently.  They were never a model of patient ease and satisfaction, but the decline in service became catastrophic once their new owners gained control.  When our practice calls them, as a doctor’s office, SENDING THEM PATIENTS to see someone in the practice, Physician, PA or anyone, we spend over an hour on hold.  After a couple of weeks, learning this was the routine, rather than the exception, we stopped calling them.  If patients demand we call them, we decline.  We tell them the alternative practices or give them the opportunity to spend an hour-plus on hold for an appointment that will not be timely.

I’m not talking about patients with a bit of knee pain.  I’m talking about patients seen 24 hours earlier in the ER with a complicated fracture in need of a surgeon.  I’m talking about my receptionist who shattered her elbow roller skating, temporarily splinted in the ER on a Sunday, and told to see “Doctor X” on Monday ASAP, with no appointment time given in the ER of the hospital which owns the practice.  Of course, it was impossible for her to get the appointment after 90 minutes on hold.  Finally, she fled to a different orthopedic group.

That means the group totally failed to act as the “backup doctor.”  The hospital, as the practice’s owner, failed totally in the essential follow-up plan.   Is this a loss of potential income from a well-insured patient? Absolutely!  Is this failed hand-off a case of malpractice? Ask a lawyer….Do the doctors know this is happening?  Maybe.  Are they noticing a decline in their surgical caseload?  They certainly must notice their schedules are a bit of a mess.  They are definitely unhappy.  Patients report terrible experiences if they manage to penetrate the phone maze and get an appointment.  They describe horrific bedside manners from physicians who used to be adored by their patients.  In short, it is a practice that has turned dysfunctional.  The doctors and physician extenders, now hospital employees, are burned out, unhappy and it is showing in their work.

Is the hospital at fault?  Of course! The hospital is the manager of the practice.  The doctors are now mere employees.

One of the complaints I hear most from hospital-employed doctors: “We have no staff!  Why can’t they hire more staff?  No one answers our phones.  I don’t have a nurse.  I’m doing all my own extra work!  I never had to do this before!  They’ve cut us to the bone as far as support.”

Now, toss a pinch of salary dispute into the mix and you have doctors looking to leave.

Let’s not totally beat up on the hospitals, though.  Practices tend to sell because they find they have hit a brick wall.  In general, key practice leaders in such a floundering group find they have to make dramatic changes in order for the practice to survive.  They usually know exactly which changes are needed.  But they are stuck.  The changes are simply too painful or involve an infusion of too much money.

Surprisingly often, office buildings are a key source of trouble. The offices were built as an investment by the practice.  Now, older physician investors want to retire.  They want their money and they want it NOW.  Decades earlier, when agreements were created, no one ever planned for this.  Unfortunately, the practice now has a mess.

Other times, unproductive partners have been allowed to stay too long.  Staffing inefficiencies seem impossible to fix.  Overhead percentages became too big.

In short, the practice is sick. Can the hospital fix all of this?  The hospital infuses a lot of cash and buys the buildings.  That fixes the issue of buy-outs and real estate conflicts. Now, the management piece needs repair.

Unfortunately, hospital administrators have no idea how to fix the basic problem:  Healthy practices do not sell themselves to the hospital.  The practice, now in their ownership, has been sick for too long and is way too complicated to repair.

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