Tuesday, June 22, 2004

Over the weekend I had the pleasure of attending the VHA Georgia Physicians Leadership College. Physician medical staff leaders from several hospitals across the state attended. The presentations were mainly concerned with how to run meetings and other such things. A recurrent theme was the need to, for lack of a better term, "spin" your message to most effectively reach your target audience. This was assisted by a tool called the "Medical Staff Menangerie". This assigned various members of the medical staff to animals based on their attitude, age, specialty, and personality type. So the lesson is that you have to approach the "young wolf" differently than the "lion king".
Based on the discussion there are a two big problems facing medical staffs in this day and age; call coverage and reimbursement and problem physicians.

The call reimbursement issue is causing a great deal of consternation where it is currently undergoing discussion. There is debate not only between physicians and hospitals but amongst physicians themselves whether call pay is a good thing or not. The hospitals are in a position of not really wanting to find additional money for call pay, but feeling pressure to do so rather than face a massive medical staff exit or revolt. Some physicians (usually older ones) regard unassigned call as a social obligation and a price to pay for hospital "privileges". They are four-square against any movement to secure additional funds. There are also issues of fairness in such a system. Does it apply only to trauma? If so, who gets the money? The general surgeons? orthopedists? plastic surgeons? Given that this question has been settled between the hospital and the Acme Surgical Corp., I am very happy. (We do get paid for call, BTW). The "pay for call" group makes their case by arguing that the requirements to take emergency call put them at risk from multiple angles. There can be a significant economic cost if you have to bump an insured patient to provide care in an emergency situation. There is a risk of litigation involved as well as outcomes under these situations may not be ideal. This combined with a general reduction of reimbursement from other sources makes such situations less attractive all the time. Remember that the ones raising these points during the meeting were not "troublemakers", but physicians who worked closely enough with hospital administrations that they were willing to foot the bill for the conference. A wise physician once told me that EMTALA turned care for the uninsured from a obligation that was freely and (to a point) gladly taken, to one that was legally mandated and now resented.

The problem physician is no longer the surgeon who throws instruments in the operating room. The physician who berates the staff and yells at them also falls into this category. Nurses nowadays are not going to tolerate the B.S. that was considered acceptable behavior in years past. The point was made that the real problem was not the incompetent physician who pitched a fit, since they were either ignored or on their way of the staff anyway. The problem is the otherwise "good" doctor who pulls these sort of stunts. This has the potential to become a patient safety issue since if a nurse gets yelled at enough for calling a physician, they won't call anymore and the patient may suffer. As medical staffs become less tolerant of such things, the policing of our ranks will improve.
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