Monday, April 13, 2009

Are Medical Staffs Independent or Even Relevant Anymore...
I have been dragooned into a leadership position at Big Hospital. Hooray. Another physician (employed by the hospital) pointed out the multiple incestuous relationships contracts The Acme Surgical Group has with the hospital and asked was there some sort conflict associated with that. Upon a moment's reflection I was able to point out the other Faustian bargains contracts that past physician leaders had made with the hospital.
This got me to thinking, are the days of the independent medical staff numbered? And are they relevant today?
I define as an independent member of the medical staff as a physician who :

  1. Has full, unrestricted admitting privileges (no "consult" or "courtesy"privileges).
  2. Takes call, according to bylaws, without compensation from the hospital.
  3. Does not receive a payment from the hospital on a fee-for-service or other basis for providing uncompensated care
  4. Does not have a contract to provide services to any hospital, with the exception of such things as EKG, echo and PFT interpretation. I am uncertain as how to approach unpaid "medical directorships".

I will admit that the above requirements are stringent, but they probably were the norm for most non hospital-based physicians in the not too distant past. I will also admit that I do not meet my own definition of "independence". My thoughts as to the "why":

  1. The rise of hospitalists and the economic realities of outpatient versus hospital burdens for primary care providers has caused many to forgo hospital privileges
  2. Hospitals are having to pay physicians to take call and provide guarantees for Medicare/caid rates for unfunded patients
  3. Hospitals are increasingly employing specialist physicians, as the procedures they perform can generate income for the hospital.
  4. Given the lifestyle concerns of recent (and not so recent) residency graduates, the appeal of a salaried hospital position is strong.

It is also difficult to get physicians to participate in the ongoing workings of the medical staff. yes the quarterly meetings are popular because a free dinner is thrown in. But it is a Herculean effort to get physicians to agree to be on committees, much less show up for them, for many the same reasons that local medical societies struggle to survive.

Proponents of a strong medical staff have our old, dear, friend the Joint Commission to thank since they require hospitals to utilize their medical staffs for credentialing and peer review.

But if the members are dependent on the hospital for all or a goodly portion of their income, just how independent are they?

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