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| Unify medical staffs within systems | ||
By Eric E. Shore, DO, MBA, FAAFP. Published Novmber 1998
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The place of physicians in Healthcare Systems is, in reality,
yet to be defined. It is instructive, though, to examine why our general approaches have
been fragmented at best, and adversarial at worst. As physicians, we are taught, from the beginning, to think autonomously. We have a very individualistic mindset, and tend to believe we are right while others are wrong. This serves us well in Medicine, where a sense of ego is all that stands between the clinician and insanity, but interferes greatly with everything else. We have always had separate hospital staffs, even in affiliated hospitals, because of a concept of "turf." Who will be chief? Who will decide? If Dr. X is good enough for small hospital A, does that make him/her good enough for University Hospital B? On and on it has gone, with the profession shooting itself in the foot with each division, and making us easy prey for those who take a larger view and are more organized and goal oriented. It is not the business people who keep us apart, we have done it to ourselves, and the results are going to be increasingly devastating. When once an Internist may have had an inpatient census of 6 - 8 patients spread across 2 or more hospitals, today that is probably reduced to 2-3 patiens at one hospital (or worse, all referals to "hospitalists" so that managed care patients can be cared for in a more "cost effeective" manner. This means that he/she doesn't have enough admissions in at least one hospital to be re-credentialed there, and staff privileges are eventually suspended (with NPDB consequences as well). With that loss of preivileges may also come "Deselection" by a managed care company which requires those priveleges as a prerequisite of being on their panel. This can be carried on and on, but at least in this vein, we have simple cures. Unify the staffs of hospitals within each system, provide a mechanism for re-credentialing physicians who have fewer admissions or refer to hospitalists, and then create a professional coordinating committee among the staffs of the various systems that would encourage a uniformity of approach. Only when these simple steps are taken, will we be ready to move on to secure more physician representation among the governing bodies of the systems within which we practice, because only then can we be taken seriously by people whose organizational skills are learned and practiced. |
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