Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, April 30, 2007

Department Meeting

Every other month there is a luncheon meeting of the Department of Family Medicine at the hospital where I am on staff. Given that I no longer actively admit patients, the actual meaning of the term "on staff" lends itself to some interesting discussions, but I digress. Actually, there's a meeting every month, but its location alternates between two of the three hospitals in the "Health System" to which they belong. (The third doesn't have an active Family Practice presence; it's a large community version of the "general" hospital, which in this day and age means that it has a large number of highly specialized services.) The staff bylaws require attendance at two such meetings annually. You may ask why, if I no longer admit patients, I continue to maintain staff privileges at all. It is a reasonable question. The answer is that the insurance plans with which I contract require it as a condition of said contracts. Kind of circular, but there it is.

So every other month I leave the office as close to 11:45 as I can manage and make my way to the sprawling suburban hospital "campus", as they like to call the sprawling suburban complex of hospital, attached medical office buildings, the obligatory Cancer Center and the acres of concrete meadow that never -- and I mean never -- have a parking space the first three times you ride around them.

We used to meet in the Board Room, an impressive, mahogony panelled room with an enormous dark wood table surrounded with green cushy swivel chairs. Now, due to assorted construction projects, we are relegated to a tiny room off the Doctors' Cafeteria dominated by four rectangular tables pushed together in the center of the room and surrounded by light blue hard plastic chairs about four inches from the walls.

Lunch is served. It is provided by one of two alternating drug companies, so there has to be a brief "And now a word from our sponsor" moment on the agenda, to which I have no choice but to listen politely, even as I fume. Come on, guys; we all claim not to listen to this bullshit in our offices. Why to we just sit there and take it at Department meetings? I'll have to call the chair and ask to have it added to the agenda next time we meet.

There is a predictable and depressing pattern to these meetings. We complain that the ER isn't letting us know what happens to our patients when they present there. The ER representative says they'll try harder. We complain we aren't getting information from the hospitalists when our patients are discharged. The hospitalist representative says they'll try harder. Then we get to hear from the hospital president.

An older lady fond of perfectly tailored pastel suits, her presentation too is predictable. The hospital is doing fabulously! Admissions are up; surgeries are up; deliveries are up; census is up; they're raking in money hand over fist, up an impressive percentage from the last period measured (month, quarter, fiscal year; whatever.) I struggle not to wince during this part as I reflect on the fact that unlike the hospital, my income has been steadily declining year by year, quarter by quarter, sometimes even month by month. But it's the next part of the talk that always pisses me off.

They need money. They're building a new Patient Care Pavillion, new operating suites, a whole new ER, a new parking garage; all this shit that needs money. They have millions already but they need millions more. Fundraising efforts are detailed, and always inlcude mention of staff participation. That's right: in addition to paying $350 dues annually for the privilege of missing half a day of work every two months, just so the insurance companies will continue to allow me to "participate" by receiving 76 cents on the billed dollar (on average, for office visits), I'm also being hit up for money. Sorry, Madam Hospital President. I have kids to put through college.

Only once in the last eight years I've been at this hospital did this pattern change, and I'm pleased to say it was I who opened my mouth after the first part of the talk. I raised my hand and began ranting (that's really the only word for it) that it was all well and good that the hospital was doing so well, but I wasn't. Not only did I fail to benefit from any of those hospital dollars, but many of them came from my referrals; if not directly, then through my referrals to the hospital's specialists (instead of to the specialists at another hospital much closer to my office, where I was in fact on staff for the first ten years of my practice.) My colleagues joined in, and we basically chewed her a new one.

Neatly coiffed gray (excuse me; silver) hair: $120.00
Perfectly tailored pastel suit: $349.00
That deer-caught-in-the-headlights look: priceless.


At Mon Apr 30, 04:27:00 PM, Anonymous Anonymous said...

Good for you! Sometimes I think hospital presidents, CEO's, etc all live in a fantasy world. Next time, tell her to be the first to hand over some money. Lead by example!

At Mon Apr 30, 07:22:00 PM, Blogger Lynn Price said...

You are my new hero.

At Tue May 01, 11:38:00 AM, Blogger XE said...

Good on ya!

At Tue May 01, 03:29:00 PM, Anonymous Anonymous said...

Check with your insurance contracts. Mine no longer require me to have hospital admitting privileges, just the ability to get them hospitalized at the participating hospital (for you, via the hospitalists).

At my hospital (we are a one hospital town here) we are changing the Bylaws (hopefully) to include the category of Associate Staff. As an Associate Staff, you may visit your patients, look at their records, but not have Active Staff privileges. You are on record as being a Member of the Medical Staff, but you don't have to go to meetings! (You don't have a vote, either, but you are freed from the meeting requirement.) This still satisfies the "membership" requirement that ancient health plans and malpractice insurance plans may have.

I have been involved with Med Staff Leadership meetings for 10 years now. This idea is actually old. We are just slow getting it going. It is to help free folks like yourself who no longer desire to do hospital work and focus on your office practice, which you have done to help survive the declining office income. You have chosen spending productive time in the office rather than unproductive time driving to and from the hospital.

At Sat May 05, 07:55:00 AM, Blogger MonkeyGirl said...

There is no way her suit only cost 350 bucks. ;-)

You make me laugh. Consider yourself reciprocal blogrolled.

At Tue May 08, 10:45:00 AM, Blogger Sid Schwab said...

Our staff adopted a rule that if you missed too many meetings you were fined a hundred bucks. Well worth it.

At Wed May 09, 09:20:00 AM, Blogger CrankyProf said...

Oooh, I think I teach the occasional course at a similar Large Suburban Hospital -- in the same small room off the caf, even.

We crammed eighteen students (+ me) around those four tables. What a pain - literally.

The new parking garage at LSH is a bit over the top -- considering that the gates are up (meaning parking is free) after nine each night, and all darn weekend. No wonder they want $$ from y'all.


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