Volume 2, Issue 1

 

A Voice and Vote

January 25, 2011

Though there is an ever increasing shift in focus of direct care of patients from a hospital to an outpatient setting, prompted by both government and private insurance companies, the need for hospitals will certainly continue and thus it is most likely that physicians during their careers will come to interact with community hospitals on multiple occasions.

Which directly leads to the following question: are local physicians playing a meaningful role in the direction, administration and function of their community hospitals and if not, why not? Certainly, private bottom line for profit hospitals may be less inviting for community physicians to join in leadership/ trustee type roles, than community sponsored not-for- profit hospitals, but clearly they too would not wish to alienate the local community physicians and would welcome their input and often indeed seek it out, (especially from busy referring physicians) more forcefully than the not-for- profits.

Due directly to low patient reimbursement rates of most major insurance companies, community physicians can no longer financially support the sometimes significant time allotment required to manage the care of their patients admitted to their local hospitals. As a direct result of this phenomenon, a new physician specialty was born that of the “Hospitalist”.

This new entity has further increased the disconnect between the local physicians and their local hospital thereby further diminishing their role and influence on any decisions being made in the hospital.

Clearly then, how can the local physicians offer any opinion when they have little direct interaction and only base their opinions on their patient comments and feedback. Currently, there exits an ACGME requirement that hospitals with accredited residency training programs assign residents to many meaningful hospital committees. This recommendation is a good thing. as it provides them with a voice and vote at the table along with the feeling that they have a meaningful role in the institution they labor. Yet, rarely does level of participation continue past their post residency training periods. Though there is little to no financial incentive to become active in hospital committee work (and yes it often leads to time loss as well as direct financial loss) community physicians must continue to stay involved otherwise all those “administrative changes” that physicians don’t like will be done without any meaningful discussions and they will feel more like strangers in their community hospitals than their own referred patients.