Sandy Brown, MD


September 12, 2008

Several years ago, a local health clinic had me piqued. As a federally funded rural health center, they were obligated to take after-hours care of their patients, but they had no doctors on their staff qualified to perform hospital medicine and no contracts with community physicians to cover hospital admissions. Instead, they chose to dump them on the admit doc on call for unassigned patients. That stuck in my craw, for a number of reasons. First, their patients were not –unassigned–; they consider the clinic to be their healthcare provider. Second, the clinic received special dispensation for taking care of Medicaid patients and needed to comply with funding requirements, which stipulated 24-hour coverage. Third, they were a competing medical practice but did absolutely nothing for me in return for my services. Fourth, I hated feeling used.

Furthermore, they received grants and loans that solo practitioners were ineligible for, for funding the building costs of their 14,000–sq ft facility ! But every time I called the clinic administrator, she pled poor and said that they couldn't afford to hire a locum or pay us for taking call. Because I was not in a call group, whenever I wanted to get out of town for a weekend, I had to either swap for a medical admit day or pay my colleagues for the favor. Sign out to medical admit without first clearing it with the doctor on call? That was professional discourtesy, and probably abandonment of my patients to boot.

Finally, a colleague and I had to send them a formal letter saying that we weren't going to interrupt our day or night to take care of their patients anymore; it was unethical, high-risk, and possibly illegal. Putting it in writing got their attention, and pushed them to enter into an arrangement with a larger group for coverage. Why was it so hard, I wondered, to get these people to do the right thing?

What I find galling is the general lack of regard in which we physicians seem to be held these days by administrators and even hospital personnel. I don't mind being called Sandy rather than Dr. Brown, but some of my colleagues do, and can't seem to get nurses and techs to stop using their first names. I also don't mind not having convenient doctors' parking at my hospital, or not getting free meals in the cafeteria. (Lunch is my time to get away from my practice.) However, I do believe that having a doctors' dining room, as with doctors of yore, would contribute to collegiality and better patient care, a relatively inexpensive investment that would yield great dividends among physicians who seldom find another reason to visit with one another. Even the –doctors' lounge,– which in a bygone era was a morning oasis stocked with choice edibles where physicians gathered to relax before starting their day, has become an anachronism. Unfit for lounging in, our hospital finally gave our lounge a makeover last year; it had become an embarrassment to show to physicians who we were recruiting. We are given free coffee, prepackaged baked goods, and occasionally a piece of fruit. There's no reason to gather at that watering hole.

Is there a concerted effort to divide and conquer us, or is it all just part of the hubris that managed care has brought?


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