How Self-employed Physicians Took On a Hospital CEO--and Won

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February 06, 2019

In This Article

Hospitalist Plan Became Extremely Unpopular

The recent resignation of Allen Weiss, MD, CEO of the two-hospital NCH Healthcare System in Naples, Florida, was the culmination of an epic struggle between a powerful CEO and self-employed physicians on staff over control of their patients.

It wasn't the usual ouster of a hospital CEO, which you might see at a failing institution. Under Weiss's leadership, NCH had sterling financial and quality scores. Up until the very end, Weiss was beloved by his board and by many of his employees. And he still is a board member of the American Hospital Association.[1]

But on January 23, the NCH board voted to accept Weiss's immediate resignation. The decision followed an almost unanimous recommendation by the NCH medical staff that the board fire Weiss, which took place the week before.

At issue was a new policy, championed by Weiss, that assigned all patients on certain units to NCH-employed hospitalists. The policy started as a pilot in one unit last April. Three months later, Weiss pronounced it a success, based on data from the pilot. The pilot spread to two more units, and it was expected to eventually cover all of the system's 12 units.

Weiss's policy, however, was anathema to Naples' self-employed doctors, whose patients represent about half of NCH admissions. They were prevented from treating their patients in the hospital. Though they could still visit their patients, they could not write orders for them.

In its January 23 decision, the board ended the dispute over the program. The program will continue, the board said, but all physicians—not just NCH hospitalists—could participate in it.

The self-employed physicians on the NCH medical staff did not oppose the program itself but did oppose the way Weiss carried it out. So they consider this decision also a victory.

"The power of the medical staff and organized medicine made this happen," says Cesar De Leon, DO, a family physician on the executive committee of the medical staff and president of the county medical society. "Physicians on staff showed a strong message of unity of standing up for our patients and for ourselves."

Dispute Sparked Community Interest

Last fall, when the dispute started to heat up in public, the disgruntled doctors were lifted by a wave of public sympathy. Patients were concerned that their own doctors wouldn't be able to oversee their treatment in the hospital.

As is typical around the country, most Naples physicians do not personally go into the hospital to treat their patients. They depend on hospitalists. However, rather than using the NCH hospitalists, who are relatively new, they have been using their own.

These outside hospitalists say they were willing to work in the new NCH program but were not allowed in. If the new program were to go system-wide, as was expected, they would lose their jobs, and the self-employed physicians would have been forced to use the NCH hospitalists.

Meanwhile, some 40 concierge doctors in Naples, one of the largest concentrations of these doctors in the country, would have been directly affected if the policy went system-wide. Concierge doctors pride themselves on overseeing all aspects of their patients' care, including inside the hospital. Several of these doctors played central roles in the dispute.

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