Work Book 1
New Models for Hospital-Physician Relationships
Hospital leaders around the country are experiencing growing pressures, challenges and changes in their relationship with “their” physicians. Physicians also play a variety of changing and often conflicting roles with the hospital—partner, competitor, employee or independent contractor.
On one end of the spectrum are disinterested and uninvolved office-based physicians. On the other end are hospital-based physicians whose finances and futures are inextricably intertwined with those of the hospital.
As these critical relationships evolve, several new realities are emerging. The first is the disquieting truth that hospitals need physicians more than most physicians need hospitals. The second is that each physician is unique, with different expectations and attitudes based on variables, that include, but are not limited to, his or her age, gender, specialty, income requirements, family situation and personal history. The third—and for hospital leaders perhaps the most challenging truth—is that the traditional vehicle for housing, organizing and facilitating the practice of physicians within the hospital, i.e., the hospital medical staff, is rapidly losing currency and may soon be an organizational dinosaur.
The Demise of the Traditional Medical Staff
The traditional medical staff model was originally designed during a period of financial robustness, when both hospitals and physicians could be independent, yet codependent. They were both relatively unaccountable to each other and rewarded by a payment system that reimbursed hospitals for their costs, or beyond them in some cases. Today, this model is showing its age and inappropriateness as the health care market squeezes out inefficiencies at every turn, demands quality and transparency that can best be achieved through real teamwork, and does not tolerate variations in cost and quality.
Symptoms of the declining utility of the traditional medical staff include physicians who: refuse to take emergency department (ED) call without compensation; open ambulatory care facilities that compete with hospitals for profitable patients; don’t attend medical staff meetings; are reluctant to serve as medical staff leaders; and have an adversarial relationship with admin-istration over resource allocation, capital acquisition, strategic planning, quality improvement and patient safety efforts. Most hospitals and medical staff leaders are responding to these issues as they emerge, addressing the symptoms of the problem instead of the core challenge.
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