An e-mail memo by Kaiser Permanente physicians in Northern California shows Kaiser's doctors are chafing under changes designed to make the lumbering system more competitive.
The memo, signed by 56 Kaiser physicians, appeared on a Kaiser electronic bulletin board and was leaked to the San Francisco Chronicle. Kaiser made it available to MODERN HEALTHCARE.
The doctors called for replacing Harry Caulfield, M.D., as the region's executive director. Elected by Kaiser physicians in 1990, Caulfield's term expires next year. "We need a change in vision and personnel to avoid disaster," the memo said.
The doctors said Caulfield hadn't consulted with physicians before making "drastic cuts" that are harming "the caregiver-patient relationship." Kaiser has doubled the number of administrative personnel while cutting "front-line personnel," such as nurses, the memo said.
"Physicians are facing increasing scrutiny of every decision we make, yet administrators are not held to the same expectations for accountability," the memo said.
The memo has given fodder to managed-care foes. In a press release, the California Nurses Association said the physicians are showing that through "medical rationing" Kaiser has "taken medical decisionmaking power out of the hands of doctors."
A proposed state ballot initiative sponsored by the CNA is designed to combat such abuses at Kaiser and other managed-care plans, the CNA said (Jan. 29, p. 8).
Tom Debley, a Kaiser spokesman, said the memo was part of Kaiser's "democratic system." He said Kaiser's physicians were voicing their concerns about changes at Kaiser as part of the debate around the re-election of Caulfield.
Kaiser's elected board has nominated Caulfield for a second term. Kaiser's 3,000 Northern California physicians will vote on the nomination later this year, Debley said.
He said the memo was wrong about the number of administrators added to the Kaiser system, but he said he could provide no other figures.
Among other changes, Kaiser has implemented programs whose goals are to cut costs per enrollee at least 5% a year for the next five years, Debley said. "We will not do that at the cost of quality," he said.