The 1,200 full-time faculty members at the University of California at San Francisco's medical school are on the verge of getting a vote into how medical center business affairs are conducted, according to the head of the Academic Senate.
The faculty's voice will be heard in business meetings by a representative body called the Clinical Practice Organization (CPO), says Lawrence Pitts, M.D., a professor of neurosurgery and chair of the Academic Senate.
Details still must be worked out as to the size and composition of the hospital's managing board, Pitts says. He all but predicted physicians would have one or more votes, although he was reluctant to be more definitive until the new UCSF hospital CEO is seated, citing the importance of maintaining collegiality.
The faculty's new role is the result of intense pressure brought to bear on university officials in the wake of a financial debacle that resulted from UCSF's disastrous 2 1/2 year merger with Stanford University's School of Medicine. Officials, shaken by the massive scale and severity of the merger's collapse, agreed to the faculty-physicians' demands.
Pitts led the negotiations on behalf of faculty with UCSF's senior administrators--the chancellor, the dean of the medical school, the chief medical officer and others. "I made them aware of the faculty's feeling of disenfranchisement, the feeling of 'no one is asking my opinion' concerning the merger. I don't think they (administrators) had perceived this; they thought they were giving us good information."
Pitts describes the CPO as a structure of department chairs and elected faculty members "who will worry about the management and financial side, about billing and collections, about contracting, quality assurance, best clinical practices" and other issues "where the rubber hits the road." A search is underway for the CPO director.
"There is a clear intent by the physicians to be more involved than they were in the past," Pitts says.
The CPO arose from the ashes of the failed merger of the hospitals and clinical enterprises of UCSF and Stanford's schools of medicine. Formally approved in concept by both universities in July 1996, the union was troubled from the start.
Designed to staunch the flow of red ink spurred by managed care, it was supposed to save tens of millions of dollars through such factors as eliminating duplication of facilities, personnel and equipment. But things didn't work out that way, and by last summer, faculty sentiment on both campuses was openly against continuing the merger.
Last August, top officials of the merged entity, UCSF Stanford Health Care, resigned in the wake of an anticipated $170 million deficit, the forced closure of a UCSF satellite hospital in a poor neighborhood of San Francisco, intense criticism in the state Legislature and the likely loss of thousands of jobs.
After the California state auditor threatened to file criminal charges against UCSF Stanford Health Care, Stanford's then-president, Gerhard Casper, formally called for an "unwinding" of the merger. On March 20, UCSF Chancellor J. Michael Bishop sent a letter to faculty members announcing the dissolution of the merger between the hospitals at UCSF and Stanford University as of April 1.
"The major problem the faculty had was the top-down corporate kind of management style the leadership used in planning and implementing the merger," says Warren Gold, M.D., a UCSF professor of medicine who opposed the union from the start.
Gold, who is chair of the Academic Senate committee on clinical affairs, was asked by Pitts to represent the faculty at a January retreat between faculty and administration where the CPO's role was hammered out. The new collaboration can only succeed, Gold says, "if both parties (faculty and management) feel it's important to sit down in the same room and talk."
But Gold is skeptical of the eventual outcome for a variety of reasons, not the least of which is his concern that faculty-physicians don't have the temperament, patience or skills needed to immerse themselves in the minutiae of administration and the bureaucratic infighting that frequently accompanies it.
"I don't know if you'll see a major change in (physicians') political behavior," Gold says.
Pitts is more optimistic, although he understands Gold's skepticism. "I think he is quite reasonably in a position of 'show me"'--but notes the faculty won't suddenly have to start tackling balance sheets and back-office billing mechanisms. "There are professionals the physicians can hire."
Asked whether that might include a physician practice management company, Pitts laughs and says, "It could be, but we're smart enough now to at least ask the right questions."
Alternatively, Pitts says, "If Mark Laret (M.D., the new CEO of UCSF Medical Center, whose appointment was announced on March 21) can work out terrific billing and contracting systems, it could be that we'd turn over the managerial things to qualified managers in the hospital."
On the other hand, Pitts warns, "If Laret feels the only way he can make the place work right is to have control of all the money, hospital and physician money, that would not work."
Laret was unavailable for comment.
Ted Shrock, M.D., UCSF's chief medical officer, remembers the day when Pitts told him and his colleagues that faculty felt out of the decisionmaking loop.
"I was a little puzzled by that because the people who put the merger together--and I was not one of them--had tried to communicate with faculty," he says.
UCSF has always run "on the basis of cooperation between leaders," Shrock says, "and I expect the same thing" with the CPO leader.
Shrock says the director will work cooperatively with senior administration.
But, he warns, "We don't want someone who will compete with the new person (Laret) we went through so much time and effort to (find to) lead the show."
In this uncertain and embryonic state of affairs, Gold already is warning against short-term solutions that "are merely Band-Aids." His warning comes in the wake of a University of California Regents meeting March 15 that predicted continued losses of at least $50 million at UCSF for the ten-month period ending June 30.
Even the optimistic Pitts acknowledges the future is cloudy. "If the local newspapers come out with a headline that says, 'Prominent Clinicians at UCSF Resign for New Jobs With Great Dissatisfaction,' that would be a sign" that the collaborative process is not working, he says.
Pitts says he made it clear to Laret during the interview process that "a willingness to compromise" was part of the job description and says Laret agreed with that sentiment.
"It's a clean slate, as far as I'm concerned," Pitts says.
Steven H. Heimoff is an Oakland, Calif.-based healthcare business writer.