Though hospital-physician relations have chilled in recent years, physicians still can cite hospitals that work hard to maintain good relations with them, to the benefit of both institution and doctors.
Joseph L. Murphy, M.D., a Chicago internist who is a member of the governing council of the Organized Medical Staff Section of the AMA, says: "The word 'friendly' doesn't apply to hospitals any more. Now you have the bigger corporation setting most of the standards, and an impersonality has developed."
But even Murphy says there are exceptions, such as his St. Joseph Hospital in Chicago, where he is president of the medical staff. Murphy says St. Joseph has a participative culture, even though it is a part of Chicago's eight-hospital Resurrection Health Care.
According to a 2002 survey of hospitals by Merritt Hawkins & Associates, a physician recruitment firm based in Irving, Texas, there is money to be made in cooperation. Each internist, the survey says, brings in $1.5 million a year for the hospital, while a general surgeon brings in $1.8 million and cardiac surgeon $3.1 million a year.
"A doctor is like an outside consultant to the hospital, but a consultant who has a great deal of control over spending," says Michael Deren, M.D., a thoracic surgeon in New London, Conn., who is on the OMSS governing council.
William Monnig, M.D., chairman of the OMSS governing council and a urologist in Edgewood, Ky., says physician-hospital relations are being chilled by highly competitive markets.
"Where there is competition for hospital services and physician loyalty, hospitals don't treat physicians as well," he says.
Hospitals may pressure physicians not to admit patients at a competing hospital, apply for full privileges elsewhere or serve on a competitor's committees.
They also may try to dissuade physicians from investing in competing ambulatory surgery centers, Monnig and others say.
However, they add that hospitals also are increasingly joining with physicians in joint ventures for ambulatory surgery centerss and surgery hospitals.
What makes for a physician-friendly hospital?Here is what some leading doctors in AMA's Organized Medical Staff Section think hospitals should do to keep their physicians happy.
- Physician self-government. The medical staff should elect its own president, department heads and representatives to ad hoc committees.
- No loyalty oath. Physicians should not be required to refer all their patients to the facility or be penalized for investing in an outside venture such as a surgery center.
- Strong ties between doctors and leadership. Doctors should have a few seats on the board, and the top administrators should be friendly and receptive.
- Hospital autonomy. If it is part of a large healthcare system, the hospital should be able to develop its own policies with physicians on staff.
- Full panoply of clinical services. Hospital should provide the full breadth of specialties and work closely with doctors in considering purchases of high-tech equipment.
- Basic amenities. Hospitals often don't appreciate the basic things doctors need, such as convenient parking, secure storage, a comfortable doctors' lounge and a work site on each unit.
- Cleanliness. Dirty hospitals are not only a quality issue but also drive patients and doctors away.
- Paying for call duty. Physicians are split on whether it is permissible to pay certain high-demand colleagues, such as neurosurgeons, for call time while others work for free.
- Use of employed physicians. The hospital can enhance local healthcare by hiring new physicians, but they should complement existing doctors and not compete with them.
- Go easy with patient safety initiatives. For example, computerized physician order entry should be phased in so physicians can acclimate themselves to it.
- Doctors should discipline their own. Physicians should be in charge of investigating quality allegations and disruptive doctors.
Some physician-friendly hospitalsFriendliness, like beauty, is in the eye of the beholder. Nominations came from consultants, doctors on the governing board of the AMA Organized Medical Staff Section and the MP staff. Included in this list are multihospital systems that nominators say have not lost the friendly feel of a community hospital.
- Delnor-Community Health System, Geneva, Ill. Competing against expansion-minded rivals, management at this one-hospital system listens and often acts on ways to develop value-added programs for its medical staff.
- Freeman Health System, Joplin, Mo. This three-hospital system has four doctors on its 13-member board and includes physicians on all decisionmaking committees.
- Hackensack University Medical Center, Hackensack, N.J. At this 683-bed independent hospital, nurses do more of the routine work, freeing doctors to spend more time on their more serious cases.
- Lehigh Valley Hospital, Allentown, Pa. Physician leaders play a key role in capital expenditure decisionmaking, and physicians participate in quality improvement, patient-focused care and performance evaluation.
- Memorial Hermann Healthcare System, Houston. The system and its provider-network subsidiary, which includes 3,000 physicians and an elected physician board, have combined to craft an ambitious Internet strategy.
- Norton Healthcare, Louisville, Ky. This seven-hospital group has created system-wide credentialing and quality reporting programs for doctors while retaining doctors' autonomy at each hospital.
- Memorial Hospital, South Bend, Ind.This 520-bed independent hospital has a fitness center for physicians and an electronic medical record system, and administration has an open-door policy for physicians with concerns.
- Scripps Health System, San Diego. Physician committees at this five-hospital system are key to strategic planning and management decisions and give the doctors greater access to the board.
- Sioux Valley Hospitals & Health System, Sioux Falls, S.D. This 25-hospital system emphasizes physicians and nurses working in teams, and the staff elects a "physician of the month."
- Wellmont Health System, Kingsport, Tenn. This five-hospital system has six physicians on its 17-member board, and the system pays for physician leadership training for newly elected officers of the medical staff.