A recent article on a
The Changing Business of Medicine still disturbs me (The Orlando Sentinel strangely requires that you pay for any article over a week old so I can only provide a link to the opening lines). The article is touted on the front cover of the business section as "a new model of medicine' and essentially introduces the Orlando community to some general surgeons now employed by Florida Hospital. Understandably the young surgeons like not having to deal with insurance, overhead, the investment of long hours and all the business-related matters that come with solo or group practice. Their malpractice insurance is paid by the hospitals – no small thing since Florida surgeons usually pay upward of $150,000/year.
One has to ask: why would a hospital pay $150,000 plus salary for 5 surgeons and pay for their office space and all administrative functions? Why would they undermine the surgeons who have loyally supported their hospital and outpatient surgery center?
I don’t think it is concern about patient care, especially when we have so many fine surgeons in the Central Florida area. We are a major city, not a rural area that has no surgeons.
I am concerned about 2 things:
1. that the action, for whatever reason they decided to hire their own surgeons, creates negative consequences for patients and their surgeons.
The general negative consequences are:
a) it undermines those surgeons who DO put up with the hassles of running a practice, dealing with long hours, and usually cannot afford full malpractice premiums – yet who stay in practice because they do care about patients. That includes my own surgeon. And it expects those same surgeons to continue bringing their patients to the hospital and outpatient surgery center while reducing the number of patients they see.
b) it reduces future access and choice for patients. Why would anyone go into surgery with not only the current challenges of malpractice risk and declining reimbursements, but now the fact that they would have to compete with hospitals? If this were the true reason, it reveals the band-aid approach to healthcare issues that tend to make the problems worse instead of better.
c) it creates an unfair competitive advantage for local surgeons since Florida Hospital has the marketing power of it’s 7 local hospitals and the resulting referral network. It also owns all the CentraCare 24 hour centers and major imaging centers. They can funnel patients to their practice.
d) it is potentially a conflict of interest. With a hospital signing a physician’s paycheck, realistically, who will the doctor be most loyal to in a situation where there is conflict between patient interest and hospital interest? What will it mean in terms of necessity and intensity of procedures for patients?
2. My second, and now larger concern is that, whether by deliberate intent or simply by effect, they are being dishonest with patients and the community.
Why would the hospital hire its own surgeons? I could understand it if it were for a very specific focus. For example, if surgeons no longer want to take on-call, or they need surgeons specifically for liver or other transplant teams, or more trauma surgeons for their ER. I could understand it if they needed a couple of surgeons to direct their general surgery residency program.
Yet, when I contacted the hospital, their spokesperson beat around the bush with reasons like “to provide critical services. . .residency . . .access for patients . . . a new blend of community and hospital employed staff . . . .blah, blah, blah -- but most of those reasons simply do not make sense.
• Access for patients is not an issue with so many good local surgeons of all ages and levels of experience.
• Hospital hiring undermines future access and choice for patients.
• Critical services would seem to imply things like on-call, ER, etc., yet I know someone who was referred to the group for a small melanoma, which any surgeon could do. I received a referral to the hospital employed group from one of the hospital’s local women’s centers for a biopsy. When I asked if there was someone in the group who specialized in breast health, I was told that any of them could do it. (By the way, there ARE surgeons in Orlando who specialize in breast care, some of whom are listed as part of the hospital’s own breast care team.)
• A new model of medicine. For what purpose? In the past, hospitals hiring physicians has been a costly enterprise for the hospital. Why is it being resurrected? One reason could be that with the power and size of a hospital, or hospital network, the hospital could negotiate higher reimbursement from insurance companies in ways that an individual doctor or even a small group could not begin to do. Yet it still seems the expenses would eliminate significant profit.
The only reason that makes sense is that they need patients for their residency program and the fact that all of the surgeons are listed as faculty supports that assumption. So, why doesn’t the hospital present the group to the public as the residency program?
My guess is that the ‘practice’ is set up to provide surgical cases for the residents to work with. I could be wrong, but I imagine most surgeons in private practice might be reluctant to have resident involvement with the increased malpractice risk. By the hospital having its own group, it can guarantee those cases and offset some of the expenses of providing supervising physicians for residents by income produced by the doctors in their office and in surgeries done at the hospital and its outpatient center.
And THAT disturbs me even more, not because they have a residency program, but because they are not upfront about it with potential patients in relation to this group of surgeons.
Part 2: Ethical conflict
