Are Hospitals Betraying Community Surgeons?

The Orlando Business Journal announced this week in its cover story a 'New Model of Medicine'. The new model means that hospitals are not only hiring more hospitalists, but also specialist. In the article, they featured 3 young general surgeons who are now employees of Florida Hospital in Orlando.

While the article explains the role of hospitalists, it did not really explain the general surgeons. Reference was made to a surgical residency when the new medical school opens within a year or two and an attempt to get a liver transplant program in the future. These 3 surgeons in their 30’s are part of the faculty of the residency program. Perhaps they are the best and brightest of their programs and have 5 years or so under their belts. However, since so much of surgical proficiency comes from hundreds of surgeries, I find it curious that they bring in such young surgeons for a brand new residency program.

My bigger concern is why and how the hospital is employing 3 new surgeons full time right now when those programs are off somewhere in the future. There was no mention in the article that they are trauma surgeons or surgeons to simply take call – which I would think would be a selling point to the public if that’s what they are doing.

I could be wrong, but my take is that they are beginning to set up a hospital based program of general surgery that eventually will pull in residents, but that right now involves these new surgeons. It appears to be a trend around the country. Are these departments doing breast biopsies, gallbladders, hernias – all those procedures that are the bread and butter for community surgeons in private practice? If so, it is a betrayal of those physicians who support the hospitals.

Combine that with the massive marketing and referral system of a large hospital network with satellite hospitals all over Central Florida and I imagine it will indeed impact surgeons in private practice. The article talks about the new surgeons not wanting to deal with the hassles of the business side of practice, reimbursement, malpractice premiums, etc. which is certainly understandable. But what about those excellent surgeons in the community who ARE dealing with all those hassles – and now having the hospital they help support undermine them by creating its own department in competition with them for patients and facility time? The hospitals should be actively finding ways to partner with and assist physicians ‘dealing with the hassles’. Hospital systems could use their size and power to push for insurance reform, standardization and other ways that would benefit their own bottom line as well as support private practice surgeons. Instead they undermine them. The surgeons here deserve better support.

As a patient who has benefited from a private practice surgeon, I am concerned and angered. If surgeons are struggling with declining reimbursements and the ‘hassles’ while trying to provide quality care, what is going to happen with a massive system sucking in referrals and perhaps having priority for facility time?

As a patient, I am also leery of surgeons who would have full responsibility for their patients and yet be beholden to their corporate employer. I want, and have, a surgeon who, if necessary, will stand up to policies, procedures or anything that prevents me and other patients from getting the care we need. Will an employee of the hospital be willing to take on the institution that pays their salary?

If the hospital creates this surgical department in direct competition to our community surgeons, not only surgeons will suffer, so will patients.