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Hospitals go to great lengths to control physicians. They take undeserved public credit for physicians’ work. Curiously, physicians capitulate. Why?
Prior to doing a talk before a state specialist society, I attended a cocktail hour where the topic of conversation centered on hospital politics and new policies that I believe have little or nothing to do with quality or safety. They are, however, very effective at controlling and intimidating physicians.
The most egregious policy I heard about empowers floor and operating room nurses to formally cite fellowship-trained, board-certified surgeons for affronts or “infractions,” real or imagined, including questioning clinical decisions they do not agree with, all resulting in a hospital administrative review.
Many hospitals seem to be forgetting that doctors are their customers. Many physicians seem to be forgetting that hospitals are their vendors. Here is the reality of the physician/hospital relationship coming from a former hospital CEO:
• Hospitals cannot so much as dispense an aspirin without physician approval.
• Hospitals are not clinicians.
• Hospitals cannot admit a patient nor can they determine care.
• Hospitals are only as good as their staff is at following doctors’ orders.
• Hospitals are only as good as the diagnostic and procedural equipment and facilities, and the technicians who operate them, that they provide for doctors to use, perform procedures with, and interpret findings from.
• Hospital safety and clinical protocols are not determined by hospital administrators, they are determined by physicians.
• Hospital safety and quality of care is limited to how well staff executes doctors’ orders and follow doctors’ rules.
• Hospitals do not even credential physicians for admitting privileges, physician committees do.
As hospitals seek to gain more control over physicians, there are five things every physician can do to responsibly and professionally remind them that they do not have that power:
1. Hospitals are an extension of your practice, not the other way around. Their quality of care, service, and safety must meet your standards. If they do not, respectfully and professionally express your concerns and recommend how they can improve. If the hospital does not or cannot meet your standards, send your patients elsewhere until it does.
2. Hospital staff is there to execute your orders. They can also backstop you to prevent errors and omissions. Treat them with the respect and professionalism you expect in return, and they will typically respond in kind. If not, send your patients elsewhere until they do.
3. Exercise your right to select site-of-service in the best interest of your patients, including their financial interests. This includes specialists to whom you refer. If a hospital charges $5,000 for a diagnostic test, for example, and an independent facility of equal quality charges $1,000, the path is obvious. Let administration know that this is your policy, and it will not change until they do.
4. Lastly, if hospitals institute rules that impair or attempt to control or supersede your clinical judgment, or if they take other measures that are unacceptable to you in your clinical judgment or are contrary to your patients’ best interests, send your patients elsewhere until they change.
All of the above count even if you are employed by the hospital.
Only physicians and, to a lesser extent nurse practitioners and physician assistants, have the power of the pen. It is the real and only power in medicine, and for good reason. With that power comes responsibility. Exercise both, and ancillary providers, including hospitals, will respond or they will fail.
Hospitals physician committees set community standards that you must meet to earn privileges. If you meet those community standards, the hospital must meet your standards.
And good riddance to the hospitals that do not.