J. Michael Pontious 2014-07-30 04:55:08
So What About the Medical Staff? One of the things never taught to me as a resident was my participation in the hospital medical staff. I do remember, as a resident, going to medical staff meetings in the small hospital in which I trained, because there were two or three members of the medical staff that were rather spirited and would often come quite close to fisticuffs... back in that day there was not much of medicine that was entertaining, so you went to these meetings just to say that you were there when the stuff hit the fan. But there was very little taught or mentored about the responsibility...I am afraid that we are now reaping the unintended outcomes of this kind of omission in professional training. These days I look around at hospital department meetings and physician attendance is horrendous. I know there are lots of excuses....”this is not an efficient or effective use of my time”, “I am losing money each and every moment I am here”, “Nothing ever gets accomplished in those meetings” or “until they start paying me for my attendance, do not expect me to participate in this sham”. Each and every one of those excuses contains a strand of truth, but there is a more subtle and pervasive process going on at the level of leadership decision making by hospital medical staffs...they are not waiting for any of us To figure this out before proceeding. You cannot really blame the hospital, who left to their own devices would rather not deal with members of the medical staff. The relationship is often contentious and strained. Although both members of this relationship would like to see this as a partnership, it rarely is a partnership. And yet the Joint Commission, Centers for Medicare and Medicaid Services, the Oklahoma State Health Department and a slew of other regulatory organizations have dictated that members of the medical staff be involved with the decision making and quality of services provided within the hospital. So the hospital, by hook or crook, seeks Medical Staff input. As it stands now, that is by the few brave souls who continue to see their participation as part of their professional responsibility, than other physicians who constantly have an “agenda”, or had their arms twisted and in a moment of weakness agreed to the task, but only as a short timer. And then there is the major change over the last decade or so which is one of the more subtle changes of leadership, in the use of hospital employed specialties or physicians who are employed by the hospital.Participation in Medical Staff leadership is embedded in their contract. The power of the contract is utilized as A club to motivate the physician to participate in the process. I find this an extremely anxiety provoking situation.It rarely is what is best for patient care and more often than not this ends up being what is the best decision for the bottom line. We have all been hit about the head and neck with the mantra of “Where there is no margin, there will be no mission...” I sense that the future will hold more of this kind of change for those of us that continue to take care of our patients in the hospital environment. As the silos and walls surround each of us in the new world order, I believe the quality of patient care will be degenerated.Utilization review and peer review will become statistical games. Medical staff input will fade away and quality and clinical review in hospitals will Be directed, measured and defined by non-physicians. This will not be good for our patients...this will not be in the best interest of the institution and I know it will not be best for our profession. We are very close to closing another chapter in our professional lives with our abdication of Hospital Medical Staff direction to the institution. As for me, I am going to continue to play the game and keep looking for those moments when someone believes in something strong enough to come to fisticuffs to make their point...seems to me the world was much more honest in those days...
Published by Oklahoma State Medical Association. View All Articles.
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