6 signs of a splintering hospital-physician relationship

One of the best ways to determine a course of action is to first identify the worst scenarios and then steer clear.

Last September, Richard Gunderman, MD, PhD, professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department at Indiana University in Bloomington, wrote an op-ed titled "How to Discourage a Doctor" that was published on The Health Care Blog.

In the article, Dr. Gunderman details his time in the waiting room of a hospital executive suite in which he finds and reads through a document titled "How to Discourage a Doctor."

The pamphlet discusses the growing stresses healthcare executives face in today's changing regulatory environment and identifies the main cost driver in nearly every hospital as its medical staff. This document then goes on to outline ways for healthcare administrators to more or less control physicians and strip them of their autonomy.

An excerpt:

"To truly seize the reins of medicine, it is necessary to do more, to get into the heads and hearts of physicians. And the way to do this is to show physicians that they are not nearly so important as they think they are. Physicians have long seen the patient-physician relationship as the very center of the healthcare solar system. As we go forward, they must be made to feel that this relationship is not the sun around which everything else orbits, but rather one of the dimmer peripheral planets, a Neptune or perhaps Uranus."

Dr. Gunderman's piece is a satirical presentation of a burgeoning issue in healthcare today. The piece is meant to be humorous but not entirely — satires, after all, are intended to draw attention to greater societal and cultural issues.

In the case of "How to Discourage a Doctor," the cultural issue is evident — the often troubled relationship between physicians and hospitals.

Hospitals are increasingly acquiring physician practices, for any number of reasons. And though not necessarily correlated, physician burnout remains a critical issue.  This is concerning given the symbiotic relationship between an engaged and motivated physician and a safe, healthy and pleased patient.

Understanding what impedes a strong hospital-physician relationship thereby offers insight on how to improve them. Here are six of the most influential things in any hospital-physician relationship and how they can go awry — as inferred by Dr. Gunderman.

1. Financial support. When EHRs and billing and coding systems are costly, physician practices have few places to turn. If physicians feel forced to rely on the hospital for financial support and muscled into relationships with hospitals, the relationship can hold resentment and turn sour.

2. Job security and compensation. When physicians feel their job security and pay is being toyed with or held over their heads, this undermines confidence and can push physicians to feel beholden to hospital administration, infers Dr. Gunderman.

3. Decision-making. In the satirical world, Dr. Gunderman says the best way to discourage a physician is to refer to such their decisions as "anecdotal, idiosyncratic, or simply insufficiently evidence based." Hospital administrators are wise to avoid this.

4. Productivity expectations. Physicians are not factory workers. Increasing or  establishing exorbitant caseload expectations can wreak havoc. The goal shouldn't necessarily be to produce more and more.

5. Authority. If physicians actually possess limited control over their work, they may fall victim to "learned helplessness," which Dr. Gunderman defines as a sense that physicians cannot meaningfully influence healthcare.

6. Priorities. Physicians don't do the work they do for the benefit of the hospital — they do what they do for the patient. In the satirical world of discouraged physicians, Dr. Gunderman wrote, "When physicians think about the work they do, the first image that comes to mind should be the hospital, and when patients realize they need care, they should turn first to the hospital, not a particular physician." Physicians are the ones providing care — not the hospital. When priorities get mixed and hospital interests supersede patient interests, the entire healthcare model gets warped.

More articles on hospital-physician relationships:

AMA develops competency exams for aging physicians
9 things residents consider when deciding where to practice
The PPACA effect on physician practices: 7 statistics

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