Tuesday, October 30, 2007

Hospital-Physician Relationships Revisited

Hospital-physician relationships deeply interest me. With the help of a former hospital CEO, Jim Hawkins, I even wrote a book on the subject “The Sailing the Seven “Cs” of Hospital-Physician Relationships: Competence, Convenience, Clarity, Continuity, Competition, Control; and Cash (Practice Support Resources, 2005.

These relationships have always been testy, tense, even tumultuous. Today, they are even more so because of tightening economic conditions. Hospitals and physicians, after all, must cooperate and compete at the same time.. This paradox has spawned the term “co-opetition” – a term yet to make into most dictionaries.

Recently, despite market forces of decentralization, convenience, and outpatient-based care, the power balance may be shifting to hospitals. The reasons are many:

Hospitals have more,

• access to capital,

• unified organizational structures,

• political influence as large employers,

• visibility in the community.

But the reasons may be even deeper. Because of the physician shortage, social obligations to treat all in the ER, and increasing tendencies of specialists to bolt from the hospital to form and own their facilitates, including hospitals, hospital CEOs are spending most of their waking hours these days on physician relationships.

From the perspective of hospital CEOs , the top three physician issues of the day may be,

• Emergency call coverage

• Physician employment

• EMR technology that tethers physicians and hospitals

Of these, paying physicians for ER coverage may be the most pressing because caring for patients at their sickest is the hospitals’ reason for being. It is clear specialists will no longer cover for free, given the physician shortage, declining physician reimbursement, and the malpractice climate.

Physician employment is growing fast because doctors don’t want to put up with business concerns, hassles, malpractice fears, and long hours. Doctors, especially the young but the older too, seek security and more balanced life styles.

EMR technologies binding hospitals and physicians together are much talked about, but slow to evolve because lack of return on investment on both sides of the aisle, physician resistance to information technologies, and the variety and instability of HER vendors.

What is your template for better hospital-physician relationships and ties that bind?

For publications related to this topic, see Sailing the Seven “Cs” of Hospital Physician Relationships, The Voices of Health Reform, Innovation-Driven Health Care, And Who Shall Care for the Sick?


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