It is a common and unfortunate scenario in emergency medicine to see an emergency department staffing contract change. Frequently, the physicians, physician assistants, and nurse practitioners are notified late in the process. Sometimes, they are given the opportunity to stay and practice at the same hospital under a different corporate name. Contract turnover is rarely anticipated, and can cause significant disruption to an emergency department. If you have spent a number of years working in your department, you may believe that your company has an excellent relationship with the hospital, and that your contract is not at risk. Having seen this occur several times, here are some scenarios that should bring you cause for concern:
- The waning relationship: If you are a physician administrator, try to recall the first day you arrived at your hospital. Remember the meetings and group decision making that occurred between you and the senior executives (chiefs, VPs, etc) at the hospital. Each of them had a pain or pressure point and you made a list of what those were. Your task was to handle those issues while moving the department forward. You met regularly, you gave frequent updates, and though it was not always good news, the general consensus was that you were accomplishing the goals one step at a time. Fast forward 10 years and you don’t seem to have those meetings anymore. After some time, it was felt the department was moving along well and the meetings were unnecessary. Communication was relegated to email or worse, an intermediary. It seemed to make sense. After all, you were busy, they were busy, and you could always call if it was urgent. You lost track of the pulse on the organization and what was happening at the senior level. Do you know what your CEO is hearing about the ED ? Did you know that your CEO gets regular requests to take over staffing? Did you know there were problems he/she was having with the ED? Did you know your competition requested a meeting with your CEO and it was scheduled just to keep “options open” ?
- The problem physician: You run a well oiled machine and the ED performs well. You have some characters staffing the ED, but hey, who doesn’t? Medicine is diverse with a variety of personalities and physicians are no exception. Surgeons have the worst reputation, and you don’t have anyone like that on your staff. Sure there may be one or two docs who are difficult. They have difficulty communicating with staff, they anger easily, and they talk … to everyone. They talk to administrators, consultants, friends, board members, and community members. But it’s just talk. It’s harmless. They work alongside nurse who give them nicknames and have to work around their quirks. You’ve counseled them and behavior has not changed, but we all know physicians don’t grow on trees. It takes years to find a good fit, so we placate senior administrators by having “talks” with our problem physicians. Your competition knows it. In fact, this may be one of the most common entry points for a “talk” with a hospital administrator. “You have a problem doctor? Maybe two? We can take care fo that for you?… let us manage the doctor and either rehabilitate her/him or replace them.” Or better yet “you give us a list of the ones you want and we will replace the rest.” Unfortunately this is also an extremely common method of taking over a staffing contract. The lure of a new panel of providers with expert qualifications and impressive bed side manner is significant. Your administrators are not uneducated, and know that there is a team of starter docs that begin the new contract and are eventually replaced. But that period of time may be all that is necessary to help with a critical period, pressure from a board of directors, or even to help exert control where none is perceived. Trading their current problems for theoretical ones down the road may be just what they need.
- Lack of innovation: This one is more of a challenge. In emergency medicine, we are the kings and queens of work arounds. We are the epitome of flowing water, looking for the path of least resistance to achieve our goal of patient care and flow. At some point, there is going to be disagreement about the solution to a problem. A long standing group may have the luxury of digging in heels and waiting out an administrator in order to gain a critical resource. But, this approach has consequences. The department suffers, and each side develops blinders around an issue and looses focus on the patients. There are times when a department’s performance may suffer for years. During that time, administration begins the search for other options. When the physician group is perceived to be the problem due to a lack of teamwork, it is easy to begin looking elsewhere. Teamwork may not lead to a perfect solution, but consistent progress is necessary. Innovation comes in many forms: hiring new graduates who bring fresh perspective, employing physicians with prior experience, consulting friends at other departments who have had to combat similar problems. No matter what you are experiencing, someone else has dealt with a similar issue. Utilize your resources, membership organizations, other directors, whatever it takes. Maintain the focus on the patient and safety and away from personal conflicts.
If your emergency department finds itself in the midst of a staffing contract change, the American College of Emergency Physicians provides guidance on many of the issues encountered during turnover in this document.
If your emergency department is battling performance or patient flow problems, reach out to us here. We can help.