David Hoidal will resign as chief executive officer of University of Alabama-Birmingham Health System effective Jan. 4. The University of Alabama at Birmingham has not yet named replacement to head the system, which includes 908-bed UAB Hospital, the Kirklin Clinic, Callahan Eye Foundation Hospital, Viva Health, UAB Highlands, Health Services Foundation, Medical West in Bessemer and Montgomery Baptist hospitals.
The American Hospital Association says that a letter recently sent to presidential candidates about specialty hospitals is "all fiction, no facts." In response, the AHA and the Iowa Hospital Association sent their own letter to the candidates that says limited-service facilities drive up the nation's healthcare costs and threaten to dismantle vital community resources for patients.
Paul Salles, an executive vice president of the Louisiana Hospital Association, has been tapped as president and chief executive officer of the Metropolitan Hospital Council. The Metropolitan Hospital Council represents the interests of community hospitals, which have all contended with a shortage of doctors, nurses and support staff since Hurricane Katrina.
Oak Hill Hospital in Brooksville, FL, has made $700,000 in improvements to its surgical department. The investment includes upgrades to thecystoscopy department and other improvements to the facility's operating rooms.
Now that we're nearly halfway through the last month of the year, I decided to clear out my in-box. In the process, I figured I'd share with you a few e-mail responses I've received recently. As I noted last week, many readers commented on my columns about generational differences. In fact, I posted a question on this topic on HealthLeadersMedia.com. At the time I am writing this, 52 percent of users say Gen X and Y physicians are inferior to previous generations, 27 percent say they are superior, and 20 percent say they are comparable.
On to the mailbag:
I Agree! From my perspective as a 50-year-old emergency physician who hires new grads regularly, the crop of physicians coming up through the ranks tend to approach medicine as a job--not a career. When they interview they want to know about salary and time off more than anything else. It's disheartening to see.
Michael Christopher, MD, FACEP Chief of Staff Emergency Department Medical Director St. Joseph's Hospital and Medical Center Phoenix, Arizona
Nonsense! I usually enjoy your columns on HealthLeadersMedia.com, but I must say that the criticism of Generation X and Y doctors by older physicians is just utter nonsense.
The "tradition" and "work ethic" of working 36-hour shifts every few days and being a "doctor" 24 hours a day at everyone's beck and call are based on the silly "macho" attitude developed over the years by doctors, particularly when they were so well compensated for their "selflessness."
Crazy work hours like that are inhuman and help no patients. The fact that more than 100,000 people die every year from medical mistakes, that more than 250,000 people are injured every year because of medical mistakes, that when a patient goes to a U.S. doctor, he/she has only a 50 percent chance of getting the proper treatment, and that there are disparities in medical treatment based upon race/ethnicity, gender, and age can all be linked to these hours and this mind-set.
Times have changed; compensation has changed; the expectations of a father's involvement toward his family has changed; the need for a mother to work while taking care of her family has changed.
Medicine IS a job.
We're not God. We're not even as important as we think we are. If I die, there are numerous healthcare professionals to replace me. Most of what I do can be done by a nurse practitioner, a nurse, or even a tech.
The older doctors have put themselves on a pedestal as if they are part of the most important and indispensable profession in the world. Generation X and Y doctors have gotten over those delusions.
Reality has set in.
Sincerely yours, C Ghosh, MD, MPH New York, NY
Don't Forget Pas I respectfully want to comment on your recent article entitled, Looking Upstream that ran November 8 on HealthLeadersMedia.com. In reviewing changes that you feel will hit the healthcare system over the next few years, I actually agree with most. One prediction hit me as being awfully one-sided in its view. That was the one titled "Family Docs Will Step Aside." While I also agree with what you said about that prediction, I have to point out a few other thoughts.
I am a PA who finished my training program in 1975. I have been involved in medical politics for almost 40 years and have lived through many changes to our healthcare system. NPs and, I might add, PAs (whom you omitted), have been providing high quality primary care for decades. There are about 100,000 in the primary care specialties and another 80,000 spread over a large number of other specialties. The fact that we already provide a large portion of primary care to the citizens of our country is not new. We are not interested in "taking over" primary care, just the acknowledgement that both professions are already providing a considerable share of it.
Also, both professions do bring something to the table regarding the future of medical care and what we bring, may in fact, help to save primary care. Why? Because as you pointed out, physicians generally do not want to practice in the primary care specialties any longer. They are making this decision with their feet. Many physicians are looking at medicine's future and seeing PAs and NPs as a solution to a number of the inequities seen in today's system.
We would ask that the larger organized physician groups start to view us not as competition, but as colleagues who want and value a relationship with them where we are given recognition as valuable professionals. We will be glad to give that recognition and support back. All one has to do is read a few articles on the retail clinics where organized medicine has made unprofessional remarks telling patients we will "miss things" or that we don't "know our limits."
Statements like this show that these groups are not ready to provide a comprehensive solution to this mess we call primary care delivery, as they will have to work with and recognize PAs and NPs (as hundreds of thousands of their members do now) to have these changes succeed. They should realize that statements like those only serve to drive away the very groups they need to be closer to.
My last point would be to ask why you see the increasing use of NPs and PAs as a negative? To quote the article, "I'd be especially interested in any predictions that are favorable for healthcare. Those are pretty hard to come by." I think prediction number two is quite positive, and I am surprised that as a health leader it appears you do not feel the same.
Sincerely, Dave Mittman, PA Secretary American College of Clinicians Natick, MA
I appreciate that these readers took the time to write me--and allowed me to publish their comments here. I'm always interested in hearing what's on your mind. Feel free to write me directly, or you can use the HealthLeadersMedia.com's new "remark" feature below this column.
Editors Note: We asked members of the Physician Compensation & Recruitment advisory board and other compensation and recruitment experts to discuss perceived generational differences between today's physicians and to assess how these differences might influence compensation and recruitment trends.
James W. Lord, principal, ECG Management Consultants "While generational differences are not new to the workplace, they appear to be more pronounced today than they have been during any other period. Most of that comes down to the simple reality that people are living and working longer than they ever have. As a result our workforce spans 18 to 70+ years, which to my count is at least four definable generations (Pre-WWII, Baby Boomers, Generation X, and Generation Y).
"Traditionally, the medical profession required physicians to be entrepreneurs who ran their own small business. As a result, long hours and patient service were a part of running a successful practice. Today, there are many more options (e.g., large group practice, employment, subspecialization, academia, etc.) and as a result we see some physicians looking to limit call coverage requirements or investigate part-time opportunities.
"However, administrators and independent physicians need not worry; the physician entrepreneur is not dead. In fact, high-producing, hard-charging physicians are still being minted in schools of medicine across the country. A well-designed compensation plan can provide a structure that allows variability across the group if desired.
"Tiered compensation systems help to balance extremes and ensure that appropriate levels of compensation are available to high, low, and median producers. The tiered plan is also helpful in addressing the cost of part-time practice and can be very effective mechanisms to balance across generations."
Marc Bowles, chief marketing officer, The Delta Companies Many baby boomer physicians:
Have one or two jobs, but look for a career
Don't fight the system and will put up with bureaucracy
Are more willing to operate "status quo"
Look for job security
Many Generation X physicians:
Have many jobs, look for the best opportunity
Routinely challenge, question and ask why
Are hungry for technology and learning
Find security within themselves
"The differences are real and good administrators will benefit from remembering who their audience is."
Max Reiboldt, CPA, managing partner and CEO of The Coker Group "There is no question that the Generation X physicians are extremely different in their thought processes relative to work ethic. As for values, I do not believe there are significant differences in values relative to clinical quality and patient dedication; however, in terms of work ethic, the 'Q of L' (quality of life) syndrome clearly exists.
"As it relates to compensation, many of the younger physicians still want comparable wages. They believe that their productivity should be maintained because of technology and practice support efficiencies and even if it is not (such as within a hospital-employed setting where productivity generally is less), they still expect commensurate benchmark compensation. In private groups, it is difficult to motivate younger physicians to produce at the level of productivity that justifies their expected compensation. That is why so many incentive-based plans are considered and indeed must be implemented in order to maintain sufficient motivation for individual productivity and also maintain a reasonable economic position for the practice and/or hospital network.
"Another area where the Generation X physicians are somewhat different relates to their willingness to take ownership-both literally and figuratively-in the business operations of the practice. Many physicians have the Q of L syndrome to the point that they do not want to become partners in the practice. They merely want to work as a good clinical practitioner, go home, and 'leave it all at the office.' Hospitals have continued to promote this attitude by the development of hospital-based specialists such as hospitalists, laborists, intensivists, and surgicalists.
"Thus, there are many challenges confronting the practice as they consider recruiting and even more importantly retaining younger physicians. The ability to assimilate all of these 'moving parts' is challenging. At the foundation of this is a sound operational and strategic plan including a well thought-through income distribution plan that still ultimately compensates even the younger physicians on a fair and reasonable incentive basis, mostly tied to their individual productivity."
A jury in Massachusetts has awarded $2.5 million in damages to a woman who received HIV treatments for almost nine years before discovering she never actually had the virus. In her lawsuit against a doctor who treated her, Audrey Serrano said the combination of drugs she took triggered a string of ailments.
This article examines Peter Pronovost's efforts to improve medical care delivery, specifically, how a simple checklist was able to "transform intensive care."
Thousands of registered nurses at 13 Bay Area hospitals affiliated with Sutter Health plan on striking on December 13 and 14. Hospital officials say patient care will not be impacted because they've hired hundreds of replacement nurses.
