Staff revolt opens the way for new ED doc group
Staff revolt opens the way for new ED doc group
Manager prevents mass resignations
In early February 2008, all the ED physicians at St. Anthony's Medical Center in St. Louis, including ED medical director Ed Ferguson, MD, submitted their resignations over a dispute with the administration concerning the establishment of a physician group. Previously, all ED physicians had been on salary. That could have been the end of things for the department and its physicians, but instead, Ferguson and his colleague, Mike Rush, MD, went to work and eventually established their own democratic group, with Rush elected president and Ferguson medical director.
"This will be the first independent democratic [ED] group in St. Louis," says Rush. "I hope it is a much more positive model."
The trouble began when the hospital administration, which had been hinting at changing the ED employment model for several years, strongly suggested in September 2007 that Serio Physician Management, a Denver-based company, manage the process by first holding the contract and later transitioning to a physician-owned group, according to Ferguson.
Not all the ED docs were opposed to the concept, notes Ferguson. "I did not disagree with the concept, and most of us felt it would be a good thing," he recalls. "But I generally feel you should be aware of administration bearing gifts." The staff, he notes, were half-"boarded," and there was a suspicion that the administration planned to get rid of the nonboarded docs.
In addition, Serio just moved too fast. "In the interest of time, Serio was made the contract holder as of Jan. 1, [2008]," says Ferguson, noting that under this arrangement, the physicians initially would be employees and then transition into being owners in the contract. Under the plan, Serio would manage the physicians for at least two years, at which point the ED physicians would be able to buy the practice from Serio for an amount that would be based on the value of the practice at the time of sale.
"The hospital requested that we terminate our contracts with the hospital [rather than having contract terminated by them] effective the day before our contracts with Serio were to begin," notes Ferguson.
All of the doctors were given the opportunity to sign with Serio, he says, but many were reluctant to do so. "Some docs resigned because of the turmoil and their perceived need to secure a stable job. Other docs resigned because it was necessary to terminate their contract with the hospital in order to engage a contract with Serio," he explains. "Once things fell through with Serio, however, most docs decided to keep their termination effective because it wasn't clear what was going to happen as of April 1."
In addition, says Rush, "We had no choice in that process. They were going to be our management firm for two years, take an unspecified amount of money off the top, and we would not see the books until the last six months of the contact. Having this crammed down your throat is not optimal in anybody's mind."
Once the resignations reached a "tipping point," he says, everyone put up their hands and said they would not be part of a group with this structure, and they basically all said, I'm out."
Saving the day
Not content to see the whole ED physician staff disappear, Ferguson went to the hospital administrator and painted a stark picture.
"I said, 'It looks look like this could be very, very bad. As it stands, there will not be anyone working here as of April 1,'" he recalls. "I suggested he might want to talk to a couple of contract management groups and get a backup plan in place."
While the administrator was doing this research, one of the ED physicians tried to form a private group. "There were so many emotions involved he had trouble convincing enough docs it would be a good thing," says Ferguson. (Ferguson says this experience has taught him many valuable lessons. See box.)
It then occurred to Ferguson that if he approached all the doctors he knew in the community and handpicked a few to start the group, it might work. "The opportunity to start a new group from scratch comes once in a lifetime," he notes.
Rush says, "It would have been the easiest thing to turn away. But I'm from this community and did not want to see this happen to the hospital." So partnering with Ferguson, he also contacted physicians in the community.
Once there were enough physicians on board, they went to an attorney, formed a corporation, and gave a presentation to the medical executive committee. "We just received a letter from the hospital that they would work with us to get a contract in the next week or so to staff a new ED by April 1," Ferguson reports.
In fact, adds Rush, "They agreed to help us get up on our feet financially," although he would not reveal the exact amount of that financial support.
The administration was pleased that the group would include doctors with whom they were familiar, he says. "We will have seven out of 11 initial partners who are either present or past St. Anthony's docs," says Rush.
In addition, he says, administration has agreed to work with the group on some nursing issues it had identified. "Basically, we will do an operational analysis, look at some ways other large hospitals do things, and come together as doctors and nurses and decide optimal staffing ratios for our institution," Rush explains.
In early February 2008, all the ED physicians at St. Anthony's Medical Center in St. Louis, including ED medical director Ed Ferguson, MD, submitted their resignations over a dispute with the administration concerning the establishment of a physician group.Subscribe Now for Access
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