Physician exodus (surgicaleth departus)

By Stephen W. Earnhart

President and CEO

Earnhart and Associates


We have talked much over the past several years about the opportunities available to surgeons outside the walls of the hospital. The trend is actually increasing as more physicians get on the bandwagon and join their peers in surgery centers or the corporate world.

We oversee many joint ventures between surgeons and hospitals on ambulatory surgery center (ASC) projects in which both parties are present at the meetings. While the process is dynamic and constructive, I am continuously amazed by the aggressiveness of the physician partners at these meetings. Gone are the days of accepting promises by hospital administration. The physicians are looking for answers and results, and they are not resting until they find the right response or someone who will give them the results.

Many physicians tell us that they are fighting for their careers and survival in this industry of decreasing reimbursement, increasing complexity, and decreasing personal reward and satisfaction. They tell us that past loyalty to the organization (hospital) is exactly that — in the past. Their desire for increased efficiency, competitive pricing, lower costs, and equity participation goes beyond personal relationships with hospitals or issues of loyalty. As a result, hospitals lost 12% of the ambulatory surgery market share — in just one year between 1997 and 1998, according to SMG Marketing Group in Chicago.

Can anything be done to stem this exodus? Actually, quite a bit. My firm has seen most of the ways that physicians and hospitals deal with this issue. Some of the ideas and strategies hospitals have employed in the past just don’t work at all, while others only inflame the parties and make the situation worse.

The real risk hospitals face when trying to prevent physicians from moving forward on an ASC project, either individually or with an outside group, is bringing it down to a "personal issue" and not a business issue. That often can backfire on the hospital on issues and programs other that just the ASC programs. Others strategies, however, can be quite effective.

How can you, from a senior-level management position, prevent your surgeons from walking out and opening their own surgery center? What will it take to partner with them instead of their doing it with someone else? Bottom line: Listen! You need find out what the issues are. Could this project be done as partners? What is the root problem? Can it be fixed?

If you want good, honest data, you need one-on-one, face-to-face, personal and private interviews with each of your surgeons (or the leaders in the groups). Develop a comprehensive interview sheet so your interviews are consistent and measurable. Have internal marketing people or someone within the system (who your physicians trust) conduct the interviews. If you don’t have that, get another impartial party to do it. But get to the issues. Quickly.

So many times we get called in when it is too late. Contracts have been signed, and commitments have already been made to others that are binding. The overwhelming response from physicians is: "Why didn’t they listen to us? We gave them the opportunity to work with us, and they turned it down."

The greatest compliment you can pay most people is to nonjudgmentally listen to their thoughts and ideas. I guarantee your surgeons have the answers to your questions.

Once you have the data — do something with it. We cannot recommend strongly enough: Develop a steering committee made up of your physicians. If you, as an organization, cannot do something with your physicians on a joint venture basis because of bond issues, board problems, certificate of need restraints, etc., let that steering committee be the author of such news to the rest of the staff. Most hospitals constantly think that only they can come to those decisions and deliver the results. Let your physicians be part of the discovery process. The absolute worst thing you can do is nothing.

Send newsletters to the physicians each month that update them on the progress of the ASC project. Let them know there is activity going on and that the project has not died or stopped.

Slip a copy of this article to your boss or senior management if you think this is an issue at your facility. The sooner you act, the better chance you have of working it out.

(Editor’s note: Earnhart can be reached at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: World Wide Web: