How you can keep your surgeons happy — Part 2

By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Austin, TX

Last month, we talked about what our surgeons really are looking for in the operating room environment, be it freestanding or hospital-based. There were a number of questions posed to surgeons from all over the country based upon our database of 4,500 direct, one-on-one interviews with them. I ended last month’s column with some other questions that I told you I would answer in this issue. Here they are, and I’ve added more:

What do you love in the operating room?

Being top dog in the OR. We enjoy being looked upon with respect, not just for our technical skills, but for our ability to be in charge and help guide the facility into being an efficient place of business. It is nice if the staff could like us. That is not really required to make us whole, but we are like everyone else: We don’t like to think the staff don’t like or approve of our personality.

Reality check: We think that we should be in charge of the operating room environment, but we also know that we have to be backed up by strong administrative guidance and support. One thing that a surgery center that we own or have an interest in gives to us is the good old days that every surgeon longs for, at least inside the OR.

• Do you guys really want to be in control?

"Control" is a difficult concept. By control, we want to make sure that the hours of operation meet our needs and the needs of our patients. We want to have the ability to have input into the people we work with and the ability to hire and fire staff that makes a difference in patient outcomes and the work milieu. We are tired of being subservient to administrators who do not understand what we do and how we bring value to the organization. If "control" is making sure that we are in charge of the clinical environment, then yes, we want control. Any time someone has 51% of something, they are in control, not the people who have 49%.

• How hard do you think it is to run a surgery center or hospital OR environment, honestly?

As a rule, surgeons have NO training or expertise in management or administration. Granted, there are those extraordinary surgeons out there who do know what they are doing, but for the rest of us, we generally are unaware of our limitations. Therefore, that question is a difficult one to answer. As surgeons, we are accustomed to running our own offices, admittedly not always efficiently. The perception among many surgeons is, how hard can it be? If hospital departments cannot understand how important turnover time is to a surgeon, then how can a surgeon understand how difficult it is to run the operating room?

• How can hospitals head off surgeon relation problems?

I took a different tack on this question; I will give you their comments and then add mine.

Surgeons: Keep a level playing field among the staff. All physicians are equal; none should be "more equal" than others. In other words, stop favoritism with selected surgical staff. We know when administration doesn’t like us. How cooperative would you be with someone who does not treat you with respect? Provide us with an efficient place to do business. This is how we make a living! We cannot make a decent pay if half of our day is spend watching staff members take breaks and complain about the paperwork they have to do. Stop sending down policies that affect our workplace without consulting with us. Don’t think that the person you have on your staff who is supposed to know what the surgeons want actually does! Rotate the position, and get fresh ideas.

Earnhart: I am working under the assumption that those who generate the revenue are the clients and the rest of us are support staff to them. Sur-geons are clients of hospitals and surgery centers. Focus on their needs, not the needs of the support staff. Meet with surgeons in their office. The majority of surgeons resent sitting in your waiting room, looking around at everything that they paid for with their support to the organization, and waiting for you to finish your phone calls.

Sit in the surgeons’ waiting room for a while and see how they live. It is not nearly as opulent as yours.

Stop thinking of their surgical volume as yours. You provide a place to accommodate them. They decide, ultimately, where to take their patients. The tide has turned, and more surgeons are aware of the value of their contribution to your organization. Stop running your facility by the numbers, and try running it like it should be run: an efficient facility that caters to the needs of those it is trying to attach and keep.

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.

Contact Earnhart at 8303 MoPac, Suite C-146. Austin, TX 78759. E-mail: Web: