Don't worry.  Be happy.  Your future is all planned.

The only problem is that it's been planned by the hospital and you might not like what they have planned for you.

Controlling the Medical Staff

For the past decade or so, hospitals across the country have been making a concerted push to gain control over their medical staff.

They have seeded lockstep medical staff officer promotions with employed or financially compromised physicians.

They have adopted policies such as conflict of interest policies and "side" rules and regulations outside of the medical staff bylaws that, they claim, do not require MEC or medical staff-wide approval.  Those policies permit the administration to remove physicians from practice at the hospital outside of the protections and process of the medical staff bylaws.

Employment/Financial Control

In states allowing the direct employment of physicians, and in others through devices such as foundations and via significant stipend support arrangements, hospitals have sought to buy the cooperation of a significant percentage of the medical staff.  In many cases, their controlled physicians have reached the tipping point such that they outnumber the non-controlled physicians participating actively in medical staff affairs, thus allowing the administration virtual control over the staff while feigning its independence.

ACOs and Physician "Alignment"

Closely related to the previous point, hospitals are taking advantage of society's communal phase of the Me-We Cycle^TM (see the October 31, 2011 issue of the e-Alert) to create Accountable Care Organization models and other so-called "alignment" structures to gain financial and political control over the members of their medical staff.  Of course, the very clear but seldom mentioned message is that if you are outside of the structure, you will be excluded from any significant financial or professional role in respect of the hospital's community and its referral patterns.

Replacing Professionals with Paraprofessionals

Hospitals are benefitting from the expanding role of paraprofessionals.

Take, for instance, the push by CRNAs to be recognized as equivalent replacement providers of anesthesia services.  Hospitals, seeking to break the financial and medical staff voting block hold of anesthesia groups, are often more than willing to accept CRNAs in place of anesthesiologists.  They view them as cheaper, more controllable and disposable.

Surgeons supporting this move will be shocked to learn that surgical PAs will soon be pressing for the ability perform some procedures unsupervised. 

Dr. Nurse

Doctorate degrees are becoming the top professional degree in many paraprofessional categories.  Once the nurse specialist performing your function becomes a "doctor," you will become irrelevant - or so goes the thinking of hospital-centric healthcare pundits.

What You Can Do

Become involved in medical staff activities.  Only a very small percentage of medical staff members take any interest in participation. 

Lobby hard to preserve the traditional patient-care role of physicians.  Physician extenders are one thing; physician career executioners are another.

Demand that the medical staff has separate, independent counsel, not an attorney controlled by the hospital.

Push for the incorporation of the medical staff to clearly separate its existence from that of the hospital.

Or, you can do nothing and let the future that the hospital has planned for you come to fruition.  After all, you have been guaranteed a choice in regard to healthcare. 

*COMPLIMENTARY*