Somewhat fictionalized deposition transcript of an emergency room physician in Virginia:
Question: Doctor, how long have you worked in the emergency department at Virginia Mountain Hospital?
Answer: 1 year.
Question: Are you an employee of the hospital?
Answer: No.
Question: Who is your employer?
Answer: I’m not entirely sure.
Question: Who signs your paychecks?
Answer: No one, I get direct deposit.
Question: Did you sign a contract with a corporate entity?
Answer: Yes. It says I am an independent contractor with Southwest EM Physicians, LLC.
Question: Who is your supervisor at Southwest EM Physicians, LLC?
Answer: I don’t know.
Question: Your CV says you have worked with Team Health / Schneider / Schafer / Apoll0 / AMN Health / TCW Global / Brightstar in the last 6 years. Why did you change jobs so much?
Answer: I didn’t change jobs. The hospital changed contracts. I still work for Southwest EM Physicians, LLC but they staff with a second party, who has a contract with (INSERT BIG NAMED VENTURE CAPITALIST OWNED STAFFING COMPANY) who contracts with the hospital for six months or a year.
Question: Do these companies have policies and procedures that you follow or that help guide you as an emergency medicine physician?
Answer: I don’t know.
Question: Do you follow the hospital’s policies and procedures for the emergency department?
Answer: I don’t know. I’ve only been to that hospital four times.
It is an odd exchange. One where I usually feel confused, and unsure who works where, who is the boss, and who is in charge of patient care.
But this is the new normal for emergency departments in small to mid-size hospitals. Why? Well, there are a number of reasons. None of them, as far as I can tell, make better patient care the motivating reason to outsource.
One group of Emergency Medicine Physicians, The American Academy of Emergency Medicine even writes about the downfalls of Corporate Medicine warning:
“The corporate practice of medicine has introduced several challenges and concerns that affect both healthcare providers and patients. Recognizing these issues is crucial for understanding the broader implications of corporate involvement in healthcare:
- Compromised Patient Safety: Cost-cutting measures and administrative burdens can lead to under-staffing, reduced quality of care, and increased risk to patients.
- Erosion of Physician Autonomy: Physicians may face pressure to prioritize profit over patient care, compromising their ability to make independent clinical decisions.
- Burnout and Job Dissatisfaction: The stress of working under corporate mandates can contribute to physician burnout and job dissatisfaction, ultimately affecting patient care.
- Increased Administrative Burden: Physicians often face a higher administrative workload due to corporate policies, reducing the time they can spend with patients and potentially decreasing the quality of care provided.
- Reduced Access to Care: Corporate policies and cost-cutting measures can result in fewer available services and longer wait times, reducing patient access to necessary medical care.”
So, what is the impact? Indirectly it means neighbors are no longer caring for neighbors. It means turnover is high. It means providers live hours and hours away, commuting to cover a shift to work in a facility they do not know, with nurses and mid-levels they have never worked with before. Then, these doctors return home to a different state. It means providers don’t know the capabilities of the hospitals where they provide care, as well as they should. It means they don’t always know the consultants, or where to transfer a patient in need of additional care. It means the patients being cared for are more likely to receive care from someone who is unoriented to the facility and community and less prepared to access necessary referrals or resources. It means, in my experience and opinion, more room for error.
So why is it being done? Money. Usually, one company makes money and another saves money. According to a recent article in Journal of American College of Emergency Physicians-Open private equity is buying these staffing companies at an increasing rate. “The profit-driven model raises substantial ethical concerns for patient care and physician autonomy.”
So why does this matter? Why should patients care who and how their local emergency department is staffed? Don’t let the name badge fool you. Your doctor in the ED is not likely an employee of the hospital. He or she may not be a member of your community, know the staff with whom he or she is working. In sum – it matters because it is a growing concern for patient care. In sum – it’s just one more place where things are not what they used to be.
