I found your recent article, “To Terminate or Not to Terminate?” (The Rheumatologist, April 2015), very relevant to my practice.
The hospital system I practice in, Summa Health, Akron, Ohio, has two rheumatology groups with active hospital privileges. My partner and I are both part-time female rheumatologists who work for a hospital group, Summa Physicians Inc. The other group consists of six full-time male rheumatologists. When the other group decided to cover hospital consults only on private-pay patients who were already in their practice, my partner and I were faced with the prospect of covering most rheumatology hospital consults all year long. The hospital could not force the other group to take calls, and it was implicitly implied that our group, which is a physician group allied with the hospital, would then take all the calls.
We tried to do this for a couple of years, but it was a burnout situation when we were faced with the demands of a busy outpatient practice and family life. I myself have six children. I eventually told the hospital that I would look for work elsewhere if my call volume was not adjusted. The hospital admitted that it could not force us to take calls either at this point.
Here is the system my partner and I came up with. It has worked relatively well for the past six months or so:
- My partner covers routine consults two days a week, and I cover routine consults one day a week. Otherwise, only emergency consults are called to whichever one of us is on call for the remainder of the week.
- All consults are doctor to doctor only. This step alone cut our consults down by about 50%. Only essential, relevant consults were being called to us. Plus, as you allude to in your article, we were getting the information directly from the physician about what the problem was and then could communicate our recommendations to the same physician, which I think is in the best interests of the patient.
- We have the deciding say in whether we will come in to see the patient. For a routine consult, the patient needs to be admitted with a problem relevant to our specialty. If we can work the problem up as an outpatient and give guidance to the primary care service, we often choose this option. We do not, for example, want to see someone for workup of a positive ANA who is in the hospital for diverticulitis or diabetic ketoacidosis.
I feel my experience would have been much better if my employer had recognized that my partner and I were in a burnout situation. They did not offer us guidance, and we were left to discover on our own that the hospital could not force us to take coverage—although we were able to come up with a reasonable plan to handle hospital work, one that seems to make everyone happy.
Kim Stewart, MD
Summa Physicians Incorporated Rheumatology
Author Colin C. Edgerton, MD, replies: Thank you, Dr. Stewart, for sharing your experience. We commend your efforts, and we find the solution that you negotiated with your hospital employer a wonderful example of physician leadership—doing what is best for the patient while maintaining autonomy of practice.
We share your concern that hospital employers be able to assist physicians by proactively recognizing on-call burdens and offering solutions. Many physicians may feel that it is their implicit duty to accept the status quo and may not realize that better systems may be negotiated.