Keeping the doctors happy

A couple of local doctors sent me interesting letters responding to our April 29 editorial, “Let the hospitals hire.” One was too long to print and sent anonymously, the other not intended for publication. Both enhanced my understanding of a complicated issue.

The editorial argues for an end to California’s prohibition on hospitals’ directly hiring doctors, stating it is harming small rural hospitals and independent nonprofits like Enloe Medical Center. California is one of only five states that don’t allow hospitals to hire doctors directly. It does allow them to set up a foundation to do the hiring, but the process is expensive and cumbersome. The result is that the hospitals must work with private-patient doctors, who often are unwilling to take call—that is, come into the hospital when needed.

The first letter, the anonymous one, insists that, if the remaining private physicians were forced to compete with hospital doctors, “the whole fabric of community medical practice would risk collapse.” The foundation model, the author continues, provides the benefits of direct hiring without its potential pitfalls and is one Enloe can well afford.

I called Enloe CEO Mike Wiltermood to ask him about this. He didn’t buy the first comment, since direct hiring exists in all but a few states and hasn’t destroyed medical communities elsewhere. And the foundation model, while workable for some hospitals, may not be the best one for Enloe, he said.

The second writer was on a committee last year working with Enloe to set up a foundation. After a year and a half of effort, Enloe backed out, he writes, because it didn’t have or want to spend the $25 million it would cost and wasn’t sure it had the ability to run such a complex organization.

Enloe has trouble getting docs to take call and rounds, he writes, because it has a history of “mindless regulations and bureaucracy that make taking call there a nightmare.” Also, the reimbursement rates are too low. “Doctors did not stop taking call out of greed or laziness,” he writes, “rather frustration with Enloe’s bureaucracy and being tired of getting up at 3 a.m. to treat patients, often for nothing, who might well turn around and sue you.”

Wiltermood responded that the hospital could have raised the money. The main reason it withdrew was because it was uncertain of the outcome and decided to take a more gradualist approach before investing millions of dollars. He said he regretted inconveniencing the physicians.

He agreed about the overabundance of regulations but said they were the state’s, not Enloe’s, and meant to ensure patient safety. Some are outdated, but the hospital still has to comply with them. And he shares the frustration with reimbursement rates, saying Enloe has set up several programs to augment them.

The real issue is fairness to doctors, he said. Enloe can contract with them individually, as it does with numerous physicians (such as those in the Emergency Department), but because of outdated laws cannot provide them with benefits. That makes it difficult to recruit and support new physicians.

Ultimately, Enloe wants whatever’s in the best interests of doctors, he continued, for the simple reason that it’s good for the hospital to have satisfied doctors on board.