Wednesday, December 15, 2010

Family Medicine: Hospital Staff Holiday Parties, Diminished Family Medicine Presence and Bananas Foster

Around Christmas time, hospital medical staffs have Holiday Gatherings to hold the quarterly medical staff meeting and celebrate with a lavish dinner, music and pleasant comaraderie.  Each physician or non-physician member of the medical staff is invited to bring a guest to share in the celebration after the meeting.  The exact format varies from medical staff to medical staff.  I belong to two hospital medical staffs in one hospital network.  I enjoy the Holiday Parties.  I'm curious about what's happening with the physicians and the system.

This year, for the Holiday Party, the big community hospital rented the main level of a performing arts center downtown in the major city nearest the hospital.  Hundreds of physicians, spouses and significant others and hospital leadership gathered in a grand "eatathon" and brief medical staff meeting.  The chocolate fountain was a hit, but many missed the Bananas Foster that was a tradition at the smaller venue of previous holiday meetings.  The Indian food was wonderfully spicy but the music was too loud for casual conversation within about 90 feet of the entertainment (forcing some to eat more to remain sociable).

Near the salad bar, I conversed with a cardiothoracic surgeon about a shared patient who  had a difficult situation.  He was worried about her and the complex decision process that faced her.  I offered to help in the clarification session to aid in patient understanding.  I picked a seat at an empty table where a plastic surgeon joined us for conversation.  He is in private practice and proud of his certified operating room where he can do plastic surgery without a hospital.

The chief of staff announced the retirement of a general internist who had practiced in the area and admitted to the hospital for 45 1/2 years.  Wow!  How many thousands of patients must he have served.  I felt humble.  While later walking around the performing arts center to find a less noisy location to be able to hold a conversation with a friend about our family, another physician greeted me and stated that he was closing his endocrinology practice in 4 months.  He thanked me for referrals over the years.  A greeting to a medical school classmate and polite,"What are you up to these days?"  brought the response, "A lot, we just sold our practice to this hospital network, who out bid the competition."

Retirements and selling practices in bidding wars caught my attention.  There is movement in the system.  People are jockeying for position.  How do you hedge your bets?  How do you best serve your patients?

One day later, my wife and I attended the small community hospital Holiday Medical Staff Meeting.  We voted for staff leaders before the meeting.  All candidates ran unopposed and were announced as winners later during the meeting.  A brief slide show showed the progress with the new hospital next door to my office.  Enthusiasm bubbled through the room.  The food was great (pecan crusted walleye and sushi were unique items).  The dessert included the Bananas Foster and the same chocolate fountain as the previous evening.

Conversations with an urgent care medical director who trained in family medicine and another family physician who has a huge practice both centered on family medicine workforce development.  Who is going to see all these patients?  More and more are showing up at the urgent care with no family physician.  Many are from practices recently vacated by the 5 1/2 family physicians who left our county in the last 19 months.

The hospital network trains physicians, including cardiology fellows to help with the new heart hospital they just opened, but none in primary care, so they have no way to replace these physicians unless they come from elsewhere.  To make matters worse, the flagship hospital of the competing hospital system which just opened a new heart hospital tower, closed and bulldozed their family medicine training center, so they train no family physicians.  The Osteopathic hospital in town still has a small family medicine training program as does another community hospital in the northwest area of the city.  That hospital acquired a heart hospital  in 2008, so we now have three heart hospitals in case anyone didn't notice.  The biggest family medicine training hospital in the area closed over ten years ago, eliminating twelve new family physician graduates yearly.  Is this area turning into a cardiology over-served and family medicine under-served area?  Who pays attention to the primary care needs of this area?

Conversations with three independent practice physicians who are generalists resonated with some concern about their relationship with the new hospital, since other groups may show up and compete for patients.  Many are concerned about the big groups being bought by the hospitals.  "How can we compete with hospital owned groups?" they wonder.

Holiday Parties enable relationship enhancement and have information and food ups and downs, sometimes with Bananas foster (it was delicious).


  1. Two thoughts which we can discuss when we meet tomorrow. Where is the venue in this marketplace for those physicians who care about the "healing" that does and/or does not happen? There is need for a news article about the impact of more heart hospital capacity on the economics of the community

  2. Well...well....mixing with the VIP's are we? :) Golly...I'll have to drink egg nog alone with your blog and dream of such conversations. Ha!

    Oh you know I am know I love your insights and recollections of conversations and places I will never be...sob..sob...don't worry...I'll be alright! Sniff! Doctor please send a cure for insecurity! *BG*

  3. Poignant, isn't it? I definitely can reverberate with the scenario. As a family physician employee, just said, "Take this job and shove it" to the local hospital network. This oligopoly stopped all primary care training commitment over a decade ago and is crying the blues about not being able to find primary care docs, especially FP's which is the sob story that got me to work for them part time. After the experience I had for eight months: Let 'em wine and dine the specialists while brow beating the primary care services to see more for less with less--a hideously ineffective EMR. I have better things to do and visions of sugar plums dancing in my head. I mourn however for the patients who are calling my home now daily asking if this is a doctor's office taking new patients.