X-Ray Dept. Packs It In
Daily Observer
“Finished,
blotto, they quit.” S.Q. Lapius waved his cigar with an air of finality.
“Who
quit?” I asked.
“The x-ray department over at the hospital. All of them. Gone. The whole kit and kaboodle.”
That
was precious information and deterred me momentarily from completing the
dictation of a case report. “Who is
going to do the radiology now?” I asked.
“Oh,
another doctor has been hired and there will be a reasonable albeit bumpy
transition period.”
“Exactly
what happened? I heard some rumors, but
this is certainly a shock.”
“That’s
the way it is with institutions. In with
the new, out with the old,” Lapius said sharply. “The details aren’t very important. Simply that the old
radiologist and the board of trustees couldn’t come to contractual terms.”
“But
these changes take their toll in hospital efficiency,” I remarked.
“Astute
observation, Harry,” Lapius said, complimenting the
obvious. “The fact is that question
whether a hospital is entitled to hire physicians to run a department has not
been answered at least to my satisfaction.”
“Why
shouldn’t a hospital be allowed to hire physicians?”
“Because a hospital is not licensed to practice medicine. Nor are the members of the Board of
Trustees.”
“Suppose
the Board of Trustees is composed entirely of doctors?”
“Even
so, they are a board, a legal entity.
Legal entities cannot practice medicine.”
“Are
there alternatives?”
“Of
course, Harry. Hospital based
departments could be concessioned to the
physicians. The hospitals should be paid
rent. Provision should be made for
excess monies to be devoted for research.
The hospital should stipulate a rate of expansion, commensurate with
community growth. The contract could
even stipulate a fixed fee for service for the physicians.”
“How
would that differ from the usual employment contract where the hospital hires
the doctor?”
“All
the difference in the world,” Lapius said through
tight lips, lighting a cigar.
“You’ve
got one lit already, in the ash tray over there,” I said, pointing.
“Oh
yes, well put it out like a good fellow.
One is all I need. Where was
I? Oh yes, all the difference in the
world. If the department is set up as a
concession the doctors have the right to hire help at the highest salary base,
to buy the best equipment regardless of cost, to expand into other techniques. On the employer-employee basis, the hired
doctor must go to the administrator for every expenditure. He can’t compete with the market for the best
technicians, nor has he a free hand to buy the best equipment. Why should any doctor have to be satisfied to
work with the tools provided by a Board of Trustees or a hospital administrator. They
really haven’t the sophistication to know the intricacies of the
specialty. Too often good practice is
impeded by their budgetary scruples.”
“But
suppose the doctors who set up the concession are pinch-pennies?”
“Get
rid of them. The hospital would have the
right to expect the very best service for the right of concession.”
“But
who is to judge?”
“Details, my boy, mere details. They can easily be worked out.”
“But
if a hospital can’t practice medicine, then how can they hire interns and
residents? Wouldn’t that be the same
thing?”
“Certainly,
Harry. It would. The hospital should turn over the monies to
the medical staff to hire interns and residents, as well as emergency room
physicians, and be responsible for them and the jobs they do.”
“Fine,
but suppose the staff doesn’t accept that responsibility?”
“Then
we would be back to where we started and the hospital would have to practice
medicine.”
“So
why bring it up in the first place?”
“Why
don’t you go back to dictating your charts?”
Lapius said huffily. “You obviously weren’t listening to anything
I said.