ER Doc Gets Canned

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Birdstrike

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Anecdote:

Just got word an ER doc in my large multi-specialty group got fired, not by our group, but by the hospital CEO (long story, pissed someone off, was a jerk, nothing substance abuse or medicine/competency related) . We're a private doctor owned group, but apparently the staffing contract with the hospital has some line in it to the effect of, "You work at the pleasure of the hospital CEO and he can fire you anytime he wants, for any reason, or for no reason, and you're screwed. Sorry, but not sorry." I'm paraphrasing obviously, and translating it from legal-speak, but literally, that's the ultimate result of the contract. What's the point of the story? Don't be a jerk, know every line in your contract, check your contract for a killer clause like this and also, know how easily replaceable we all are, especially if you're a hospital-based, particularly employed, physician of any specialty.

None of this will come as much of a surprise to the seasoned-citizens among us, but meet:

Modern Medicine, folks.

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Plural of Anecdote!

Same thing happened to me more or less, without the 'being a jerk' part. Just ran afoul of the wrong person at the wrong time.
 
Docs get canned all the time for bad customer service scores. This will increase as CMS ties satisfaction scores with hospital reimbursement.

Hopefully Senator Collins' proposal to limit patient satisfaction surveys asking about pain control questions will pass. Senators Grassley and Feinstein had already asked CMS to justify their actions (back in 2014), which there has not been a good justification yet. Drug seekers that don't get their opiates will always score a provider poorly, which will affect CMS reimbursement and ultimately that provider's job. So, in essence, asking pain-related questions on a satisfaction survey encourages more opiate prescriptions.
 
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Anecdote:

Just got word an ER doc in my large multi-specialty group got fired, not by our group, but by the hospital CEO (long story, pissed someone off, was a jerk, nothing substance abuse or medicine/competency related) . We're a private doctor owned group, but apparently the staffing contract with the hospital has some line in it to the effect of, "You work at the pleasure of the hospital CEO and he can fire you anytime he wants, for any reason, or for no reason, and you're screwed. Sorry, but not sorry." I'm paraphrasing obviously, and translating it from legal-speak, but literally, that's the ultimate result of the contract. What's the point of the story? Don't be a jerk, know every line in your contract, check your contract for a killer clause like this and also, know how easily replaceable we all are, especially if you're a hospital-based, particularly employed, physician of any specialty.

None of this will come as much of a surprise to the seasoned-citizens among us, but meet:

Modern Medicine, folks.

Every contract with a CMG I have looked at had a clause like that, as does my current contract. I don't think its something we need to bring the pitchforks out for. After all, if the hospital (as represented by the CEO) does not want a doc there, what possible use is the doc to the group? Do you think the CEO has no right to choose who is allowed to work at his hospital? Or should the CMG keep a doc who can not work at the hospital they staff?
 
Every contract with a CMG I have looked at had a clause like that, as does my current contract. I don't think its something we need to bring the pitchforks out for. After all, if the hospital (as represented by the CEO) does not want a doc there, what possible use is the doc to the group? Do you think the CEO has no right to choose who is allowed to work at his hospital? Or should the CMG keep a doc who can not work at the hospital they staff?
Color me silly but yeah I dont think a hospital CEO should have that say. Med staff with a proper arbitration process. Screw the suits.
 
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Hopefully Senator Collins' proposal to limit patient satisfaction surveys asking about pain control questions will pass. Senators Grassley and Feinstein had already asked CMS to justify their actions (back in 2014), which there has not been a good justification yet. Drug seekers that don't get their opiates will always score a provider poorly, which will affect CMS reimbursement and ultimately that provider's job. So, in essence, asking pain-related questions on a satisfaction survey encourages more opiate prescriptions.

Pain-related questions are irrelevant. Drug-seekers who don't get drugs are going to score the physician poorly on every question regardless of what they ask. If they really want to do customer service surveys (which they shouldn't), then screen out the druggies, crazies, malingerers, and super-users.
 
Color me silly but yeah I dont think a hospital CEO should have that say. Med staff with a proper arbitration process. Screw the suits.
In past life I've thrown people off my sites before. The company was welcome to stay but the worker was not allowed back. I never demanded they be fired but they weren't allowed to be assigned to my project.
I get that the ceo could be getting silly and this may not be justified but the ceo is your customer. You work to make the cep happy and offer them a better situation than anyone else can or literally everyone goes home when your sdg/cmg loses the contract.

Make the customer happy unless they are so out of line you'd rather lose them
 
Color me silly but yeah I dont think a hospital CEO should have that say. Med staff with a proper arbitration process. Screw the suits.

The way I see it, both contractually and in some essential truer sense (for want of a better word, spiritually) physicians are the guests of a hospital. That's why we are called 'attendings' (because we attend, or visit, a hospital) and what we have are called 'privileges' (as opposed to 'rights') to work at a hospital. The hospital gets to choose who they want to keep. I would much prefer if they had some sort of better mechanism, but if they want someone out they really don't owe them due process. You don't offer arbitration to a contractor you don't want fixing something in your house any more, do you?
 
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You need to understand your individual contract as well as the group contract.
If someone really wants you out, you will be gone.
Your contract will determine if they need to compensate you to get you to leave.

While my individual situation might be a little more complicated, I work in an at will work state.
Either party can terminate the agreement at any time without cause.

While I might be pissed if I got canned, I understand this is always a possibility.
For that reason, among others, I try to be careful about doing anything that will annoy any of the higher ups.
This involves giving in to certain unreasonable demands at times.
 
The way I see it, both contractually and in some essential truer sense (for want of a better word, spiritually) physicians are the guests of a hospital. That's why we are called 'attendings' (because we attend, or visit, a hospital) and what we have are called 'privileges' (as opposed to 'rights') to work at a hospital. The hospital gets to choose who they want to keep. I would much prefer if they had some sort of better mechanism, but if they want someone out they really don't owe them due process. You don't offer arbitration to a contractor you don't want fixing something in your house any more, do you?
You have no idea what you are speaking of.. Dopey
 
I am not sure why doctors feel that they are any different than other employees. You can get fired for not doing a good job, pissing a client off, not getting along with others, etc.

If you don't want to be fired, become and owner/boss. You work as an EM doc, you work for a group, and said group has to have the blessing of the hospital. You are not important as the contract. No different than a surgeon pissing off the CEO and not being able to work in that hospital. What is his choice to do surgery? Its another city, another hospital, or a surgery center.

What do we do as an EM doc? Another city, another hospital system, or a FSED.
 
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I am not sure why doctors feel that they are any different than other employees.

Because a physician is bound by an oath to set aside his or her own interests to act in the best interest of the patient. Sometimes this involves telling patients things they don't want to hear, or refusing a request to do something. This puts a physician in a very different category than other employees who deal with clients.

That having been said, being a jerk is always a bad idea.
 
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Exactly what Old Mil said. In most industries "the customer is ALWAYS wrong". In medicine it's different in that "the customer is MOSTLY wrong". We are actually penalized for appropriate treatment and doing no harm.

Last night I saw a young college girl who was complaining of "swollen glands.". She had definite submandibular lymphadenopathy but no other findings. I explained to her that it was likely viral. She consulted her " doctor" friend who was really a physical therapist via text and told me that I should check her for mumps and that a CBC was a "routine part of any workup". I calmly explained to her that we don't have the ability to check for mumps in the ER and that a CBC would tell us nothing. I discharged her home and within 10 minutes she was complaining to the House Supervisor.
 
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Exactly what Old Mil said. In most industries "the customer is ALWAYS wrong". In medicine it's different in that "the customer is MOSTLY wrong". We are actually penalized for appropriate treatment and doing no harm.

Last night I saw a young college girl who was complaining of "swollen glands.". She had definite submandibular lymphadenopathy but no other findings. I explained to her that it was likely viral. She consulted her " doctor" friend who was really a physical therapist via text and told me that I should check her for mumps and that a CBC was a "routine part of any workup". I calmly explained to her that we don't have the ability to check for mumps in the ER and that a CBC would tell us nothing. I discharged her home and within 10 minutes she was complaining to the House Supervisor.

Isn't mumps a clinical diagnosis that can be further worked up with labs, etc?
I would have just showed her a picture of what mumps looks like, and explain to her that she doesn't have this. I would have also told her about the viral syndrome and to monitor the lymph nodes and if they don't improve then to follow-up with her PCP. At least she'd have a little more of an answer than "we don't have the ability to check for mumps in the ER and that a CBC would tell us nothing"
 
Exactly what Old Mil said. In most industries "the customer is ALWAYS wrong". In medicine it's different in that "the customer is MOSTLY wrong". We are actually penalized for appropriate treatment and doing no harm.

Last night I saw a young college girl who was complaining of "swollen glands.". She had definite submandibular lymphadenopathy but no other findings. I explained to her that it was likely viral. She consulted her " doctor" friend who was really a physical therapist via text and told me that I should check her for mumps and that a CBC was a "routine part of any workup". I calmly explained to her that we don't have the ability to check for mumps in the ER and that a CBC would tell us nothing. I discharged her home and within 10 minutes she was complaining to the House Supervisor.

...
 
Isn't mumps a clinical diagnosis that can be further worked up with labs, etc?

Yes it's a clinical diagnosis. I'm not aware of any labs in the ED that would add to the diagnosis. Even outpatient what would change your management?

I would have just showed her a picture of what mumps looks like, and explain to her that she doesn't have this. I would have also told her about the viral syndrome and to monitor the lymph nodes and if they don't improve then to follow-up with her PCP. At least she'd have a little more of an answer than "we don't have the ability to check for mumps in the ER and that a CBC would tell us nothing"

Of course I explained that to her. I'm not ******ed. I was trying to give the shortest version of the story. It was after I explained to her about viral syndrome and PCP follow-up that she busted out her "doctor" friend to the nurse treating her, and I had to go back and deny all her requests for extraneous and pointless testing for a minor, non-life threatening illness.
 
I meant to say it's a clinical diagnosis. What I had issue with is you said you didn't have the ability to check for mumps in the ER. I guess I was half asleep when I typed or I seizured because I didn't intent to say it can be worked up further with labs. I guess it's the word choice when talking to an 18 yo F. I would just show her a picture of mumps and say this is what you don't have. Pictures mean more than words to these folks. If I can show pictures, I do, even to older individuals.

At any rate, it sounds like from your follow up post that it wouldn't have mattered and she was just gonna be a little **** bucket anyways.
 
How easy is it to get fired for poor patient satisfaction scores, lets say if one is employed by a CMG? and by poor I mean 'decent' just not 'drug dealer good'.

Additionally, how easy is it to get fired for lets say, nurse or ancillary staff complaints? one of our sites has terrible support staff, who dislike residents and new attendings, and file constant reports, almost to a malignant scale, literally about nothing much at all. Lets say you are an attending at a site like that and your medical director gets BS thrown their way about employees constantly..Grounds for firing?
 
I am not sure why doctors feel that they are any different than other employees. You can get fired for not doing a good job, pissing a client off, not getting along with others, etc.

If you don't want to be fired, become and owner/boss. You work as an EM doc, you work for a group, and said group has to have the blessing of the hospital. You are not important as the contract. No different than a surgeon pissing off the CEO and not being able to work in that hospital. What is his choice to do surgery? Its another city, another hospital, or a surgery center.

What do we do as an EM doc? Another city, another hospital system, or a FSED.


The real issue is that physicians are essentially employees today, yet we aren't afforded the opportunity to form unions like other employees. That CEO would think twice about firing a nurse employee of the hospital or even a janitor (cause he'd have to deal with the union at their backs raising hell) but no problem to can the doc who was short with him or rubbed the wrong person the wrong way.


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The real issue is that physicians are essentially employees today, yet we aren't afforded the opportunity to form unions like other employees. That CEO would think twice about firing a nurse employee of the hospital or even a janitor (cause he'd have to deal with the union at their backs raising hell) but no problem to can the doc who was short with him or rubbed the wrong person the wrong way.


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Employed physicians absolutely are able to form unions and there is at least one physician union for employed physicians. Totally legal for employed physicians.
 
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My understanding of NLRB regulations is employed physicians can unionize so long as they are not independent practitioners. If you are part of a CMG you could unionize with other physicians in the CMG. If you are employed by the hospital you could unionize with other physicians in the Hospital. If you are part of a SDG you are SOL because it would be seen as collusion.
 
The sad part is that most of us spend several more minutes buffing the chart and justifying our refusal of ridiculous requests in anticipation of complaints of this sort. The irony is that many times administration doesn't really care whether it was appropriate, only that it generated a complaint.
 
The sad part is that most of us spend several more minutes buffing the chart and justifying our refusal of ridiculous requests in anticipation of complaints of this sort. The irony is that many times administration doesn't really care whether it was appropriate, only that it generated a complaint.

Most of the time I don't even know about a complaint until the hospital has investigated, and sent a letter to the patient apologizing for my behavior. Very upsetting when this happens.
 
How easy is it to get fired for poor patient satisfaction scores, lets say if one is employed by a CMG? and by poor I mean 'decent' just not 'drug dealer good'.

Additionally, how easy is it to get fired for lets say, nurse or ancillary staff complaints? one of our sites has terrible support staff, who dislike residents and new attendings, and file constant reports, almost to a malignant scale, literally about nothing much at all. Lets say you are an attending at a site like that and your medical director gets BS thrown their way about employees constantly..Grounds for firing?

in my experience:
fired for pt satisfaction only - rare, can happen if hospital takes a VERY pro-pain med position and you won't comply - i'm aware of 1 hospital/multiple docs and 1 doc at 1 hospital and regarding 1 pt where hospital/c-suite type demands that pt be given high doses of dilaudid on request led to physicians leaving or not welcome back/worked at another site.
-- it has been my personal experience, s/p denying countless drug seekers/negotiators requests AND CHARTING APPROPRIATELY... not an issue. never a P-G or the like citing lack of pain meds or abx, despite what you will read on sdn.

nurses/staff affecting physicians - in residency it didn't seem to matter and it was a major "write-up" sort of culture, but a resident-run type of place and i was not aware of any staff-resident issue. in private groups, however... it has been my experience that hospitals will have nurses do "36o" type reviews on the physicians, but in my 8+ years since finishing residency, have yet to be asked to fill one out on a nurse. have seen the same attribute being ascribed as a wonderful positive and as a terrible negative.
 
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To be honest you have to be a pretty big d!ckbag or reckless to get canned at least in my hospital system.. Seen it twice and I was surprised it took so long.. It may vary though depending on your location and the relationship of your group with the system.
 
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