Prohibitions on hiring EPs as hospital employees

[emememem]

I recently came across some examples of states that have legislation on the books preventing hospitals from directly employing certain specialties (EM, Anesthesiology, Radiology, Pathology). Can anyone shed some light on why this is the case, and why these specialties are singled out? Best guesses are appreciated as well.

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[filhodeinferno]

Maybe it's because someone from our realm was actually able to lobby in our behalf with something.

Seems like that'd be a first, though.

 

[swamprat]

Which states R these?

 

[emememem]

I can't remember all of them but it seemed mostly limited to the South. I found the Tennessee statute (63-6-204):

"Notwithstanding the provisions of this section, nothing shall prohibit a hospital licensed under title 68, chapter 11, or title 33, chapter 2, or an affiliate of a hospital, from employing licensed physicians other than radiologists, anesthesiologists, pathologists, or emergency physicians..."

I assumed some big lobbying efforts went into the decision but I couldn't figure out why those specialties were able to procure an exemption but others were not. Just curious!

 

[hoot504]

Can someone enlighten the less erudite (me) about the significance of this?

 

[Vandalia]

In theory, to prevent a conflict of interest. Please note the key word is theory. The theory falls apart when you dissect it. In practice, it is whoever has the best lobbyists.

The idea going back to the early 20th century was that there would be a conflict between the physician's duty to act in the best interest of the patient, and the employee's duty to act in the best financial interest of his employer. This is also linked with, and the rational behind, the fact that the "corporate practice of medicine" is illegal in most states. Emergency medicine, pathology, radiology and anesthesiology are singled out in some places for special restrictions because their practice of medicine is almost exclusively within the hospital. A family physician, for example, might have a practice that is owned by the hospital, however, there is not a complete overlap with what he does and the hospital's operations. (Think of those Venn diagrams from high school.) On the other hand, basically every decision the EM physician makes directly effects the hospital's profit.

Also, a hospital has more power over "hospital-based specialties" than they do over other physicians. Lets say a family physician is affiliated with a hospital and he thinks they are behaving unethically. It is far easier for him to break away from the hospital and continue his practice than it would be for an EM physician or an anesthesiologist. No hospital, no job. For these specialties, the hospital holds all the power - at least traditionally they have. It is far more difficult for a hospital to cancel an entire contract rather than fire an individual physician. This, theoretically, means that EM physicians have more freedom to make decisions in the best interest of the patient.

 

[Arcan57]

I would point out that it's actually easier to fire a IC doc than an employed one. If there's a group that still has due process as part of their contract with the hospital, it's in a different region of the country than were I've worked.

 

[deleted109597]

All it does is make the hospitals create shadow corporations to pay the physicians instead of out of the hospitals budget like it does every other employee.
Same as "corporate medicine" laws.

 

[deleted480308]

Just legal wrangling, much like midlevels getting independant practice all you need is votes in the state congress...not logic

 

[DocEspana]

Also remember.... a lot of the new ER attendings WANT to be hospital employees. If the pay is even slightly comperable (it will be less. potentially a lot less) it makes sense for someone like me to chase a 501 (c)(3) job. Nearly all hospitals are, but most (with plenty of exceptions) groups are not. I'll be 4 years of residency down when I graduate. That means 5 years of paying back almost nothing toward my loans and only 5 years of paying back decent amounts towards my loans to qualify for the PSLF program.

Of course, you get that job that pays the big bucks, maybe you dont care as much.

 

[Birdstrike]

Texas was part of the Confederacy, though. That's pretty hard core "southern" cred. Maybe we can just agree that Texas is in the Southwest and call it a day.

 

[Apollyon]

Texas was part of the Confederacy, though. That's pretty hard core "southern" cred. Maybe we can just agree that Texas is in the Southwest and call it a day.

Texas Republic, CSA, Mexico, France, Spain, USA - the "Six Flags Over Texas" (which any Texas high school graduate should be able to tell you). And, no, Texas is Texas. Arizona and New Mexico are "Southwest".