Issue link: https://beckershealthcare.uberflip.com/i/717576
39 INTEGRATION STRATEGY environment. Working here is a lot like primary care, even though I'm a specialist. Since our hospital is so small, I'm oentimes the first line in dealing with a patient's health." Q: What do you dislike the most? "I dislike that there are treatment limitations due to the hospital's small size. e biggest question I face every day is whether ancillary care patients who need more radical surgeries should be sent to a bigger hospital than ours. If you turn a surgical case away, the hospital and physician don't earn money, so sometimes hospital leadership sees me as an obstacle or product of financial inefficiency. at dilemma has weighed on me philosophically." Q: What do you wish the CEO did differently? "e CEO is turning the hospital around and trying to meet the needs of the patient population within financial constraints. Our 12-bed in- tensive care unit is managed by primary care physicians and surgeons. If a physician is in the OR, then they're not available to care for pa- tients. Our CEO recently hired an intensivist to cover night call from 7 p.m. to 6 a.m. when practitioners in the community are not readily available." Additional comment "It's hard to see a patient, go through their whole medical history, be- come invested in their case and then send them away to a larger hos- pital. e hardest case you ever do is the one you never do." 5. Plastic surgeon at an 848-bed hospital in the Midwest Q: What do you like most about your organization? "It's hard to say because there are so many things I don't like about it. Perhaps one of the things I like the most is the physicians' lounge. It provides good food and a nice atmosphere, but I would trade that in a minute for so many other things I don't like." Q: What do you dislike the most? "I don't like the authoritarian way the hospital operates. e rules and regulations interfere with patient care and take away physicians' inde- pendence. Leadership takes advantage of physicians and makes them do inappropriate things that are adverse to patient care. e hospital hires outside physicians and will terminate contracts if they don't act subservient to leadership." Q: What do you wish the CEO did differently? "I wish they wouldn't buy physician practices. I also wish they would honor and respect physician autonomy." Additional comment "Leadership expects physicians to refer patients to other clinicians only within the health system when in some cases it may be in the patients' best interest to be referred elsewhere." 6. Geriatrician at a 500-bed hospital in the Midwest Q: What do you like most about your organization? "One of the nicest things about working with a large organization is increased access to specialty care. Having that access for patients to see any specialty physician is so much more seamless. We have the ability to consult other specialty physicians without patients leaving our office. If I have a question for a neurologist, I can ask for his or her recommen- dations, and it saves the patients a lot of time. I also like the research opportunities, which can translate to practice changes. Lastly, I like that none of the patients are turned away if they can't pay." Q: What do you dislike most? "e biggest challenge would be — just because my organization is so big — when I want to make changes at the personal level, I can't just do it. It has to go through a big committee. And everything has to be standardized, even putting up a poster to inform patients about a new medication. It becomes harder for physicians to make those changes. Since my organization is large, it is compared to other large organiza- tions, and there is a lot of pressure to meet quality metrics and improve- ments. at means physicians are asking patients about colonoscopies and other preventive care measures when someone comes in for back pain. It takes away from patient care, so in some ways it can be negative. However, sometimes it's making sure every one gets preventive care no matter what they come to the hospital for, which is good." Q: What do you wish the CEO did differently? "We [physicians] hardly interact with the CEO. My CEO is fairly new and a physician, so we're hoping the individual will have a better understanding of what it is like to practice and make more practical changes. I think most CEOs are very receptive to opinions. However, since we don't interact on a daily basis, I would not consider going to my CEO with recommendations, as they would redirect me to some- one else closer to me." Additional comment "I really enjoy working at my organization. Even if I need to relocate, I would always look for a large organization. I like that security. I don't have to worry about medical records, and we have lots of resources. Physicians can focus on patient care." 7. Emergency department physician at an 80-bed hospital in the Northeast Q: What do you like most about your organization? "I like the overall character of the organization. We have a mission to take care of the poor, uninsured and homeless — we take care of ev- eryone. I also like the people who work here. We treat patients better than we know some of our competitors do." Q: What do you dislike most? "Sometimes the organization can be a bit small-minded and bureau- cratic. ere are some difficult people. Even in a good organization, there are difficult people you have to deal with. Nobody is 100 per- cent." Q: What do you wish the CEO did differently? "On the whole, I like the CEO. I wish I had a more direct line to the CEO; now there are layers in between us. I wish the CEO was more accessible to physician leaders and physicians in general. ere is someone in between us now, and that person is difficult to deal with. Everything is filtered through that person before it gets to the CEO." Additional comment "e hospitals that do well engage their physicians in operations and planning and don't dictate things. My hospital has done a good job of that. Sometimes physicians don't realize hospitals want their input."