X-Ray Department
Wants to Compete
“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.