Bad Blood: Orthopedic Surgeons vs. Hospitals

October 15, 2015
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If you have a radio, you’ve probably heard Taylor Swift’s most recent number one hit, “Bad Blood.” Swift was probably not talking about a workplace feud, but the song got me thinking about the ongoing conflict between hospitals and physicians.

“Now we’ve got problems, and I don’t think we can solve them…”

In running OrthoServiceLine.com, I hear often that orthopedic surgeons and hospitals don’t get along well. But as an outsider to the healthcare industry looking in, I began to wonder… How did this bad blood start and is there anything that can be done?

If you have a radio, you’ve probably heard Taylor Swift’s most recent number one hit, “Bad Blood.” Swift was probably not talking about a workplace feud, but the song got me thinking about the ongoing conflict between hospitals and physicians.

“Now we’ve got problems, and I don’t think we can solve them…”

In running OrthoServiceLine.com, I hear often that orthopedic surgeons and hospitals don’t get along well. But as an outsider to the healthcare industry looking in, I began to wonder… How did this bad blood start and is there anything that can be done?

Then I read this quote from Dr. David Fox in a news article earlier this year:

“Hospitals and doctors don’t trust each other. There’s not an orthopedic surgeon out there that trusts his hospital. You can’t find one. If you do, he’s lying.” 

Ouch!

Ever since the industrialization of American healthcare, tension has existed between medical facilities and providers. In recent years, it’s become increasingly difficult for physicians or hospitals to consider themselves to be completely autonomous units due to the changing payment landscape in healthcare. Consequently, this forced relationship has bred a certain amount of suspicion.

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According to Becker’s Hospital Review, one reason that physicians often distrust hospitals is competition. As hospitals hire an increasing number of specialists in fields like orthopedics, others in that field may view the competition as a threat to their independent practice, leading to feelings of resentment. Also when physicians have ownership in a local surgery center, the hospital team can feel like their profitable patients are being siphoned away.

High executive turnover could also contribute to the mistrust. Becker’s pointed out that the average hospital CEO’s tenure is somewhere between the length of 3 to 5 years. That means that in the course of a doctor’s career, it is likely that multiple executives will come and go. These short-term relationships can lead physicians to doubt that the hospital’s C-suite actually cares about their concerns.

The increasing push toward bundled payments and value-based care in healthcare can’t be ignored. Because hospitals and providers are more and more dependent on each other to maximize reimbursements and gainsharing, suspicion can develop over whether the other partner is doing an equal share to provide both quality care and economic value. Hospitals + Physicians + Payers Leadership reported that while doctors were once applauded for their ability to bring in revenue, they may now be viewed as a threat to the hospital’s shared-savings contracts.

“Band-aids don’t fix bullet holes”

Is it possible for hospital service line leaders to take baby steps toward healing this rift? Or does the bad blood run too deep? For the sake of patient care, it’s important for hospitals to make their best effort to work together with physicians.

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A good first step is simply to listen. Arizona Health Futures reported that a common theme in improving hospital-physician relationships is the importance of listening to each other and developing an inclusive culture where both parties have adequate input in decision making. Trust is built through openness over time, so the sooner this can start the better. While an agreement won’t always be reached, be sure to validate the physicians’ feelings even if you can’t necessarily make all the changes to accommodate their wishes.

Transparency is also key. Doctors and hospitals need to sit down and have an open conversation about data and outcomes. Having a clear plan for how to focus on improvement will help both sides to build trust in the other. Make sure that expectations are clearly outlined and everyone understands their role in the process.

And don’t think that you can get away with half-hearted attempts. After all, “band-aids don’t fix bullet holes.”

You tell me, what have you found that works to build trust between hospitals and orthopedic surgeons? Comment below or email your thoughts to ortho@wellbe.me and I may feature your advice in an upcoming article!