I found myself sad reading Dr. Michael Hay’s column on the breakup of San Angelo’s largest multi-specialty clinic, the Shannon Clinic. Some twelve years ago I celebrated the marriage of the clinic with the hospital as a member of the administrative team. The integration of hospital and physician resources would help Shannon better serve the community.
While it was a nice vision, money got in the way. Physicians through their hospital work took care of many patients without the ability to pay. This number has grown to 46.7 million nationwide with our area’s population over 25% uninsured.
In the clinic setting doctors were told their salary depended on their work, also known metaphorically as “you eat what you kill”. To help make up for uncollectible bills, the clinic offered a number of services traditionally provided by the hospital to boost physician incomes. Having competitive salary guarantees and steady income streams are important considerations for physicians considering San Angelo as a practice opportunity.
The cycle continued long enough that the hospital supposedly lost money from the heavy burden of providing care for the uninsured. Physicians found this not to be true in a recent meeting, the hospital ended up being profitable this past year. This might be contributing to the physician frustration evident in Dr. Hay’s piece.
As in a divorce people go their separate ways. Doctors almost look like the children in the mix. Who will get and keep custody, the hospital or the clinic? As the organizations split the hospital is encouraging as many physicians to remain with them in a new physician division, composed of essentially solo practices under an umbrella. Once again money enters the picture. Who will offer the most attractive package to members of the Shannon Clinic? However for many doctors, intangibles will drive their decision. Who do they trust to manage their livelihood, to have as a partner?
What would happen if the kids stuck together and said they wanted new parents? The acrimony between providers and the hospital is unfortunate to say the least. At a time when people need to be collaborating to serve the whole community, their attention is focused on fracturing. It brings to mind efforts in the Middle East. When peace is needed most, strategies are employed to stir division. Having the target warring amongst itself is a time old tradition. Thus the saying, “divide and conquer”.
Pressure on America’s community hospitals is growing. Physician fees under Medicare are slated for a significant cut under the President’s budget. An honest discussion of those factors and collaboration to deal with them seems in order. That is yet to occur publicly.
Shannon even waffled in their brief response to Dr. Hay’s column. “At this time Shannon anticipates there will be some changes in the structure of physician practices”. Anticipate? The system is driving the changes.
They had a chance to speak to their strategy and why, but basically passed. Acquiring and later spinning off assets to maximize returns is a game for Wall Street, not Beauregard Avenue. Shannon should be about patient care. Where that ends up after all the in-fighting remains to be seen…
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