February 20, 2010

Doctor: 'Corporate model' doesn't work for individual practices

A doctor who attended last week's meeting with Wheaton Franciscan executives is suggesting The Journal Times misrepresented his statement about the meeting.

Dr. Dennis Anderson was quoted in the JT's Feb. 16 story, "All Saints doctors, administrators make plans to move forward together." Some doctors have criticized the story for downplaying the concerns of physicians considering a split from Wheaton to form their own medical group in Racine.

Anderson was a critical source in the story because he represented a group of about 50 doctors considering a split from Wheaton; most other doctors at the meeting were not part of the dissident group. The JT paraphrased Anderson in the story as saying he favored reaching an agreement "within the hospital's current corporate model."

Here are the relevant paragraphs:
Orthopedic physician Dennis Andersen summed up the doctors' position, saying they are frustrated that doctor-patient relationships have been clouded by corporate management, which creates patient disengagement with the hospital and means some patients are not seen soon enough or cannot spend enough time with a doctor. Anderson said doctors are also frustrated that doctor-administrator relationships have been clouded by distrust. He said those frustrations boiled over last week.

Andersen is among those who are weighing all options including cutting ties with Wheaton. But after the Tuesday meeting he is hopeful an agreement can be reached within the hospital's current corporate model.
Anderson said the paraphrasing did not accurately reflect the statement he gave the JT. He provided the full statement to the RacinePost for readers to consider:
I have been asked numerous times if my quote in the Journal Times following our meeting on Tuesday Feb 16th was accurate. The full statement given to the Journal Times was as follows:
First of all, I would make a distinction between quality of care and quality of service. Quality of care in Racine, such as the ability to replace one’s hip, deliver a healthy baby, or diagnose and treat an infection is as high as ever. The quality of service, however, has suffered greatly of late.
When you visit you doctor, you have an innate sense of what an ideal visit should be like. You call for an appointment and someone answers the phone promptly. You get an appointment right away. You spend time with the doctor, and he or she listens, diagnoses the issue and recommends an effective treatment. However, when the reality differs greatly from that ideal, then there’s a problem. If the reality is that you call and get a machine and you have to leave a message, that doesn’t get returned for hours; you don’t get an appointment for 3 weeks; your doctor rushes through you appointment with little communication, and has very little time to spend with you to diagnose and treat the problem, you feel disengaged from your doctor.
By the same token, when we, as employed physicians, approach our administrators with an issue, we innately have an ideal encounter in mind. When the reality is something greatly different from that ideal, we feel disengaged from our administration. This is what boiled over at the meeting on Wednesday Feb 10th. The administrators have become more and more distant from our practices, and we feel more and more disengaged, until ultimately we feel that there is simply no control of our own practices anymore. As a consequence, our service to our patients suffers as well.
In the same way, when an issue arises in the office, I automatically think of what I would do to solve the issue if I were in, say private practice, where I could make all my own decisions. For example, if I have patients complaining about getting an answering machine instead of a live person answering the phone when they call, then I would get rid of the machine. If it takes too long to answer the phone, I would hire more receptionists. If waiting time for x-rays is too long, I would buy and staff another x-ray machine. If staff quits or goes on leave, I would hire temporary or permanent replacements. When what really happens in response to issues such as these is the same as my ideal solution, I’m in a good place. However, when 10 out of 10 times, the real response is completely different than what I would have done, then something is wrong. That “something” deserves a high level of scrutiny.
Over the 15 years of my employment here, it seems that the one thing that leads to this much discrepancy between what should happen and what does, is the ongoing need the follow a rigid corporate model. Corporate models may work fine for Hospitals, but they are not working well for our individual office practices. For example, so often, just as the physicians see that we should be increasing staffing to better serve patients, the system instead cuts staffing further, because that is what dictated by the current model or current budget, regardless of the impact on our service to patients. Electronic health records are only good if they match the best practices of an individual specialty. A one-size-fits-all system may work well for corporations, but the reality is that an orthopaedic office does not run like a pediatric office. To try to make them one and the same ruins them both. I find myself constantly repeating, “This is not what I would do if I were in private practice.”
What is clear is that the current corporate model is and has been failing to live up to the wants and needs of our patients for some time. The task of the group that met on Tuesday is to restructure that model. Exactly what form the new structure will take on remains to be seen. However, a great number of physicians in our group have simply lost faith in the corporate model of medicine. After all, if I have to continually say, “This is not what I would do if I were in private practice,” then one obvious alternative exists – private practice. This is the gold standard against which I compare all other models, so why not consider the gold standard itself? To return to the day when service put the patient first, any restructuring within a corporate model must closely resemble that gold standard. If not, we need to consider letting it go. After fifteen years of failed attempts, many physicians have simply given up on that tract, but we are willing to listen. It may be possible within the corporate “employed physician” model, but experience tells us that it is a very steep hill to climb. All previous attempts, despite good starts and with all good intentions, eventually evolved back into the same corporate hierarchy that we see right now. That is, except one – private independent practices partnering with a hospital. I was encouraged at the meeting by the fact that Mr. Buser has kept all models on the table for consideration – including ideals outside the corporate model. Including that of letting the physicians reorganize in private practices once again, so that we may provide the responsive type of care that we once had in this community.
Let me reassure our patients that talk of 50 physicians wanting to leave this community is exaggerated. We want the most effective and responsive type of medical care that we can deliver in here in Racine. We would seek partnership with Wheaton - partnership that works for everyone. This may mean separating from a rigid corporate structure here at Wheaton, but barring legal action by the Wheaton organization, no one that I have talked to wants to leave this community.

This was the full statement that I gave to the Journal Times. I will leave it up to the reader to decide if this was accurately reflected in their article.

Dennis Andersen, MD


  1. I am not going to comment whether Dr. Anderson's comments were accurately portrayed because to do so would only continue that which divides us.

    What I am going to say is his statement goes light years in the direction we need to go.

    First, a simple direct explanation on how he sees the reality of the situation, namely a history of poor service to the patient compared to what it should be. I can personally testify I have had my own share of poor service at All Saints. The worst is that feeling Dr. Anderson conveyed about not feeling my doctor spent enough time with me.

    Next, a simple direct solution. Split away and let the "free market" of practices operate in such ways that provide the customer the best experience.

    For the first time I actually feel a ray of hope that something meaningful can come from all this. It is certainly a damning testament to those who have managed from on high in both the recent and far past from Wheaton. These guys and gals in their ivory towers simply have no clue what it is like to work to provide good service down in the trenches like the docs do. I value Dr. Anderson's statement that differentiate between good service and good health care. That was very useful and helpful to actually say that.

    Bottom line is I am hoping now whatever form of structure is implemented that Wheaton will not get in the way. In this situation less structure will be better.

  2. It seems like Wheaton is running similar to what Federal healthcare plan with the public option would be. Over worked under paid doctors have been expected to be the outcome of the recently proposed national healthcare system. The only difference is that the money being saved is being paid to incompetent management versus the federal model that would used the "saved" costs to spread the limited healthcare service available to more people. The feds would be just as incompetent.

  3. Take the administrators from Wheaton and the city of Racine and stick them in the middle of lake. In fact you could round them up easily at one of Mayor Dickert's fundraisers. He won't comment of the state of our only hospital because they have been donating to is re-election campaign, which started the day he was elected. Time to clean both houses, Wheaton & City Hall.

  4. Dr. Andersen's letter speaks well about the type of individual private practice he prefers. When he became an employee, he probably sold his practice to the hospital. That sale involved trade=offs for the money he received; and support he continues to receive when the employer pays salaries, pensions, health care and dental benefits, rent, malpractice premiums; new buildings, new equipment; and bears the risk when Medicare, United, Blue Cross cut payments.
    Free markets aren't free from costs nor accountability. Why did Racine Clinic and Kurten sell in the first place?

  5. Way to go Dr Andersen, well said. I have worked with you for 15 years and respect what you have said now and in the past.Now IF ONLY WFHC WILL LISTEN.

  6. Further evidence of the corruption at the Journal Times and their agenda driven story line of this whole situation.

    Their reporting on any issue cannot be trusted.

    I hope these issues get resolved for the sake of the people of Racine, but I just can't see how the people can swallow this reporting from the Journal Times. It wasn't just this statement, but how they handled the whole thing. They downplayed the entire story and made the physicians out to be greedy liars.

    Had it not been for the RacinePost, nothing would be changing. What a great public service they provided by putting this story out in the open. Now, we might get better service out of it. If it were up to the Journal Times, I don't know where we would be.

    Scary isn't it? The local paper is actively working against the citizens. I'm glad the RacinePost was able to report the entire message and let us decide for ourselves on this important issue.

    Thanks Dustin and Pete for all that you do. The community may very well end up being healthier for it!

  7. Big thanks to the doctors that decided to take a stand on our behalf and for the Racine Post for being the only ones willing to report it.

  8. Dr. Andersen is one of the finest human beings that I have ever had the pleasure to meet. His integrity, professionalism, and honesty are second to none. I commend him for standing up to the "Organization".
    Ultimately, what the Wheaton's are planning is this. They are trying to stall hoping that people will get sick and tired of all the press that is being circulated. They will reassign some administrators, have a ton of useless meetings, and manipulate the Racine Journal Times to say everything is peachy. As time goes by, doctors will get nervous, such as Tim Lesage, and fold. What they are counting on is the recession to prevent good doctors from leaving. They all have mortgages, bills, student loans to repay just like the rest of us. Their ploy is to recruit young doctors and hope they buy houses here and enroll their kids in school. With multiple pay cuts and decreasing incomes, they just can't simply sell their homes and leave. This is the Wheaton trap.

    No matter what happens, doctors will leave and Wheaton will turn it around in their favor. The doctor's that left were bad apples, difficult to work with, and not company men.

    I can tell you this for sure. The organization is horribly run, patients have lost faith in the hospital, and doctor's will leave.

    The only hope is that the brave few doctors that are standing up leave, and establish their own facility. They need to beat the no-compete and go head-to-head with the Wheaton's. I have doubt the doctor's will provide better patient care.

  9. Correction to blog above

    I have no doubt doctor's will provide better patient care.

  10. The Journal Times has stood up and loudly proclaimed to the citizens of Racine that they are a corporate bought joke.

  11. Lol i had the same experiences, the "Quicky Lube" medical treatment from our wonderful wheatonINCORPORATED.....This is not the result of any kind of liberal public option...this is bureaucratic garbage brought to reality by using bottom line profit is the only reason to exist. Doctors spend so little time being compassionate practicioners of the hippocratic oath, instead they are just employees of a large corporation. With the francsican painting in the first floor lobby area to accentuate the irony permeating the all saints mess. It does not surprise me one bit.

  12. Is it true there is another meeting of minds going on?

  13. It is getting worse rather than better. Try to get a doctor ordered MRI or CT scan scheduled. The process involves at least three different departments ending in the Managed Care. None of them know about insurance coverage, urgency, or even why the procedure was ordered. They can not answer questions without pointing the finger at someone else.

    The corporate model does not work! The doctor has to be put in charge of his/her patient needs.