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