4 Hospitals, two trauma centers; over 30 health care and support facilities; 7,000-8,000 employees including close to 1,200 new hires annually; 1,930 physicians in more than 104 medical specialties; and a billion-dollar budget (4 billion gross charges).
This article will focus on Broward Health physicians. I thought Florida’s Broward Health’s well-earned reputation for corruption and based on outside political and moneyed interests was overstated. I was wrong. If anything, its history is understated. A small group of politically active physicians and typically, a placid administration did little more than facilitate physician payments and lucrative real-estate deals.
Historically, any attempt to change this culture met with swift political action after a deluge of “insider” calls demanding that the commissioners get the administration back in line.
Even the District’s governance through their by-laws required the CEO to get board approval before many administrative actions – like the hiring or firing some senior executives. After all, the Board wouldn’t want one of their “friends” fired.
So it was remarkable that in June , the Board supported a standard fair market physician contract for the top-grossing physicians, which, in some cases, substantially reduced the physician’s compensation, many of whom still made close to a million dollars a year.
Here’s how it happened. Historically, when the administration wanted to renegotiate a physician’s contract – the physician immediately appealed to both the Board (typically through intermediaries, lawyers, and even selected senior staff), thereby undermining any meaningful administrative negotiations. Too often, the result left the administration representing professional management in the public’s interest on one side and everyone else on the other.
But this time, thanks to the unusual independence of most of the current board members, and the increasing regulatory pressure to reduce health care costs, Frank Nask (CEO of Broward Health) created a broad district policy and standard physician contract to the Board for approval first. Without referencing any particular physician, this policy required all contracts to pay at the 50th percentile regional fair market price for physician services.
Some Board members, having been called by their “friends,” rebelled. Still, in a long and somewhat bizarre board meeting, they ultimately agreed, and the Board approved the policy. The physician’s response was both predictable and swift. Some physicians and physician groups threatening to leave the hospital system if the Administration imposed a fair market value contract. In the end, the Board acted, and the Administration imposed the fair market contract, and no one has, as yet, left.
Some Broward Health physicians’ misbehavior is the unfortunate exception for a profession undergoing dramatic change. On August 29, the Wall Street Journal reported that
“physicians are increasingly unhappy with their once-vaunted profession, and that malaise is bad for their patients.”
In his book “Doctored,” Dr. Jauhar says that many of his colleagues are struggling with the loss of their professional ideals, becoming “impatient, occasionally indifferent, at times dismissive or paternalistic.”
“Today, medicine is just another profession, and doctors have become like everybody else: insecure, discontented, and anxious about the future.”
In a 2008 survey of 12,000 physicians, only 6% described their morale as positive. Eighty-four percent said that their incomes were constant or decreasing. Most said they didn’t have enough time to spend with patients because of paperwork, and nearly half said they planned to reduce the number of patients they would see in the next three years or stop practicing altogether.
Mr. Nask and Broward Health are keenly aware of the importance of and committed to both physician and patient satisfaction to measure the quality of health care to the community with a renewed system emphasis on surveys, analytic scores, and data mining. Notably, Mr. Nask is modeling a modification of his fair market physician contract to include a committed level of service expressed in independently tracked physician minutes with the patient guarantees and non-clinical “paperwork” assistance. If successful, such a model for health care delivery could serve the dual purpose of improving physician morale in their profession and the quality of health delivered care to Broward Health patients. We’ll see.