In the world of physician staffing, private and public companies both have their advantages and disadvantages.  Private companies are known to be more adaptable and can react more quickly to opportunities and threats in the marketplace.  Private companies are also not as tied down by exorbitant administration costs, overhead costs, and compliance costs, as compared to public companies. 

Public companies, on the other hand, typically have more capabilities to raise capital than do private companies.  The access to capital, however, binds the company to certain stakeholders: investors, board members, and government entities.  They are constrained and obliged to the demands of these stakeholders.  There are many external pressures from Wall Street and the investment community, including extreme focus on short term gains, often at the expense of long term company goals.  

“In the constantly changing business environment, we want to be free to do what is in the best long term interest of the company, rather than being dictated by short term pressures,” says Chief Financial Officer, Jim Chandler.  “More importantly, we want to maintain our autonomy and focus on what’s really important to Onyx M.D., things like superior customer service and personal touch.  We treat our clients, providers, and employees as people, not as a commodity.” 

Onyx M.D. has instilled an “E.L.I.T.E” model, which stands for Enthusiasm, Loyalty, Integrity, Trust/Team and Ethics.  The word ELITE is very important to Onyx M.D., as the company prides itself with a level of performance and customer services that not only goes above and beyond, but is truly World Class. 

Onyx M.D. is a physician owned, operated and trained company.  This leadership provides a deep understanding to the practice of physicians and the position of health care facilities.  Being a private company allows for Onyx M.D. to conduct their business in the highest regard and give their full commitment to clients, providers, employees, and all stakeholders involved.

Health policy comprises three major priorities: reducing costs, improving quality, and expanding access.  The medical malpractice tort system is one of the largest factors influencing reform.  Addressing the issues of current medical malpractice tort system, and medical liability in general, can significantly influence the current health care system.

Medical malpractice is an act or omission by a health care provider which deviates from accepted standards of practice in the medical community and which causes injury to the patient. Simply put, medical malpractice is professional negligence (by a healthcare provider) that causes an injury.  A plaintiff must establish all four elements of the tort of negligence for a successful medical malpractice claim. [1]

1. A duty was owed - a legal duty exists whenever a hospital or health care provider undertakes care or treatment of a patient.
2. A duty was breached - the provider failed to conform to the relevant standard of care. The standard of care is proved by expert testimony or by obvious errors.
3. The breach caused an injury - The breach of duty was a proximate cause of the injury.
4. Damages - Without damages (losses which may be pecuniary or emotional), there is no basis for a claim, regardless of whether the medical provider was negligent.
   

The plaintiff's damages may include compensatory and punitive damages. Compensatory damages are both economic and non-economic. Economic damages include financial losses such as lost wages (sometimes called lost earning capacity), medical expenses and life care expenses. These damages may be assessed for past and future losses. Non-economic damages are assessed for the injury itself: physical and psychological harm, such as loss of vision, loss of a limb or organ, the reduced enjoyment of life due to a disability or loss of a loved one, severe pain and emotional distress. Punitive damages are only awarded in the event of wanton and reckless conduct.

In 1999, the Institute of Medicine reported that there were between 44,000 and 98,000 medical error injuries per year.[2]  Recently, the Institute for Healthcare Improvement reported that an astounding 40,000 “incidents of harm” happen to patients every day in American hospitals.[3]  The 1.5 million medication errors that occur every year add $3.5 billion in medical costs to the medical system, and between $17 billion and $29 billion per year in total costs to society—including medical expenses, lost income, lost household productivity, and physical disability.[4]  This is too costly to the economy, to Americans’ health and well-being, and to the public’s confidence in our health care system. 

Proponents of tort reform widely hold that as medical malpractice premiums rise, the operating costs for physicians increase.  If physicians cannot raise their prices, they are forced to close their practices because they cannot pay the overhead associated with running a practice, and access to health care is reduced for a segment of the population.  Medical liability reform is meant to reduce the cost of health care while preserving access.[5] 

In 2003, Weiss Ratings, Inc. released a study that examined physician malpractice premiums, claims payout levels, the availability of coverage.[6]  The study compared payouts in the states with caps to those without caps.  The study found that payouts were reduced in the states with caps and the growth of the payouts also slowed.  Thus, the caps on damages seem to do what the caps were intended to do:  they restricted recovery.  On the other hand, the study found that malpractice premiums continued to rise.  On this matter tort reform did not have its intended effect.  It would seem that as payouts decrease, insurance carriers would reduce premiums to reflect lower payouts to plaintiffs.  The study found that states with caps had sharper increases in median annual premiums for doctors in three high-risk specialties: internal medicine, general surgery, and obstetrics/gynecology.  In the states with caps, the annual premiums increased by 48.2 percent as opposed to 35.9 percent in states without caps.  In addition, in the states with caps, premiums were more likely to exceed the national median.

So, if medical malpractice claims are substantially related to medical errors and malpractice premiums are not related to malpractice payouts, then what can be done?   Clearly such a complex problem will require a multi-factorial solution.  To improve both patient safety and the medical liability climate, the tort system must achieve four goals: reduce the rates of preventable patient injuries, promote open communication between physicians and patients, ensure patients access to fair compensation for legitimate medical injuries, and reduce liability insurance premiums for health care providers. [7]    We must overcome the intimidating liability environment so that our common goal of fewer medical errors can be achieved. 

Overall, the remedy of this “crisis” will take a great amount of effort from the government, the insurance carriers, the healthcare industry, and the patients themselves.   We need to create a system which is fair to everyone and does not leave the providers with unlimited risk and increasingly limited reward, and still provides the adequate care for patients.

Article written by:  

Kian Modanlou, M.D.
Associate Professor
University of Tennessee, Transplant Surgery
Onyx M.D. Physician Panel

References:

1. The Four Elements of Medical Malpractice. Yale New Haven Medical Center: Issues in Risk Management (1997).
2. Institute of Medicine (2000). To Err Is Human: Building a Safer Health System (2000). The National Academies Press.
3. Kohn LT, Corrigan JM, Donaldson MS, eds., supra.; Institute for Healthcare Improvement, Protecting Five Million Lives, available at www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=1.
4. The Great Medical Malpractice Hoax: NPDB Data Continue to Show. Medical Liability System Produces Rational Outcomes, 12, (Public Citizen, 2007); see also Jay Angoff, “Falling Claims and Rising Premiums in the Medical Malpractice Insurance Industry,” (Center for Justice and Democracy 2005) available at www.centerjd.org/ANGOFFReport.pdf
5. Alexee Deep Conroy, Lessons Learned from the “Laboratories of Democracy”:  A Critique of Federal Medical Liability Reform, 91 Cornell L. Rev. 1159, 1161 (2006).
6. Adam D. Glassman, The Imposition of Federal Caps in Medical Malpractice Liability Actions:  Will They Cure the Current Crisis in Health Care?, 37 Akron L. Rev. 417, 460 (2004).
7. Thorpe KE. The medical malpractice 'crisis': recent trends and the impact of state tort reforms. Health Aff (Millwood) 2004:W4-20.

You have done the right marketing, attended the ideal tradeshows, and even published a video on your website to attract the perfect candidate, but alas the providers are still not staying with your organization.  You need options and the market place has answered. 

In fact it is harder than ever to get people to move for an opportunity.   Using locum-to-perm physicians will help you buck this “settling-in trend.”  According to a recent study, in 2000 14.2% of the population was moving within the US.  Today that number has dropped to 11.9%.  The report detailed that only 1.6% are moving between states, so getting people to move is more challenging today than ever (Source W.H Frey, Brookings Institution).

It has been our experience that the right “cultural” fit is just as important as the right “skills” fit.  So what is the way to achieve both?   Try before you buy.  Create positions that test drive physicians for at least 90 days, before offering a permanent position.  The “90-day-test-drive” gives the physician the opportunity to experience your work place and community.  
A study from the AMGA in 2006 revealed several key factors that contribute to physician retention:

• Company Culture:   A “poor cultural fit” is the single most frequently mentioned reason for physicians to voluntarily leave a practice (51 percent).
• Community:   “Relocated to find a better community fit” (20 percent).
• Family Ties:   Physician’s desire “to be closer to own or spouse’s family" (42 percent) and “spouse’s job required relocation” (22 percent).
• Compensation:   “Leaving to seek higher compensation” (32 percent).
• Schedule:  “Incompatible work schedule” and “excessive call schedule" (17 percent).

During the “90-day-test-drive”

• Engage:  Engage the provider’s spouse and peers to increase the cultural and community fit and connection.
• Set Expectations:  Set clear expectation on the demands that will be put on the provider.
• Mentorship:  Assign a mentor to the locum tenens physician. 
• Training:  Make sure during “90-day-test-drive” that the physician is trained on any coding nuances.
• Feedback:  Provide written and oral feedback during the “90-day-test-drive.”

Given that people are less likely to move between states and that ”cultural fit” is as important as “skills fit”,  establishing a “90-day-test-drive” locum tenens program at your facility will help ensure successful long-term permanent physician placements…again and again.