Today’s post is part of an ongoing series wherein we answer questions and address comments made by our followers. If you have a question you’d like to address, post it or message us on Facebook, or send it anonymously via our website.
Q: I was just informed that Dr. Uhrhammer has left Lutheran as of Friday. Where is he going and why?
A: It appears he is taking a leave of absence for an unspecified amount of time. No reason was given. NICHE recently spoke with Dr. Uhrhammer. We will update news after our next conversation with the doctor. His profile is still live on the Lutheran Medical Group website:
Q: What causes physicians to leave?
A: Lutheran Health Network’s impaired ability to retain and recruit physicians is of deep concern to NICHE. It appears to be related to cost cuts by Community Health System (CHS) and CHS’s need for profits from LHN. The effects of overly zealous cost cutting have led to Lutheran Hospital being called “dirty” and “dingy” by Bloomberg and physicians must use dated equipment. In addition, LHN has lost other doctors because of pressure to see more patients in less time regardless of their complexities.
Physicians at LHN are likely to have contracts, not unlike other “hired physician” contracts across the nation, providing salary and benefits. Their total pay is also related to their “production,” measured by relative value units (RVUs). Management can then compare costs of supporting that physician with earnings to see how profitable that physician may be. “Costs” can include accounting for each physician’s portion of corporate offices and private jets, so if CHS passes on higher corporate costs, that can be a sore point. Also, a “low producer” is likely to see a salary cut at contract time.
In fairness, quick patient visits are a national problem–as detailed in this PBS News Hour piece (https://www.pbs.org/new…/health/need-15-minutes-doctors-time): “It’s not unusual for primary care doctors’ appointments to be scheduled at 15-minute intervals. Some physicians who work for hospitals say they’ve been asked to see patients every 11 minutes.” One physician interviewed in the article says, “it’s a hamster wheel.” NICHE has heard the same from many physicians, including a pediatrician in Indianapolis who sees a patient every 15 minutes for 8 hours and an ER doc in California who has to make quick decisions, seeing patients for only 5 to 10 minutes each. More good reads on the same topic include this New York Times blog post: https://well.blogs.nytimes.com/…/for-new-doctors-8-minutes…/ and this from the National Institutes of Health’s National Medical Library: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2517888/.
LHN, therefore, may not be alone in creating time pressures. But that alone is probably not enough to cause physicians to leave. The combination of a cost-cutting culture, RVU counting, the adversarial culture that followed the firing of CEO Brian Bauer, the threatened legal assault and muzzling of the “Brave Ten” physicians who sought to buy LHN, and the resignations (forced we are told) of physicians from positions of administrative leadership combine to fuel the fire of discontent. Seeing a patient every 15 minutes doesn’t allow time for personal reflection, but at day’s end, one often adds together all positives and negatives. A minus result will bring thoughts of leaving.
Q: Darrick Hoopingarner is leaving Dupont. What happened?
A. Hoopengarner (https://www.linkedin.com/in/darrick-hoopingarner-013345100/) was Chief Operating Officer (COO) for Dupont Hospital. CHS dismantled much of the Dupont board of directors and its chairperson, Dr. Todd Rumsey, resigned. We assume this is yet another instance of cleaning out local influence that CHS commonly calls “the resistance.”
It’s notable that a surplus of C-Suite administrators is waiting for jobs as the result of CHS sales, hospital consolidations, and the impending breakup of Tenet Healthcare. Many potential CEO hires leave hospitals that were sold because they were struggling, because of regulatory problems, because of hospital cutbacks or because they were fired. For obvious reasons, this pool of candidates is unlikely the best and brightest, although many may be decent and competent. NICHE observes that candidates from these circumstances deserve extra scrutiny, lest LHN become an “adopt a CEO” rescue program. Replacement of seasoned local talent is difficult under the best of circumstances. Hiring merely to “clean house” is a trip down the wrong road.