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Wednesday, 03 January 2007 00:00

Phoenix says transition smooth despite patient complaints

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A corporate entity took over emergency room operations at Haywood Regional Medical Center last week, and so far it hasn’t gone great, according to patients and those working inside the ER.

 

The hospital terminated its contract with a long-time group of local doctors to bring in a corporate physician staffing company called Phoenix. Phoenix is staffing the ER with fewer doctors working fewer hours, leading to long patient wait times to get seen by a doctor. Patients have reported waits of six and seven hours before they were seen by a doctor, according to patients and staff members.

“This is the worst wait I’ve ever had of any hospital I’ve ever been in,” said Tommy Brown, while waiting on his son outside the ER last Friday night (Dec. 30). “They said they fired all the doctors for some reason or another and got new ones in. They didn’t get enough I reckon.”

Dr. DeWayne Butcher, the interim ER director for Phoenix, said long wait times this weekend was due to an abnormal increase in patient volume. The top culprits were ski accidents and an illness circulating across the region accompanied by nausea, vomiting and respiratory problems.

“All hospitals I am aware of in the region had the same problem we had here,” Butcher said.

The hospital terminated its contract with a long-time group of 10 ER doctors on Dec. 28 due to a dispute between the physician group and the hospital administration and board. The hospital has been trying to exert more control over the ER doctors, but the doctors resisted what they saw as a loss of autonomy that would interfere in patient care decisions. The dispute led to an impasse that ended with the board voting unanimously to bring in Phoenix.

HRMC President David Rice said one goal of the new corporate staffing company was to improve patient wait times and improve coverage in the ER.

But Phoenix will have fewer doctors — only six to eight — compared with 10 under Haywood Emergency Physicians. Phoenix will have two doctors on shift 10 hours out of the day and one doctor the rest of the time. Haywood Emergency Physicians had two doctors on shift 15 hours out of the day.

Phoenix’s schedule is leading to back-ups in the waiting room, especially at night. The busiest time in the ER is from 6 p.m. — when urgent care has closed — until midnight, when most people are in bed and are no longer falling down stairs and getting in wrecks. Haywood Emergency Physicians had two doctors on shift until 1 a.m. to cover this crunch time. Under Phoenix, the second doctors goes home at 10 p.m.

Butcher said current schedule isn’t set in stone.

“We’ll adjust the schedule if we need to to meet whatever the demands are. We will adapt to whatever happens,” Butcher said.

 

Waiting room back-ups

Last Friday at midnight, the ER waiting room at Haywood Regional was packed with patients who had been waiting three to four hours and were told it would be another two or three to go before they would see a doctor.

“They said they had 35 people and they have one doctor working,” said Chase Boyce, who broke his arm while snowboarding at Cataloochee. Boyce had plenty of company in the waiting room, with more than a dozen skiing injuries coming through the ER Friday. By 2 a.m., Phoenix called a second doctor back in to work.

Linda Martin, another ER patient Friday night, said she would have gone to Asheville or Sylva if she had known up front she would have to wait for six or seven hours. It’s a good thing she didn’t since both of those hospitals also had long waits, with a backlog of 70 people in the ER waiting room at Mission Friday night.

Nonetheless, Martin said whatever kind of conflict the hospital administration had with the ousted ER doctors, “The public shouldn’t have to suffer.”

According to sources who work in the emergency department, the turnover has not been good.

“It is nothing but utter chaos,” said one staff member who requested anonymity for fear of retribution. “It is really frustrating.” Several nurses are already looking for other jobs and more are planning to do the same.

One staff member said the new group of doctors is ordering far more tests. They said the doctors let patients sit in rooms for up to two hours after tests have come back while they make a decision what to do with them. The new corporate group brought one of its own patient forms, which the hospital staff is unfamiliar with.

Other than longer than normal wait times due to high patient volume, Butcher said the transition has gone very well.

“Things went very smoothly,” Butcher said.

 

Recruiting efforts

Other physicians in the Haywood County medical community are concerned about the hospital’s prospects for finding ER doctors who will make Haywood County their home. Currently, the doctors staffing the ER for Phoenix are temporary, most flown in from out of town.

Butcher said Phoenix will recruit a full-time team of doctors who will move here. It is a desirable area to live and work, so it will happen, but the doctors being recruiting currently work elsewhere and will have to quit their jobs to come here.

“Realistically it will take a few months or so to get them here. Meanwhile the doctors who are working here are the cream of the crop,” Butcher said, describing the temporary crew as seasoned, board certified emergency physicians.

Others in the medical community don’t share Butcher’s optimism on recruiting efforts. For starters, there is a national shortage of ER doctors, according to David Evans, an ER doctor on the executive board of the National Physicians Alliance

“There are more jobs than there are ER doctors,” said Evans, who works at a hospital in a small town in Oregon.

It is unusual for a hospital in a small community to dismiss a solid group of local ER doctors to bring in a corporate physician staffing entity, Evans said. Evans’ hospital contracts with a corporate physician staffing entity, but did so only out of necessity.

“Our situation here was there were not enough ER doctors to cover the emergency room,” Evans said. Rotating out-of-town doctors is not uncommon for corporate staffing entities.

Members of the medical community have expressed concerns over the prospects of building a stable group of doctors from scratch.

“It is unclear why the board would wish to dismiss physicians that are providing quality care and who want to stay,” said Dr. Henry Nathan at a recent hospital board meeting. “We are losing physicians as it is, despite our efforts to convince them to stay. Our focus should be on physician recruitment and physician retention, not physician rejection.”

Haywood Emergency Physicians warned the hospital that Phoenix would try to staff the ER with fewer doctors. With Haywood Emergency Physicians, there was no corporate headquarters wanting a cut of profits. But Phoenix will want a cut of the profits. The only way to do that is pay doctors less or hire fewer doctors. With fewer people to pay, there is enough left over for corporate to get a share.

But that means the doctors will work harder and more hours, one reason that only one of the former ER doctors agreed to stay on under Phoenix, despite many of them being urged to do so. The only one who has agreed to work under Phoenix is a part-time ER doctor.

Haywood Emergency Physicians also warned that Phoenix doctors will get burned out, further complicating the prospects of attracting a solid base of ER doctors.

The hospital board felt Phoenix would be more cooperative in hospital initiatives aimed at improving wait time, moving patients through different departments more smoothly, and working with a new digital medical records system.

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