BOSTON (NYT) -- Trying to boost their drooping revenue, Boston's
elite teaching hospitals are telling their top-notch doctors they
must see more patients and bring in more money.
Some hospitals are even hitting those who fail to do so where it
hurts: their paychecks.
These hospitals -- run by Harvard, Tufts, and Boston University -
- employ about 7,000 doctors, who are accustomed to pursuing their
own academic interests and setting their own schedules. Many are
unhappy about the productivity push, which has intensified in recent
months after hospitals suffered record losses in 1999.
"Many doctors feel very frustrated by the pressure to see more
patients," said Dr. Frannie R. Kronenberg, medical director of a
physicians' group at Brigham and Women's Hospital. "They've seen
their income decline, from standards that are already lower in
academic medicine. They feel that their commitment to very high-
quality care and the energy and passion they put into it are being
devalued by the pressures."
Hospitals in Boston and elsewhere across the country are using a
variety of rules and incentives to get the message across. Typical
is Beth Israel Deaconess Medical Center's request that its 120
primary care doctors increase their annual number of patient visits
from 85,000 to 100,000. In the same spirit, a new salary system at
Brigham and Women's will dock less productive doctors up to 10
percent of their pay this year. That amount will grow to 20 percent
The requirements are accompanied by a whole new Wall Street
language for doctors, one where patient visits are assigned
"relative value units" depending on complexity, and where
administrators hand department heads "balanced score cards" listing
revenue generated and goals met.
While productivity quotas at teaching hospitals in other parts of
the country have sparked union movements and lawsuits from doctors,
so far in Boston, doctors are responding more measuredly. One common
reaction: give up low-paying or volunteer teaching jobs to work
longer hours seeing patients.
Doctors in private practice, who essentially run their own small
businesses, have grown used to working longer and faster during the
1990s as health insurance companies reined in medical costs, a
movement known as managed care.
But many academic doctors, who are salaried and divide their time
among teaching, research and patients, have been shielded from
marketplace pressures until recent years. In fact, they went into
academic medicine for this very reason -- to be freed from the
commercial aspect of doctoring so they could focus on providing
cutting-edge care and diagnosing interesting cases.
Teaching hospitals, as their reimbursements from insurance and
Medicare dropped, felt the pressure too and started to scrutinize
doctors' workloads. Last year's record losses intensified their push
Doctors worry they are losing the thoughtful culture that has
flourished at academic medical centers for decades. …