Hospitals Push Physicians for More Productivity

Article excerpt

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 next year.

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 for productivity.

Doctors worry they are losing the thoughtful culture that has flourished at academic medical centers for decades. …

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