Life Update

I have resigned my medical staff privileges effective May 1. I have accepted a full time faculty position with UT Chattanooga and Erlanger Medical Center. There is some history here that deserves explanation.

After my transplant I have had two significant concerns. One is what to do with the gift of new life, the other how to obtain secure, stable health benefits. Repeatedly, in meditating on my future, my answer to its course was to teach. As a private practitioner I have touched many lives but there is also the reality of being a 'gerbil on a wheel'. Private practice is no different than sewing buttons on cards in the 1880s- the more buttons you sew, the more money you make. Private practice is a velvet lined trap, with increasing overhead and static or decreasing reimbursement. In order to maintain an income for my family, one is thus forced to do more and more, reducing the service qualities of medicine, and all but completely eliminating its intellectual sophistication.

The issue of stable health benefits is clearly best addressed by being employed with or through a large group. The overhead and regulatory aspects of practice are also best addressed this way, and so it is that physician employment is becoming much more common. I am the most active gyn surgeon on my hospital's staff. I am also the most cost effective. My practice is the largest delivering practice. I have significant additional training in minimally invasive surgery, endocrinology and ultrasound. These seem like credentials that would make me a desirable person for employment. And so it is that I have sought an employed position for more than 3 years. And here is where history starts.

I first approached a senior hospital administrator about further service opportunities, and potential employability, in September 2008. I was laughed at. In my face, literally. I let that go, and served as chief of staff, even as my renal failure reached the point of transplant evaluation and then the actual surgeries.

I have made repeatedly clear my interest in employment. I have had discussions on every level. There have been at least 4 sets of discussions over the last 2 years. I actually detailed these discussions originally, but they filled two pages with pointless words. Absolutely nothing has happened. Our call group is trying to form a single group, but without success thus far. I gave up on that process when two members went out and signed three year deals for EMR systems not favored by the hospital and not used by the MDs already on EMRs. While we have fiddled, another part of our system is rumored to have signed several ob/gyns. My partner and I made explicitly clear we were willing to be hired as a nidus for the department, and were turned down to pursue the talks with 6 that have been fruitless. The administration was made aware before declining us that I had another employment offer, and still they declined to employ me.

There can be no doubt then of the lack of interest. I saw than a program that wanted me, that values my skills and knowledge, and offers every advantage to me except that I must move. The alternative was a program that has repeatedly rejected me personally, and prolonged and pointless negotiations about employment. The choice was an obvious and happy one, and I am excited about where I am going.

I am an honor-based man. We generally measure a person's worth in the US by their income. For me, however, being treated with respect is as important to me as what I am paid. We often equate 'honor' with Christian abstemiousness, but I do not refer to the venial failings of men, wherein I am a lamentable failure. I refer to providing respect for others, and reciprocal service. And I have always been willing to serve first, to give value. I have felt profoundly dishonored by a system I have served honorably and willingly, and I have spent much of the last two years angry, offended and rather depressed. Now I feel happy and excited. And free.

I have no doubt the hospital will have no trouble replacing me. It is sobering to think, however, that I do 98% of my surgery laparoscopically, and I discharge all my hysterectomies the same day. I have seen the data: even as one administrator denigrated my practice payor mix as undesirable I was made aware that I do the most cost efficient surgery in my department. If my replacement does the same volume of surgery as I do but keeps them overnight, it will cost the hospital about 770,000.00 extra dollars. I could have been hired more than twice over for that sum. Instead, I will be teaching others, and developing cost efficient programs elsewhere. And I'm thrilled.

Vous etes digne de ce que vous avez faites.

Ted