Monday, April 16, 2007

A Shift of Leadership

The leadership role in the provision of health care services continues its shift from the medical profession to hospitals.

Evidence appeared in the April 15 Boston Sunday Globe under the byline of veteran medical reporter Christopher Rowland whose article described the growing demand of medical specialists to be paid by hospitals for providing “on-call” coverage in emergency rooms.

Historically, doing “on-call” was considered to be partly an obligation associated with hospital admitting privileges and partly a professional obligation to make sure that physician services were available for emergencies whenever the need might arise.

Now it seems that physicians no longer see it that way and will be providing on-call coverage more as an agent of the hospital than as a representative of their profession.

In the article, the President of the Massachusetts Medical Society was quoted as saying “I think it’s unfortunate that we have gone in this direction.” The head of emergency medicine for Boston-based Caritas Christi Health Care said “Ethically, morally, and professionally, we as physicians have a responsibility. Part of our service to our community and to humanity is to provide the on-call service.”

The senior vice president of policy at the American Hospital Association said “We traditionally in healthcare have relied on voluntary arrangements between hospitals and physicians” and that the breakdown of that system “is tearing at the very core of healthcare.”

All of this is a necessary, inevitable, and overdue part of the ongoing redesign of our health care system. It would be better if we could see it that way rather than as something to be regretted, but either way it is going to happen.

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