Emergency Medicine Example
As Jean-Baptiste Karr wrote more than a century and a half ago, “The more things change the more they stay the same.” (except it was in French, so it sounded a lot cooler!) Last summer, M.C.E.S. was notified by Tenet that they were invoking a clause in Observation contract to terminate our services ‘without cause’. This means that we didn’t do anything wrong, but they wanted to move in another direction. In fact, the local DMC administration made it clear that this was not their idea and they loved the job we did and didn’t want to change. Per our contract, they gave us a 6 month notice which led to a D-Day of November 15, 2017. Understandably, as the date approached most of the full time Observation physicians found other jobs—either full or part time. As the date approached, Tenet Administration (with less than a month’s notice) indicated that they changed their mind and asked M.C.E.S. to continue running the Units. We were told that this would be for the foreseeable future. Next came the really hard part! Trying to reconstitute our staff with such short notice would be formidable. One of the two full time midnight NPs had take a travel job in Hawaii with a commitment of at least 6 months and we were down to essentially one full time physician, a handful of half time attendings, a few weekend fellows and a couple of prospects. Those of you who have recently joined our group know how long it can take to credential new physicians and advanced practitioners. Hospital administration promised to help expedite the credentialing process and coupled with my begging, pleading and whining, we were able to get several new personnel on board. One problem, however, was that they were all part time people— either fellows or attendings looking for a little extra money (but on their terms regarding scheduling availability). As we entered 2018, I had one full time attending and 31 part timers! Those of you who have done scheduling realize how difficult it is to fill a schedule for 2 OBS units with these restrictions. Oh, and did I mention, my one full time person was placed on sick leave for a couple of months in the spring? Starting in July, with a new crop of residents emerging, we were able to build up a much better ratio of full time personnel and moving into the fall, they were starting to get the hang of the ‘CDU way’. We had a few credentialing bumps in the road, but with the help of the chief of staff and contacts in medical affairs, we completed the process. Meanwhile, our contract to provide Observation services to DRH and HUH had expired August 1st, but negotiations were ongoing in good faith to ink a new deal that would also extend coverage to HUH to a full 24 hours (which had been 16 hours previously). There is a mechanism to extend the previous contract month to month—to a point. Unfortunately, we reaching that point and M.C.E.S. was informed that effective February 1st, 2019, the contract between Tenet and M.C.E.S. to provide Observation services would end. As with last year, the DMC Administration does not want to do this. We are constantly reminded that they are very pleased with the service we have provided over 7 years, but the home office in Dallas has other plans. The nationwide Tenet Physician Group (TPR— Dr. Saker’s group here at the DMC) will be taking over observation services at HUH and DRH. You may see some of the same faces as the group is looking to hire our full time and many of the part time providers—maybe even me. I want to thank all of the people who have made the CDU a success. Drs. Bill Bahu and Marc-Anthony Velilla created the CDU almost 8 years ago. They did all of the heavy lifting and developed the protocols and many of the items on the Wiki. Arun Kumar, as assistant director, has been a huge help as well as all of the physicians and APPs with whom I have worked with. Dr. Sweeny, Matt Gilson, Carolyn Sabbagh and Barb Morris have kept me out of trouble and have been a huge help. Dr. Roy Elrod and some of the members of Medical Staff Affairs were God-sends when I needed people credentialed on short notice, which is no easy task. I have learned a tremendous amount during the past 5 years as the medical director of CDU and I look forward to using those skills moving forward.