A No-Holds-Barred Conversation About Our Hospital

SOMETHING DIFFERENT THIS week. Let’s call it a candid conversation about our community’s hospital, with the voices of people from the inside–employees who work at UP Health System Marquette, formerly known as Marquette General Hospital.

We’ve all heard the murmurings, mumblings and grumblings within the hospital over the past few years, and they seem to have gotten louder since Duke LifePoint took over. But understandably few of the hospital’s nearly 2000 employees want to voice their criticism publicly. They worry that they might lose their jobs.

And the media, who have their own economic concerns, also seem reluctant to take on what is arguably the most powerful institution and business in the county.

So we’ll take a crack at it.

A couple of notes first. The four employees who spoke to us did so anonymously. We’ll call them Doctor A, Doctor B, Physician Assistant, and Nurse.

After we conclude with their comments, we’ll get responses from hospital CEO Ed Banos.
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WHAT MANY OF us have heard anecdotally over the last couple of years, especially recently, is that doctors are leaving the hospital. Quitting. Bailing out.

“Absolutely,” says Doctor A. “It’s not normal turnover. Doctors are fed up. It hasn’t been good and now it’s getting worse.”

“There’s definitely been a spike in 2014,” Doctor B agrees. “People are always coming and going, but we’ve lost some key doctors recently, and many of them were people we spent a long time trying to recruit. A big part of it is a lack of respect. The administration makes it clear that everyone can be replaced at any time. You can hit the road if you don’t like it.”

So what’s caused the problem? Is Duke LifePoint the culprit here? Well, that may be a little simplistic and unfair.

“The transition to Duke LifePoint has been rocky,” the Physician Assistant concedes. “But nonprofits are being bought up by for-profits all over the country. This kind of transitioning is taking place everywhere, not just in Marquette County. When you make changes like this, people get apprehensive because you wonder whether the administration is looking for people to cut.”

The Nurse noticed the change almost immediately. “When Duke LifePoint took over, they told us we had to get our nursing budget under budget,” she says. “Otherwise, we were told they’d start slashing the staff. They were threatening people. I have a lot of friends whose positions were eliminated and some of them were awesome people.”

“Ed Banos recently told a meeting ‘We’re going to get rid of negative people,'” Doctor A explains. “That sure seemed like a threat. If we try to bring issues up, we’re reprimanded, we’re called naysayers. A nurse recently brought up a problem and she was called a troublemaker. But she was right!”

The Nurse has kinder words for the CEO. “I have seen Ed Banos around. He seems to be putting in an effort, but the rest of them (the administrators), we never see them. I don’t even know who they are. And the problem is, they’re making staffing decisions without knowing what it takes to work on the floor.”

“Comunication is essential,” the Physician Assistant tells us. “The senior administrators need to let us know what we’re doing and why, and they should listen to us. They don’t do that very well, especially the senior staff. We never see them.”

Possibly the biggest problem, according to the four employees, lies in the fact that the hospital is now owned by a for-profit, out-of-state corporation.

“Every decision comes out of Tennessee now,” Doctor B says. “That’s made a huge difference.”

“Our supervisors and managers here have no say,” the Nurse agrees. “Nobody at the hospital has any say. Everybody is a number. Everybody is replaceable.”

“We’re now practicing corporate medicine,” Doctor B continues. “It’s all about money. It used to be, What can we do for the community’s benefit? We used to feel that we had a medical mission. No more. That feeling is gone.”

“It’s all about money,” Doctor A says. “See more patients, earn more money, but do it with less staff. What can we do about it? We can leave or we can do what they want. We have to see more patients, we have to make more money. We’re being asked to make a profit on people’s suffering.”

The single, indisputable fact is that Duke LifePoint is in business to make money. It has to be concerned with the bottom line. That’s the nature of the beast. Increasingly, whether we like it or not, that’s American medicine in the twenty-first century.

“An administrator said to me, ‘What can be done to increase your productivity and our revenue?'” the Physician Assistant tells us. “It’s that simple. We all realize that’s what they want and if we want to keep our jobs, that’s what we have to do.”

“There’s a constant pressure to see more patients,” Doctor B says. “It’s always, ‘Can you see two more?’ We’ve always been encouraged to increase our patient load but now the emphasis has really changed. It’s always ‘Can you squeeze a few more in?'”

And for the doctors who aren’t seeing enough patients, there can be consequences. Their performance and salary are determined by their total of Relative Value Units (RVU’s) which takes into account the number of patients seen and the severity and complexity of the patients’ conditions. Doctors are encouraged to boost their RVU’s.

“And they have a scorecard at the end of the month,” Doctor A explains. “The fewer the patients, the worse. Names and identities are attached to the scorecards, so everybody knows the score. They try to shame you. It’s like churches that used to publicize who put how much into the offering plate.”

So is there something wrong with encouraging doctors to be more productive?

“Absolutely,” says Doctor A. “Patients get the idea that we have to hurry up because we have other patients waiting so when they’re talking to us, they leave things out. And then we as doctors are going to miss something because of the pressure to hurry up.”

Clearly, there is pressure–to see more patients, to make more money, to make certain the hospital is economically viable.

“It’s a competitive market,” the Physician Assistant points out. “Duke LifePoint is worried about Aspirus. Its just like Walmart in competition with Target.”

“There’s a fear of Aspirus,” Doctor A agrees, “a fear that Aspirus is stealing our patients. And that’s a possibility because patients are fed up with the long lines, the long waits, and appointments that are too short. The lack of attention. I don’t blame them.”

The picture they paint isn’t pretty, but they concede that this may not be just a local problem.

“For a city this size, this is a good hospital,” the Physician Assistant tells us. “We’re blessed to have the physicians and the technology we have. Yes, we have egos and problems, but that’s probably like everywhere else. My feeling is the major villain in all this is the insurance companies and federal government with Medicare and Medicaid. They force us to treat patients like numbers, not individual patients.”

The doctors are less kind.

“The Hippocratic oath says nothing about money,” Doctor A says. “We all swear by it, but that’s not how we’re allowed to practice.”

“I’m not really optimistic about the future,” Doctor B says. “How can you recruit doctors to a damaged place full of bitter doctors?”

And the Nurse has the final word. “The hospital today is not about taking care of people. It’s all about big money, big business.” She pauses. “You know, I love my work. I love taking care of people but everything has changed and it’s sad. It’s really sad.”

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NO SURPRISE, CEO Ed Banos has a different take on what’s happening at his hospital.

Unusually high turnover among doctors? Not really. “We’ve had some specialists who’ve decided to leave recently,” he explains, “but overall turnover has been normal. And those who decided to leave left for good jobs.”

Banos says he and an outside group have done their best to gauge employees’ morale, and their conclusion is that it’s actually rising.

“This has been a busy summer and a busy fall, and people have been working a lot of hours, but overall I think we’re doing well,” he insists. “And our patient satisfaction scores are improving. When I came here a year and a half ago compared to now, our quality scores are up.”

How about the criticism that Duke LifePoint is pushing the staff to see more and more patients?

“I’d like to say its like that in any business,” he explains. “We’d like them to see more patients and serve more patients. There are standards in this business and we want our doctors to perform what a normal practice can do. We’re trying to stop patients from migration. We don’t want them to go to Green Bay.”

As for the charge that the hospital is trying to weed out staff members who are maybe…too negative, Banos doesn’t deny it.

“We make thorough evaluations of all of our employees and we take those evaluations seriously,” he says. “We have a commitment to quality. We want to make sure we’re all on the same page here. We want to act as a team. If not, then maybe some employees might find that they’re not the right fit for our hospital.”

He says he understands that transitions can be difficult and that he, himself, is still relatively new to the hospital, but he insists he’s trying to build a positive relationship with his staff.

“I can’t get out and see all 2000 employees every month,” he tells us. “I do structured rounds and informal rounds every month and and we have employee forums. I try to get out as much as possible, especially in departments under stress.”

So ultimately, why is there such vehement criticism of the hospital and the way it’s now operated?

“I think it’s only a small minority who aren’t happy in their jobs,” Banos concludes.

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SO THERE YOU have it. Two very different sides of the issue.

Now, you could conclude that the four employees, from different departments, are not representative of the rest of the hospital, and that maybe they’re just whiners.

Or on the other hand, you could decide the CEO is oblivious or disingenuous, and Duke LifePoint is nothing but a cold-blooded, cold-hearted, money-grubbing corporation.

It goes without saying that all big businesses and all big institutions have problems. Employees are frequently critical of management. Who hasn’t thought, at one time or another, that his or her boss was an idiot?

But the internal, critical noise does seem to be a little louder here.

Transitions are tough. Maybe we’ll get over it. A brand new, state-of-the-art hospital, still at least a couple of years away, will certainly help.

It’s just that hospitals occupy such a special, unique place in their communities.

We care deeply about them because they take care of us. And this is our hospital in our community.

You got news? Email me at briancabell@gmail.com

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