Oct. 05--NEW LONDON -- Even as it touts its new chief surgeon to the community with highway billboards and large newspaper ads, Lawrence & Memorial Hospital finds itself accused of fostering a far less friendly relationship with at least some of its medical staff.
Frustrations and resentments some doctors say have been festering for months, and others say are symptomatic of larger stresses on the health care system, will get a chance for a full airing at an unusual meeting later this week.
"It's the worst I've ever seen it, to put it bluntly," said neurologist Dr. Laurence Radin when asked to assess the condition of the hospital's relationship with its doctors. "But I don't know that it's anybody's fault or a product of the times and the great pressure we're under."
On Wednesday, representatives of the hospital's board of trustees, the administration and doctors will meet to discuss communication problems and what oncologist Dr. Mithlesh Govil, in a Sept. 23 letter to the editor, described as the "adversarial attitude" the hospital administration has adopted toward its physicians.
Physicians initiated the meeting with a direct request to the board leadership, a "fairly extraordinary" turn of events, according to Dr. Radin.
Board Chairman Ulysses Hammond could not be reached to comment Monday.
Hospital spokesman Kelly Anthony said part of the strains are the result of changes in health care that have put in-house doctors, called hospitalists, in charge of in-hospital patient care.
"Fewer primary care doctors admit and follow their own patients in the hospital, and only about 10 percent of the medical staff attends the regular medical staff meetings any more," Anthony said. "The absence of face-to-face meetings often leads to misunderstandings. We look upon Wednesday's special meeting as an opportunity to listen and explore better processes to discuss and hopefully resolve some of these issues."
Obstetrician-gynecologist Dr. Henry Amdur, president of the medical staff, said the meeting is intended as "yet another attempt to keep the lines of communication open and transparent."
"It's been a failure all around, for a variety of reasons, and one of the challenges going forward will be to find ways to communicate across roles but also across generational barriers that exist," Amdur said.
One of the areas of contention is the establishment and growth this year of L&M Physicians Associates, a hospital-owned network of more than two dozen primary care doctors and specialists. L&M created the network to take over the private practices' administrative, billing and organizational functions, leaving doctors more time to focus on providing medical care and less on paperwork, insurance, employee and financial issues.
The hospital also viewed it as a way to recruit doctors to the area, particularly younger ones who tend to be more interested in drawing a salary as a hospital employee than in running an independent medical practice.
But doctors who want to maintain their private practices and autonomy believe the network affords doctors and the hospital an unfair advantage in keeping the flow of patients and diagnostic services within the L&M sphere, and fiercely resist the idea of becoming a hospital employee.
Other doctors, some ready to declare private practice medicine an anachronism, embrace the new model as more conducive to a regular work schedule and freedom from the challenges of maintaining an office.
"There is a shift in thinking to more shift-work mentality," said Radin, who does not plan to join the network. "That's what people want. They don't want to worry about the rest of it. The people who want to remain in private practice want to practice the old way, taking care of their patients."
Dr. Michael Deren, a thoracic and general surgeon, said the hospital should find more ways to support physicians who want to remain in private practice. Deren recently stepped down as chairman of the surgery department, but remains in full-time practice.
"You don't have to see physicians as either competitors or employees," he said. "You can see them as partners, and work with them to help keep their practices viable."
Among other factors that have soured the hospital-doctor relationship for some was the departure of three of L&M's general surgeons in a relatively short time, leaving the surgery department short-staffed. Each of the three left for different reasons, but some doctors say privately that they believe the hospital could have prevented those and other recent departures.
Instead, L&M hired Dr. Garth Ballantyne and began lauding his impressive credentials and plans to bring baryatric and robotic surgery to L&M. Some doctors say the administration too readily dismissed their concerns that the expense and resources required to bring these programs are too risky for a medium-sized community hospital like L&M.
Ballantyne has recruited his former colleague from New Jersey, Dr. Eric Sommer, and two more speciality surgeons to L&M and is looking to recruit more, all of whom will be in the physician network.
Longtime local surgeon Dr. Dean Willis is one of the newest members of the physicians network. After the departure of the three other surgeons, he said, he and other doctors in his practice were working "harder and harder and harder."
"Suddenly there was a lot of extra work, without any recognition," he said. "Our incomes were going down."
Ultimately, he decided that joining the network was the best way to survive. But among some other doctors, he said, there has been "paranoia" that the hospital has been trying to "take over" all patient care services in the region.
"I don't see that," he said.
There are changes coming on a national level, though, that will mean physicians and other health care providers will be paid by a patient's diagnosis rather than for each procedure and treatment. Some fear this will put hospital-affiliated physician networks at an even greater advantage. When the three private practice surgeons left and were replaced by those employed by the hospital through the physicians association, it seemed a foreshadowing of a future some doctors are not ready to adapt to.
"It did thrust some changes onto us faster, but we knew it was coming," Willis said.
j.benson@theday.com
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