X-Ray Department Wants to Compete


“Finished, blotto, they quit.”  S.Q. Lapius waved his cigar with an air of finality.


“Who quit?”  I asked.


“The x-ray department over at the hospital.  All of them.  Gone.  The whole kit and kaboodle.”


That was precious information and deterred me momentarily from completing the dictation of a case report.  “Who is going to do the radiology now?”  I asked.


“Oh, another doctor has been hired and there will be a reasonable albeit bumpy transition period.”


“Exactly what happened?  I heard some rumors, but this is certainly a shock.”


“That’s the way it is with institutions.  In with the new, out with the old,” Lapius said sharply.  “The details aren’t very important.  Simply that the old radiologist and the board of trustees couldn’t come to contractual terms.”


“But these changes take their toll in hospital efficiency,” I remarked.


“Astute observation, Harry,” Lapius said, complimenting the obvious.  “The fact is that question whether a hospital is entitled to hire physicians to run a department has not been answered at least to my satisfaction.”


“Why shouldn’t a hospital be allowed to hire physicians?”


“Because a hospital is not licensed to practice medicine.  Nor are the members of the Board of Trustees.”


“Suppose the Board of Trustees is composed entirely of doctors?”


“Even so, they are a board, a legal entity.  Legal entities cannot practice medicine.”


“Are there alternatives?”


“Of course, Harry.  Hospital based departments could be concessioned to the physicians.  The hospitals should be paid rent.  Provision should be made for excess monies to be devoted for research.  The hospital should stipulate a rate of expansion, commensurate with community growth.  The contract could even stipulate a fixed fee for service for the physicians.”        


“How would that differ from the usual employment contract where the hospital hires the doctor?”


“All the difference in the world,” Lapius said through tight lips, lighting a cigar.


“You’ve got one lit already, in the ash tray over there,” I said, pointing.


“Oh yes, well put it out like a good fellow.  One is all I need.  Where was I?  Oh yes, all the difference in the world.  If the department is set up as a concession the doctors have the right to hire help at the highest salary base, to buy the best equipment regardless of cost, to expand into other techniques.  On the employer-employee basis, the hired doctor must go to the administrator for every expenditure.  He can’t compete with the market for the best technicians, nor has he a free hand to buy the best equipment.  Why should any doctor have to be satisfied to work with the tools provided by a Board of Trustees or a hospital administrator.  They really haven’t the sophistication to know the intricacies of the specialty.  Too often good practice is impeded by their budgetary scruples.”


“But suppose the doctors who set up the concession are pinch-pennies?”


“Get rid of them.  The hospital would have the right to expect the very best service for the right of concession.”


“But who is to judge?”    


“Details, my boy, mere details.  They can easily be worked out.”


“But if a hospital can’t practice medicine, then how can they hire interns and residents?  Wouldn’t that be the same thing?”


“Certainly, Harry.  It would.  The hospital should turn over the monies to the medical staff to hire interns and residents, as well as emergency room physicians, and be responsible for them and the jobs they do.”


“Fine, but suppose the staff doesn’t accept that responsibility?”


“Then we would be back to where we started and the hospital would have to practice medicine.”


“So why bring it up in the first place?”


“Why don’t you go back to dictating your charts?”  Lapius said huffily.  “You obviously weren’t listening to anything I said.