A few years ago, I was at a major urban medical center, preparing to start a meeting, when the system CMO arrived and introduced himself to every physician in attendance before taking his seat. It struck me how different the working relationships are at a large-market facility compared to those at a small community health system, where the medical staff and administration are in constant contact. 

There’s a lot of discussion in the healthcare industry on the challenges faced by community hospitals today, and rightfully so. Community hospitals are vital to Americans’ access to care and many of them are in dire financial situations. But it’s important to remember that large hospitals are facing challenges as well. They are operating under the pressures of urbanization and crowded emergency rooms. And the layers of complexity and bureaucracy inherent at these larger facilities can cause a number of internal challenges, alignment issues being chief among them. 

Compensation as a Tool 

Compensation can be used as a tool to solve the problem of alignment in large-market hospitals. Oftentimes, top-down decision-making and a lack of transparency leaves physicians feeling powerless and taken for granted, which ultimately leads to a low level of trust and engagement, as well as a poor hospital culture. 

Physician Participation

That’s why physician participation is at the heart of our programs. Physicians bring invaluable insights to the table. When we’re designing call compensation programs, the first step in our process is to establish a Physicians’ Call Committee. The committee process allows representatives from every specialty an opportunity to give the committee a glimpse into the frequency and intensity of their unassigned call coverage. The physicians then work together to establish a standardized method for allocating a call pay budget. When physicians participate in the decision-making process, suddenly there’s a sense of fairness and ownership surrounding the issue of call pay. This sense of fairness and ownership goes a long way in aligning a medical staff with its administration. 

The call committee process also improves relationships between specialty groups. We’ve found that there are often misconceptions in the medical community regarding the call burdens of other specialties, but at the end of this process, physicians have a better understanding of who’s sharing this workload. And since every specialty is considered for inclusion, there is no longer a sense that the available call pay dollars only go to the specialty groups with the most political sway and negotiating power. 

Aligning Mixed Medical Staffs 

Improving relationships among the members of the medical staff is especially important in large-market hospitals since there is often a mix of employed and private-practicing physicians on staff at these facilities. Mixed medical staffs often become divided around compensation issues like call pay. While call pay is included in employed physicians’ contracts, private practicing physicians are typically paid a per diem. There is often a lack of understanding between these groups concerning how and why each side gets paid, resulting in a perceived lack of fairness and demands for more pay. These demands place administrators, who are already seeking ways to contain costs, in a difficult position. By increasing participation and transparency, these issues are naturally mitigated and a mixed medical staff can be unified around common organizational goals. 

Compensation can either align or divide a medical staff at any facility. But challenges present at large-market facilities require solutions that are designed to unify the members of the medical staff, both with one another and with administration. Alignment is the key to breaking down the barriers caused by layers of complixity.