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Life in Emergistan: Another Stupid Clause in the Contract

Leap, Edwin MD

doi: 10.1097/01.EEM.0000470677.62809.e7
Life in Emergistan

Dr. Leap is a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available at www.nursingcenter.com, and Working Knights, Cats Don't Hike, and The Practice Test, all available at www.booklocker.com, and of a blog, www.edwinleap.com/blog. Follow him @edwinleap, and read his past columns at http://bit.ly/LeapCollection.

Some friends of mine lost their fee-for-service contract when their hospital was sold. It's happening all over the place, so it's not really a surprise. But a clause in their new contract added a new wrinkle. They were not to speak or write in any negative way about their new employers. Perhaps, in other jobs, that's normal. Maybe I have been sheltered for my entire career, and this is just the way things are done. Or maybe not.

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When many physicians were their own employers, there was nobody to complain to other than the person in the mirror each morning. We were the captains of our own destiny. But with every passing year, I see physicians increasingly treated as commodities, and I find it disturbing that physicians are compelled by contract to keep silent about problems.

I've worked as a locums physician over the past year in numerous emergency departments, from the very busy to the very slow. Many were pleasant places to work, but some had disdain for the safety of patients and the well-being of physicians. I saw departments woefully understaffed; I saw monitoring for data collection that was onerous and exhausting.

I witnessed and heard about worship of patient satisfaction that left physicians and nurses demoralized. I saw electronic medical records systems that were (and are) truly the work of the Dark Lord. All of this was foisted from the top down based on consultants, nebulous industry standards, or the overaggressive interpretation of laws and regulations by an ever-growing army of administrators, to whom (in point of fact) we may attribute the lion's share of the increased costs of modern health care.

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The Rocky Shores

The result: Emergency department volume is growing, costs to patients are rising, and staff cannot keep up with the needs of patients and the endless litany of policies. This crashes onto the rocky shores of satisfaction scores and hours of charting time. It's an unsustainable formula, and physicians and nurses are seeking an exit strategy sooner than ever, leaving for administrative or academic positions because the joy of practice has been crushed from their weary souls.

Into this mélange, my friends face contracts that say they are not allowed to speak up no matter how bad it is. Don't complain; don't offer criticism. Don't use that pesky First Amendment right! Go on pretending that everything is fine. Make administration look good! Help with recruiting! Sucker some more souls into the spiritual black hole of the dysfunctional department!

Maybe I'm naive. Maybe this is how it is in every industry. Perhaps, like noncompete clauses, it's unenforceable. But even if it is, it suggests to me more nefarious trends in medicine. What it says is, “We aren't going to try to make it better, and you better just get used to it and accept it.”

When I first heard about this, I thought, “If you don't want your staff to complain, make the job so good that they don't! Make it so good that even if there is some outlier, some gadfly, some agitator, he will be outnumbered and everyone will know him for a troublemaker. Make people happy, and they won't complain!” (Seems like the same for noncompete clauses. If a group is that good, why would I want to work anywhere else?)

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Listen to the Staff

Does it seem that hard? Not to me. Here's what you do, administrators: Listen to the staff. If they say that the dissatisfied customer is a drug seeker and well known to them, then simply drop the inquiry. If they tell you that the staffing level is dangerous, do everything possible to make it better. If they say that they never get a chance to eat, make food available. If they feel unsafe, get them a guard, for heaven's sake. If they tell you that the EMR is miserable, and it takes 10 minutes for every chart, then ignore the sales representative and listen to your staff!

Spend some time every week walking around the ED during the busiest, most log-jammed shifts. Walk through the psychiatric commitment process with the staff. Sit by the secretary (or physician) as orders are entered. Experience the issues firsthand and try your best to fix them rather than dismiss them. It's called leadership. And it's stewardship of the precious human “resources” you have. How difficult would that be?

If directors and administrators would do that, they wouldn't need clauses in contracts to tell people to shut up. And they would have physicians and nurses knocking down the door to work for them. Isn't that better than putting another stupid clause in the contract?

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