Those in medicine know that each specialty tends to attract a particular personality type. These observations are only broad generalizations and so are frequently inaccurate. That said, Plastic Surgeons usually like independence and a minimum number of rules. This allows creativity and customization for our patients, but demands personal responsibility. Greater than half of all current Plastic Surgeons (and every active Treasure Valley Plastic Surgeon) are in solo practice.
My Boise area colleagues and I all maintain privileges at St. Luke’s Medical Center. Luke’s has been the preferred partner in the Valley due to their high standards and willingness to provide reasonable cosmetic fees to our patients. What I do not like about hospitals is that they have lots of rules and maintain surveillance of all medical staff practices. I’ve never had any problems with Administration; but I completed an 8 year surgical training program and no one cares about my patients’ outcomes more than I do… so leave me alone.
Every 2 years, the Plastic Surgery Division at Luke’s rotates its chairperson. None of us really want to do it as we all (I believe) like to avoid being regulators, as well as sit in boring meetings. So now that it is finally my turn to be Chairperson, I could not wiggle out of it. While I am certainly no anarchist, I am not really a corporate guy. In the interest of trying to do my job well though (my term starts in 2010), I accepted St. Luke’s invitation to a Medical Staff Leadership training course.
After completing the 3 day course, I really do not want to be the Chief of Staff or Vice President of Medical Affairs, but I do have a new appreciation for the need and process of Medical Staff Administration. The Hospital Administration is responsible for deciding who should have privileges to practice and for what scope of practice those privileges should include. The Administration is also responsible for dealing with disruptive physician behavior and preventing sub-standard medical care. These issues are important in their own right, but the Federal and Sate Government require that regulations and standards requirements are documented. It is already starting now, but in the future, Hospital (and physician) pay will be determined by quality of care measurements. If Big Brother Hospital is not herding all of us cats, these mandated measurements cannot be made. Finally, the hospital must defend against lawsuits.
While I still like being the President of my corporation, Mark D. Wigod, MD, PA, and Chief of Staff of my own ambulatory surgery facility, Meadow Lake Surgery Center, I understand why Luke’s (and all other medical centers) must have an administration structure. When I think about it, my own accreditation organization for my operating room (AAAASF), serves the same oversight function for me. It looks like I (nor any of us) will ever be a grown up. I will always try to do the best for my patients, but it never hurts to know someone is also always looking over my shoulder. You should feel reassured that doctors who have privileges in accredited facilties are regulated for your safety.
As a warning to patients, be careful of practitioners who do not have someone looking over their shoulder. This includes physicians and surgeons who do not have hospital privileges to perform procedures that they are offering to you in their non-accredited office facility. It is fair to ask, “Why do you not have privileges to perform this procedure in a hospital and why is your facility not accredited”. If you have more questions, call either St. Luke’s or St. Al’s Medical Staff Office, or the State Board of Medicine. In the end, I now understand that the hassles of regulation are worth the legitimacy they provide to me and the confidence they inspire in my patients.