Does the physician facility owner act differently  in his own facility?  Do rental cars get the same care and attention as the car that you own?  I have found that surgeons with short fuses and hot tempers are tolerated where they are non-owners,  whereas their partners in co-owned facilities are not amused by these antics as this behavior makes retention of outstanding personnel difficult.  How can this be? Wouldn’t the facility owner’s tyrant attitude be un-checked in the facility  he owns?  Or is it possible that the scrub tech or nurse that was the target could be the favorite of another surgeon (who will not take kindly to another running them off)?  Most of the time this anger from surgeons is on behalf of their patients and their frustration that no matter what they say, nothing will change for the better.  As facility owners, physicians have total control over what needs to change to enhance patient care and the frustration is therefore much less.  I have  also found in my twenty years of anesthesia practice that surgeons in operating environments where they have no financial stake are often times very needy and demand all manner of gadgets and bells and whistles that are many times completely unnecessary  for the completion of a surgical procedure. At our facility, the surgeons are constantly exposed to comments by the staff like, “Dr. X doesn’t do it that way,” or “..if you use this instead we save $75.”  In a big hospital the surgeon would say,”!@#$%^^&&*(*&&^!”..or something like that..basically…”why do you think I care?”  These cost saving tips and efficiency tips are welcome and wanted in our facility and in others where there is cost accountability.

Another thing to consider:  hospitals are paid by insurance companies for what they use…surgery centers are paid for what we do.  What? You mean the hospitals are actually incentivized to be wasteful and expensive?  And surgery centers are paid the same regardless of what their costs are for completion of a surgical procedure?  This accountability has forced physicians in outpatient centers to look the cost dragon in the eye, something that rarely happens in the big hospitals.  It has made us aware that some physicians cannot possibly complete certain operations profitably while others can.  These inefficient and wasteful physicians (rarely found in physician-owned facilities, interestingly) are actually better for the profits of hospitals as the hospital is compensated for all of the stuff that is used in addition to what is done.  Incredible, isn’t it?  What other business could work this way and survive?  Once surgeons are hospital employees (having been the victims of a hospital hostile takeover)  will their utilization of unnecessary supplies increase in accordance with the wishes of their employer?  Whose bread I eat his song I must sing…or something like that.

G. Keith Smith, M.D.