I haven't been in a blogging frame of mind lately, and I blame it on professional chaos. In a recent post I mentioned that my hospitalist colleague came very close to resigning from Xpress Hospitalists, the name I choose to use for the staffing agency who took over our hospitalist program when we could no longer staff it ourselves. Well, things have evolved since then. Here's a precis:
1. The main issue in our conflict with Xpress was their failure to expand daytime staffing at Gimbels. When we signed on, they said they thought Gimbels needed two daytime hospitalists but they wanted six months to gather data on our census. These six months included the entire last winter, a brutally busy season, during which time I regularly saw 20+ patients. (Many hospitalists I know see 20+ patients, but they don't work at hospitals like Gimbels, which is not known for the efficiency of its support services.) After the 6-month period was over, we asked Xpress "Well? What about that second hospitalist?" They said the program at Gimbels was losing money and they couldn't expand the staffing at this time. Humph. Should've seen that coming.
2. Despite a pledge not to take on more patients, Xpress went behind our backs and made an agreement with some of the community doctors to provide inpatient care for their practices. Although Xpress did not make the ultimate mistake of agreeing to take on these practices completely, they created a completely nonsensical proposal to accept the new patients up to a certain census, after which the community docs would admit their own patients and follow them during weekdays. The proposal would have had us covering those patients at night and on weekends, and potentially required us to make multiple hand-offs during the day as the community docs signed out individually to the daytime hospitalist, who would then have to parrot back the patient's information to the nighttime hospitalist. As we all know, hand-offs are a particularly vulnerable point in a patient's hospital care, and any proposal to increase them is--quite simply--a horrendous idea.
3. Xpress also regularly failed to respond to our concerns, and generally acted like absentee landowners. They tried to impose a monolithic corporate model of how a hospitalist service should be run, instead of trying to individualize the program for Gimbels. It should be noted that part of their pitch to us was the opportunity to "make your own mark" upon the program. Uh, not.
4. Although we managed to negotiate a more acceptable arrangement with the community doctors in #2--making our own mark out of an Xpress foul-up--we knew the end was in sight. The week before last, I attended a meeting with the Xpress management team and demanded to know whether they had reconsidered funding the program for more staffing. I knew they were not going to provide a second full-time hospitalist, but I had proposed an interim solution which would have effectively provided a half-time day hospitalist so we could take on all the community doctors' patients. I reminded the management of my proposal, and it was immediately shot down as too expensive. I asked them if they were capable of providing any creative solutions to our problem, and one of the suits said, "Well, Theresa, creative solutions require input from a number of sources." This sounded exactly like Dilbert-speak to me, so I handed in my resignation. A few hours later, so did my good friend and co-hospitalist. We work as a team.