How to respond to a disruptive physician who is a heavy admitter

Dear Medical Staff Leader:
One of the biggest medical staff leadership challenges may be posed by the disruptive physician who brings a large revenue stream to the hospital through either direct admissions or referrals. Such physicians may feel immune to the tactics typically employed in managing problem conduct. They feel sure no one will ultimately jeopardize the revenue they generate by taking action against their privileges.

And worse, staff may feel that this physician is untouchable, meaning whatever his or her behavior, nobody will do anything about it. Further, there may be members of hospital management or the board who discourage action against a physician with disruptive behavior because of the potential economic effect. Members of the medical staff may also weigh in against corrective action if they feel they will lose significant referral business. It can be especially disheartening to medical staff leaders attempting to "do the right thing" and manage a disruptive colleague, only to find themselves "sand-bagged" by those who elevate revenue generation above professionalism.

The best way to prepare for such circumstances is to anticipate them. In particular, there are two steps you should consider and undertake to avoid economic blackmail from problem physicians. The first is to consider this issue when you initially develop a disruptive physician policy. When presenting a code of conduct for board approval, encourage an explicit discussion in which the board considers how it will handle such situations. It is helpful to have the discussion documented in the meeting minutes to ensure there is no historical amnesia.

The second step is to start planning for revenue replacement at the first signs of disruptive behavior from a high-revenue-generating member of the medical staff. Even when early behavioral interventions are being undertaking, medical staff and hospital leaders should begin planning for the possibility this physician will not be responsive and may be asked to leave the staff. Such planning might involve the recruitment of additional physicians in a similar specialty, the identification and fostering of new sources of revenue generation to make up for lost business, conversations with payers, etc.

The financial impact of terminating the privileges of a high admitter is less scary if the scenario has been anticipated and appropriate preparations undertaken. 

That's all for this week.

All the best,

Rick Sheff, MD