marc nahuijs's Profile
first a question: why is the relationship between the physicians so laborious? Isn’t this the reason why physicians have left? For preventing future turn-over problems this seems to be a key-question.
You need new doctors, losing a program is an eternal waste! Promote the benefits of working in a small hospital with a attractive variety of seasonal-tied pathology… in the meantime make a periodical exchange-program which is lucrative and convenient for the doctors. Put them in a nice hotel, and pay extra. Every 8 weeks you work in the smaller hospital for one week. Even for young doctors with a family, this period of time is tolerable. Practices can take an extra week of waiting time. Besides this it enhances phycisians quality getting familiar with the always somewhat different character of patients, diseases and pathology at different parts of the country.
a triage model that starts at the moment when a patient makes the appointment. Even in my profession as a dermatologist, which is concidered as a small specialism quite a difference is subspecialties is present. Referrals are mostly digital and sometimes even accompanied by foto’s so a division can be made easily. The doctor with the right subspecialism is chosen by the planningoffice to have the first consultation. If a patient has a written referral from their GP and make an appointment by telephone they are asked to read out this letter. We saved a lot of time and money with this system. For example: surgical oriented dermatologist recieve patients of whom is suspected or known that a malignancy is the reason of their referral. OR-time is already reserved for taking out the tumor at this first consultation. This saves at least one consultation-slot and prevents patientfrustration being planned another day expecting to be treated instantly.
Wages in our hospital are combined: a fixed salary and variable part to be earned by individual performance indicators. For the on-call problem a ‘inconveniency surcharge’ was introduced: a 8% surcharge on top of the fixed part of the ( 100%) salary in wich there are 7 levels. A young specialist starts in group 0 and over the years you proceed to a higher level. So everybody knows that being on-call is well payed for (since it is 8% of the 100% fixed salary even if you work less than this 100% (so less than five days a week)). There is no discussion anymore. When you are employed for a longer time the 8% of your rising salary (higher group) is enough to be satisfied with. Sometimes you are lucky and you don’t have to come to the hospital that often: that is the difference and so the focus has changed.
Off course there are differences in intensity of work during on-call hours: as a dermatologist I know that a on-call consultation takes less time than for instance a cardiology-consult. The percentage of surcharge could be different for different specialties. If you take historical data you can determine what specialty should be higher awarded: not for specialism but for time spend being and working on-call. I would be satisfied with the fact that every specialism is compensated in some way even if there is a difference in percentage.
the system could be financed by calculating the total of costs wich is already reserved for on-call activities and divide this among the total group of specialisms.
a very recognizable problem!
the blend could be the introduction of a (new) system in wich, all of the quality and performance indicators are defined like: comparison of quality of individual doctors, efficiency, production, contacts and training of GP’s and other primary care workers, patient-satisfaction, usage of budget etc. A calculation model has to be determined together and with approval of the doctors. A bonus or malus is incorporated in this system. Starting with just a portion of the total of reimbursement and gradually making it a bigger part.
Never give up! You know that you are right: If there is a care-system in wich quality is not on top of the list, than there is a problem. The fact that many of the specialist are not trained enough or have the necessary skills and not want to refer patients to competent individuals is, to put it mildly, a screwed up system.
But what I understand is that you control the data and you can point and give transparency about the differences in group- or individual quality, productionlevel and give openness about patient-, colleagues- supporting personel- satisfaction. With these figures and clarity about the consequences, I as a physician would consider it a unsustainable system and would be open for at least a discussion about it.
You will make enemies but also a lot of friends that have the same intentions and goals as you have