neurosurgical staffing
neurosurgical staffing in a three hospital region
Historically, neurosurgical care has existed in 3 locations in our region. A 100 bed hospital with 2 surgeons, a 250 bed hospital with 2 surgeons plus locum coverage and a 700 bed hospital with 8 surgeons. The two smaller hospitals are 50 miles apart, the larger hospital is 150 miles from the two smaller ones. The 250 bed hospital has no additional OR capacity. There is existing capacity at the 100 bed hospital. The surgeons at the smaller hospital have both recently departed.
Care at the 100 bed hospital has typically been spine surgery with some management of head trauma. In winter, transfer out from this hospital can be difficult due to fog impairing air transport and road conditions impairing ground transport.
Care at the 250 bed hospital includes spine, trauma and some brain tumor work. They provide 24/7 coverage but some shifts are covered by temporary physicians (locums). Physician relations between this facility and the smaller hospital have historically been tense and somewhat inflexible.
The largest hospital covers the full range of neurosurgery. It is the regional trauma center. All 8 physicians have busy practices with minimal time to consider travel to or support of the two smaller hospitals. They are open to helping to recruit and support associates in either of the smaller hospitals.
With departure of the two surgeons at the smaller hospital, we are considering how best to provide coverage. Close the program? Cover the facility from one of the larger hospitals? Place a surgeon supported by one of the larger programs at the smaller hospital? Other option?
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.
The surgeon departures should viewed as an opportunity for broader strategic evaluation, aside from just program closure or moving staff. It appears that some of the hospitals face different constraints and issues, such as geography/weather/volumes. Are there services that can aligned better at the smaller hospital so the transfer issues can be mitigated? Tele-health consult options could be investigated. Better understanding the historical staffing tensions is also critical before any staffing decisions are rendered. Analysis into program quality and low surgical volumes should also be included.
I am unclear if these three hospitals are the only hospitals in the region, or these three are same system/affiliated but there are still other competitors in the region. I think approach may be different if only 3 serving entire region.
Generally, I believe not every hospital can be everything to everyone, and neurosurgery infrastructure expensive to build and duplicate. Need to understand root cause of departures and see if they are system issues, process issues, or person specific.