Turnover at TMH: Part 1
Disagreements about administration’s role over retention
December 9, 2012
Dr. Jeffrey Womble, a general surgeon at The Memorial Hospital in Craig, compares a physician choosing a place of employment to a serious, personal relationship.
"Everyone describes it, whether you go into private practice, are employed or whatever, as getting married," Womble said. "Sometimes it works out, and we all work and do everything we can to make sure it works out. Sometimes it doesn't."
But what happens when it doesn't?
Divorce can be messy.
With the recent departure of several physicians from TMH, many residents are wondering why the administration and physicians are unable to work together.
With fingers pointing every which way, it's uncertain whether physician retention is an issue Craig alone faces, or a trend being seen nationwide.
Craig community members put their trust and health in the hands of physicians who have chosen to practice rural medicine, and concern is growing as doctors depart on not-so-amicable terms.
The following is part one of a three-part series examining the issue of physician retention at TMH — whether what's happening in Craig is a problem caused by the current administration or part of a national trend — told from the perspective of current and former hospital employees as well as current administrators.
A new trend
"More and more young doctors coming out of residency desire an employee status rather than private practice. It's salaried, a guaranteed income, someone else paying the overhead. It takes all of the unknown out of it."
— Dr. David James
The medical world has shifted over the past several years from a private practice mindset to one of salaried employment.
Physicians are opting out of owning their own business and embracing the idea of working at clinics and hospitals.
But as this shift continues, physicians and administrators will either have to learn to collaborate cooperatively or consistently clash heads.
Dr. David James, a physician for 30 years in Craig, 27 years in private practice and 3 years as a general surgeon at TMH, said times change.
"Virtually all physicians were completely in private practices," James said. "Nationwide that is changing. We started seeing that 10 years ago, maybe even 15. It was becoming prevalent even then."
And as a result James doesn't see the issue of physician turnover in Craig as particularly problematic.
Dr. Scott Ellis, chief medical officer at TMH, came to Craig in 2008 because he wasn't happy with his previous hospital.
"I'll be honest, I did not share a particularly great relationship with administration so I know how difficult that can be," Ellis said. "I have not seen that be an issue here."
Having worked as both a private practitioner and an employee, Ellis said there are some fears associated with having a boss.
"There's a fear of the loss of your autonomy, but then again it does give you mobility," Ellis said. "If you have a significant amount of your time and finances invested in a practice and facility, it's a little more difficult to pick up and go, when you're employed it makes it easier."
The trend is something James speculates isn't restricted to Craig.
"My guess is nationwide doctors are just more mobile than they have historically been," James said. "And there's always the human nature of different doctors and different administrators."
Womble, one of the physicians who entered into the employment world rather than private practice, said it's the exact situation he wanted.
"I don't have to worry about all the business decisions," he said. "I take care of my patients whether they have insurance or not. Someone else deals with the financial part and I make the best medical decisions I can."
But not all physicians have found it so easy to negotiate employment with administration.
Contracts and compensation
"Coming to a rural, hunting, cowboy community has romance to it that appeals to some people. Then they come and their wife realizes it's a long distance to the mall."
— Dr. David James
Many have said rural medicine isn't for everyone, that once a physician gets here they change their mind about the northwestern Colorado lifestyle.
But for Dr. Troy Phillips that was not the case, saying he planned on coming, but never planned on leaving.
Phillips was employed by TMH for three years until he was unable to negotiate what he considered an acceptable contract with administration.
In a letter to the TMH Board of Trustees, Phillips dismissed the notion that he left for lifestyle reasons:
"Let me be crystal clear. We never intended Craig to be a short-term job, a stepping-stone to other opportunities or just a place to pay off loans.
We owned a house, my kids were enrolled in school, and my wife and I were both involved in multiple community organizations.
Our third child was born in Craig, and our home on Pershing Street was the only home he knew. We obviously still feel very attached to Craig, and probably always will."
Phillips left because he felt unsupported by the administration, specifically CEO George Rohrich.
"There isn't a specific provider that couldn't get along with the CEO," Phillips said. "It's multiple providers and one CEO. He's the common denominator."
Phillips had issues with the administration regarding patient care decisions, input on staffing at the clinic and parts of his contract that he said were breached, as well as others TMH simply failed to honor.
"When I brought it to their attention later they were very antagonistic," Phillips said. "They would come back with subtle or not so subtle threats of firing you for disagreeing.
"I had a chat with the CEO and his response was threatening with dismissal. I knew he didn't threaten without carrying it out."
When Phillips' contract came up for renegotiation, he thought it was clear the administration didn't want him to stick around.
"His (George) 'best offer' was unacceptable to me, not because of any dollar figure, but because it showed how little he valued me as a physician," Phillips said.
Phillips resigned in August and took a job in South Carolina.
"I miss Craig like crazy," he said. "I miss western Colorado, we've got lots of friends there."
But Rohrich said he doesn't set the compensation scales for physicians. Instead, salary and benefits — including paid time off and days required on — are set by a physician's individual specialty, then reviewed annually and approved by the TMH Board of Trustees.
TMH works very hard to compensate within those scales and to do so fairly, Rohrich said, while taking into consideration physician experience and national averages.
"The board has authorized me as we approve a recruitment or a renewal of a contract to negotiate within those boundaries, but just within those boundaries," Rohrich said. "So I guess the point I'm trying to make is that it's thought out, it's reviewed and it's business like.
"We're talking about serious amounts of compensation in dollars. We have to stay, even by law, within fair market values. So that's what we do. It isn't an emotional thing, although emotion is always around it."
But Phillips isn't the only former employee to take issue with the way contracts are negotiated at TMH.
Dr. Tammy Rice, a former contract anesthesiologist at the hospital, said she had similar problems as Phillips with administration, namely Rohrich, but under different circumstances.
Rice had initially attempted to negotiate with administration to become an employee of the hospital, hoping for less time on call and a competitive salary.
In a letter to the TMH Board, Rice said she received the exact opposite, more time on call and a salary that wasn't on par with her colleagues around the state and around the country.
She added she felt guilty for taking vacation time because she knew it left operating room surgeons, patients and staff shorthanded.
"When I had feelings of unrest in my head, my first thoughts were to find a way to stay in Craig, not leave," Rice said.
Rice researched average market value salaries and took 80 percent of that number to TMH in an effort to compromise on a reasonable salary.
She was asking for $35,000 a year.
"I know I have very little experience at negotiating, but I thought we would both have our starting points and meet somewhere in the middle," Rice said. "When George's second offer came back the exact same as his first, which was equal to and possibly less than what I was currently making, I decided to start looking elsewhere for a job."
And Rice got the feeling Rohrich didn't care if she left.
"The attitude of administration toward not only physicians but of long term employees seems to be that everyone is replaceable," Rice said. "If you don't want to stay we'll find someone to replace you whether you've been there a year or 20 years.
"Looking back on it now, what I was asking for in the first place was really not very much, but they weren't willing to budge at all. It got really frustrating."
In hindsight Rice is relieved Rohrich didn't give her what she was asking for, as it doesn't come close to what she earns now.
This feeling regarding contract negotiations at the hospital, however, is far from universal. Several current doctors who have negotiated contracts with the current TMH administration had a far different story to tell.
Womble, Ellis and Dr. Kristie Yarmer, a pediatrician for TMH, all said they hired a consultant or lawyer to look over their contracts before committing, just as a precaution, and said they've had no problem coming to a fair agreement with the administration.
Ellis had an employment law specialist look over his contract who found it to be simple and very straightforward.
Yarmer and Womble shared similar sentiments.
"I've had nothing but good experiences from the time I began negotiating my first contract," Womble said. "I came here straight out of residency so I was a newbie at negotiating. I hired a consultant to help me with that and they were very impressed with the contract I got."
To read part two of this three-part series, see Wednesday's Craig Daily Press or visit http://www.craigdailypress.com starting Tuesday afternoon.To read part two of this three-part series, see Wednesday’s Craig Daily Press or visit http://www.craigdailypress.com starting Tuesday afternoon.To read part two of this three-part series, see Wednesday's Craig Daily Press or visit http://www.craigdailypress.com starting Tuesday afternoon.