By EDWARD PULLEN, MD

In Philanthropy It’s All About Relationships.

Last night I spent an interesting evening as the local physician asked to come along with our local hospital on a philanthropy pitch to a local specialty group to contribute to the finishing touches of a new hospital in town.  Puyallup, WA has been an interesting community from a medical services standpoint.  Currently we are a very desirable populace to any hospital organization. We are young, employed, insured, and growing as a community.  We have a relatively high disposable income.

On top of that we have only one community hospital, Good Samaritan Hospital.  The downside is that in part because of this lack of competition from another local hospital we have fallen far behind nearby larger communities in the physical plant we use as our hospital.  My accounting daughter would probably say we have accrued a huge capital deficit in facilities.  Good Sam was recently acquired by a larger hospital group, allowing the community to plan for, fund and build a new hospital.  As physicians we are appropriately being asked to contribute to this project.

Everyone knows that the economy stinks right now.  In addition physicians now are struggling with the issues of higher expectations of service, higher overhead, reduced payment for many ancillary services, and higher state taxes in Washington, and uncertainty in future Medicare rates.  I thought these would be the primary issues we faced in discussing a contribution from this specialty group.  These issues were brought up and we all went through the anticipated woe-is-me discussion on the economy and politics about medical reform and compensation.  To my surprise the discussion quickly turned to relationships. This was where real passion came into the conversation.

In our community many specialties are represented by only one group of physicians.  This is true of the group we met with tonight, as well as many other specialties.  Though less than in some other communities some local medical groups have been acquired by hospitals. This has at times led to competition between the hospital and the private groups in town at the same time that a cooperative relationship and collaboration are needed.  We spent most of the evening discussing the need for respect, trust and cooperation.  In other businesses this might have been more overt.  Discussions of exclusive relationships or contracts for services might have been worked out. In medicine this type of discussion is forbidden.  The hospitals not-for-profit status and inurnment issues, the anti-trust rules on physician fees, rules against self-referral, and more issues I only partly understand made this type of overt negotiations clearly off the table.  Still there remains a major concern among private physician groups that hospitals will bring unfair competition against them, be able to operate physician groups at a loss in order to secure referral sources for inpatient and procedural care, and as a result be able to out-compete the private groups on an unlevel playing field.  It was interesting to see the intensity of these anxieties.  In our community we all do really work for the same cause:  good patient care and community health.  In the final story the group we met with will do the right thing and step up to contribute to our community hospital in order to improve the facilities for our patients to utilize.  Still the anxiety level of physicians remains intense about supporting their hospital who can also be their toughest competitor.

Edward Pullen, MD, is a board certified family physician practicing in Puyallup, WA. Dr. Pullen shares his viewpoints on medical news, policy and the practice of medicine from a primary care physician’s perspective at his blog, DrPullen.com.