Exclusive Contracts and Sanctum Sanctorum

 How does a country founded on the freedom of choice succumb to Exclusive Contracts. The Exclusive contract is a covenant between a hospital and a group of physicians that allows the group to provide exclusive service in a particular field thereby preventing other physicians from practicing in that hospital. The excluded physicians are not allowed to practice their own specialty in the given hospital.  The qualifications, skill levels or reputation of the physicians are not taken into consideration. This is solely based on economic credentialing. In some cases exclusive contracts are negotiated by influential but ageing surgeons with declining surgical skills in order to eliminate their competition. While the lawyers dwell only on the legality, the Exclusive Contracts defile the sacred ground of patient –doctor relation.                              

                      In a field like heart surgery the patients have no way to judge the competence of the surgeon except through the referring physicians. In most practices the referring physicians have multiple choices of the surgeons. The referring doctors will scrupulously refer the patient to those surgeons whom they will trust to operate upon themselves or their loved ones. For the poor trusting patients, this is the only safety mechanism in place. This is true for the entire practice of medicine, but more so for a surgical field like heart surgery. As physicians we create our own little sacred space with our patients. Only other physicians whom we allow in this sacred space are those whom we trust. Exclusive contracts, by eliminating the choice, breach the sanctum sanctorum between the patient and the doctor.

 

Pankaj Kulshrestha, M.D.Dayton Cardiac Surgery East Medical Plaza 627 Edwin C. Moses Boulevard, Suite 5J Dayton, OH 45417 Tel: (937) 938-9194 | Fax: (937) 938-9242 www.daytoncardiacsurgery.com

Exclusive Contracts: Who Bears the Brunt?

At first sight it might seem that exclusive contracts are harmful to the excluded physicians only.  However, the main brunt falls upon our trusting patients. Essentially, the patients of the excluded physicians are denied all the advanced technology and collective wisdom of the physicians in a given hospital. This is all the more true when a physician in a small hospital is unable to admit his sick patient to the main hospital from which he is excluded. An example in cardiac surgery may be use of nitric oxide which may not be available in a smaller hospital.  Economic credentialing denying a physician the privileges due to exclusive contracts may deny his patient the use of nitric oxide which is a life saving measure. In addition, exclusive contracts deny the patient the opportunity of the consults from experienced physicians. The excluded physicians are also not able to pursue the CME in the excluded hospital, thereby indirectly affecting the patient care. It is my sincere hope that even those physician who have never personally experienced economic credentialing, will take a stand for the sake of our patients, to eliminate such an appalling practice in a clinical fields like cardiac surgery. 

Pankaj Kulshrestha, M.D.Dayton Cardiac Surgery East Medical Plaza 627 Edwin C. Moses Boulevard, Suite 5J Dayton, OH 45417 Tel: (937) 938-9194 ' Fax: (937) 938-9242 www.daytoncardiacsurgery.com

Exclusive contracts: Are we still a noble profession?

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This message has been cross posted to the following eGroups: Connect to Justice and Ohio Medical Open Forum . ------------------------------------------- To some medicine is more than a profession - it is a calling to help others without self-interest. While primary care physicians directly serve the community, the specialists are mostly chosen by the primary care physicians. No one becomes a specialist except by the goodwill of the referring physicians. A specialist must, therefore, earn the respect and trust of his colleagues and patients. Referrals must be in the best interest of the patient and must not be based on friendship or incentives. Since the time of Hippocrates, we have distinguished ourselves as noble profession through altruistic endeavors to heal the mankind. On the other hand, the business world is solely guided by self-interest. Establishing exclusive contracts with the hospitals to gain patients is an appalling decadence of our professionalism.  ------------------------------------------- --     Pankaj Kulshrestha, M.D.Dayton Cardiac Surgery East Medical Plaza 627 Edwin C. Moses Boulevard, Suite 5J Dayton, OH 45417 Tel: (937) 938-9194 ' Fax: (937) 938-9242 www.daytoncardiacsurgery.com