Discontent Spurs Many ER Physicians to Consider Leaving St. Anthony’s

By Mary Jo Feldstein, St. Louis Post-Dispatch

Jan. 30–Emergency room physicians at St. Anthony’s Medical Center in south St. Louis County say the majority of them have resigned and could leave the hospital by April 1.

While the immediate issue is a plan by the hospital to no longer directly employ its emergency room physicians, several doctors said inadequate nurse staffing and other concerns have contributed to the discontent.

Several months ago, St. Anthony’s and a few of its physicians began looking into changing how the hospital staffs its emergency room.

Most hospitals use one of three models: employ physicians directly, contract with a third-party agency to provide physician staffing or use a physician-owned group. Locally, most hospitals employ their emergency room doctors or contract with a third party.

St. Anthony’s emergency room physicians are currently employed by the hospital and paid by the hour.

The discussions at St. Anthony’s led the hospital to bring in Serio Physician Management, a Denver company. Serio was charged with helping the emergency room doctors transition to a physician-owned group practice.

Serio would manage the physicians for at least two years. Then, St. Anthony’s emergency room physicians would be able to buy the practice from Serio for an estimated $1 million to $2 million, depending on the value of the practice at the time of sale.

While many of St. Anthony’s physicians were willing to switch to a group model, several objected to Serio’s terms. Dr. Gary Pfortmiller, one of the emergency room physicians, said the fee amounted to asking physicians to spend $50,000 to buy a stake in a practice they had worked in for years.

“It’s a slap in the face,” Pfortmiller said.

The hospital said nearly the entire staff resigned, in part because any physician who wanted to sign on with Serio had to resign from employment at the hospital. It said all who resigned did not originally plan to leave St. Anthony’s.

Since then, however, concerns over Serio and the resulting conflict with hospital administration has prompted many of St. Anthony’s approximately 20 emergency room physicians to accept new positions elsewhere or begin looking for other jobs. The exact number of physicians leaving will likely stay in flux until a final plan for staffing of the emergency room is reached.

Current employment contracts require that St. Anthony’s emergency room physicians give the hospital three to four months’ notice. For most, this period will expire by April 1. This gives the hospital and the emergency room physicians several weeks to finalize their plans.

St. Anthony’s Chief Executive Tom Rockers said he met with five or six of St. Anthony’s emergency room physicians on Tuesday. The group looked at about five employment options.

One of those proposals would have the physicians work with another company similar to Serio, and Rockers said the physicians seemed more comfortable with this new company and its terms. He declined to discuss the other potential scenarios.

The emergency room’s medical director is an example of the situation’s fluidity. On Monday, Dr. Ed Ferguson said he planned to leave the hospital for family reasons and because of the large number of physicians exiting. But during Tuesday’s meeting, Ferguson agreed to lead an effort over the next week to recruit physicians for the emergency room, Rockers said. It’s not clear whether Ferguson will stay on long-term.

Several of St. Anthony’s emergency room doctors said this most recent conflict intensified existing discontent among the staff. St. Anthony’s emergency room, one of the area’s busiest, has needed to go on diversion — or rerouting ambulances to other hospitals — more frequently in recent weeks. Some physicians attributed this to staffing issues, but Rockers and Ferguson said it was because of increased patient volumes.

Dr. Tom Hartmann says he has spent 20 years caring for patients in St. Anthony’s emergency room, but in recent years increased turnover among nursing staff, heavier workloads for physicians and other staffing issues have forced patients to wait longer for emergency room care or leave without ever being seen. Hartmann said it’s difficult to feel comfortable caring for patients who have been in the waiting room for three to five hours.

The hospital is trying to increase nurse staffing levels with more help from outside staffing agencies, and it’s also hiring additional help to assist registered nurses, Rockers said.

Rockers also said one reason he wanted the physicians to transition to a group practice is because he thought it would motivate the physicians “to work harder and smarter” and help the emergency room run more efficiently.

“When they work for me, it’s a contract,” Rockers said. “I work my shift, and I’m out of here.”

mjfeldstein@post-dispatch.com

314-340-8209

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