N.C. firm helps Thomas cover its emergency room

By JOHN HEYS
02/07/2005

After more than 25 years in private practice, general surgeon Richard Fogle got tired of the office. The paperwork. Dealing with insurance companies. Managing employees.

So when the Knoxville, Tenn., native heard about a position at South Charleston's Thomas Memorial Hospital where he could just see patients in the hospital, he jumped at the chance. Fogle began working at Thomas last month.

"If I never saw the inside of an office again, I'd be fine," the 63-year-old physician said during a recent interview.

While Fogle gets to work in the hospital away from an office, Thomas gets a general surgeon who takes call for the emergency department, day or night.

Hospital administrators expect the setup to solve a looming crisis: finding enough general surgeons to cover their emergency room.

The North Carolina company that found Fogle for Thomas sees it as a trend-setting practice that will spread to hospitals around the country. The firm also recruited another general surgeon, Dr. Noel Doromal from Virginia, who will split the on-call schedule with Fogle.

"The very dilemmas that [Thomas] faced are faced by a lot of hospitals," said David Joyce, president and chief executive of Delphi Healthcare Partners, based in Durham, N.C.

About a year and half ago, Thomas administrators came to Joyce with a problem: Several general surgeons had left the hospital. Some of those remaining didn't take emergency calls because of their age.

As a result, the on-call schedule for general surgeons was "held together by spit and dental floss," the hospital's vice president, Bob Gray, said last year.

"We were about one more [surgeon] away from it being unworkable," said Steve Dexter, Thomas's president.

The solution Joyce and his company came up with draws on similar programs Delphi has set up with hospitals around the country.

Delphi contracts with a facility, recruits the specialists the hospital needs and then handles all the billing for the physician. The company also helps the doctor find medical liability insurance.

"We'll take care of the business end," Joyce said. "You get to just practice medicine."

In return for a management fee, the hospital gets a specialist to cover its emergency room. The general surgeons already on staff get a break from taking emergency calls.

And they don't have to worry about Fogle taking any of their patients. He doesn't have a private practice and doesn't want one.

"This is what I do," Fogle said, pointing to the walls of Thomas hospital. "This is my office. This is my world."

The two surgeons join a hospital stung by a 10-percent drop in patient admissions compared to last year. Fewer patients, higher costs and problems collecting its bills left the hospital with a $3.2 million loss for its last fiscal year, which ended Sept. 30.

Since mid-December, administrators have cut 80 full-time positions by limiting hours, halting overtime, stopping the use of per diem workers and leaving open positions unfilled.

Dexter said the two new general surgeons could help halt the falling patient numbers. Because the emergency room is fully covered, ambulances won't have to divert patients to another hospital when a general surgeon is needed.

The doctor's presence should also make the hospital a more attractive place for general surgeons with their own practices. With Fogle and Doromal handling the on-call coverage, the private practice surgeons can focus on their patients.

"We see these guys as a way to grow the hospital," Dexter said.

Delphi hasn't had trouble recruiting doctors for its client hospitals so far. Many doctors, such as Fogle, have been in private practice for years and have had their fill of running an office.

"They get tired of the rigors of private practice," Joyce said.

When Delphi put out word it wanted an obstetrician for a program at a San Francisco hospital, the company received calls from 260 interested doctors. Delphi went with the applicant who was the chief of the obstetric residency program at Duke University.

"The physicians we're able to attract are extraordinary," Joyce said.

All the doctors the company recruits are screened. They must then clear a hospital's own checks, just like any other doctor applying for the medical staff.

Hospitals contracting for services is not new. Facilities around the county, including Thomas, use doctors known as hospitalists, whose sole job is to care for patients while they are in the hospital. When they're discharged, the patients go back to seeing their regular physician.

But the practice is getting more specialized. Delphi works with hospitals seeking obstetricians, orthopedics and pediatric specialists for hospital-based, on-call care.

The general surgery contract with Thomas is a first for the three-year-old company and probably unique in the country, Joyce said.

"It's very, very new," he said. "This is pretty cutting edge."

Joyce expects it to be the first of many. Other hospitals are already calling, including at least one other facility in West Virginia.