“Transition” is not a permanent solution
For a little over a month now, the Gunnison Valley Hospital emergency department has been operating without a general surgeon on call. That means the family physicians who staff the ER don’t have the option to consult with a local general surgeon to determine whether a patient can be treated locally or at a hospital with more specialized capabilities.
That fact has generated some controversy in the community, but the situation does not reflect a change in policy. According to Michelle Campbell, marketing and business development officer for GVH, GVH is actively looking to restore an on-call surgeon. Dr. John Bishop resigned the role after several months of contract negotiations with the hospital.
Campbell explained that Dr. Bishop provided on-call services to the hospital for many years but until about a year ago, those services had never been formalized. Dr. Bishop came in when he was available, and there was no requirement that he be available.
“GVH has never had 100 percent coverage in the ER for a general surgeon. Dr. Bishop was wonderful in terms of coming in on call, and being available when he could be,” Campbell said.
A year ago, the two parties formalized their relationship. This year, she said, Dr. Bishop wanted to renegotiate that contract to change the amount of time he is on call and set up a different compensation plan. The details are subject to attorney-client privilege, but overall Campbell said they would be in keeping with industry trends.
The challenge has been agreeing on “fair market value” for compensation, something GVH is required by law to negotiate. A third-party appraiser has been used to evaluate a wide range of factors and determine that fair market value—including numbers of insured and uninsured patients, how often a surgeon is on call, and how many times they come on site. The appraiser provided a range, and GVH negotiated within that range.
“Both the physician and the hospital administration provide data and information to the appraiser, and then we also provide marketplace specifics like in the summer we have a high number of tourists,” Campbell said.
But the hospital and Dr. Bishop have been unable to arrive at an agreement and in September he stopped providing on-call services. Campbell hopes it will still be possible to come to an agreement with Dr. Bishop, but in the meantime GVH has contracted with an outside agency to find temporary coverage for the ER.
“It’s our first choice to resolve the situation with Dr. Bishop and secure additional temporary coverage to cover time he does not want to be on call,” Campbell said.
In the meantime, she added, the lack of an on-call surgeon does not automatically translate to an incremental increase in the number of patients flown out of the valley for treatment. As a Level IV hospital, GVH already sends four types of injuries to other hospitals: brain or spinal cord injuries, heart emergencies like heart attacks, some strokes, and injuries that affect multiple body systems.
According to GVH chief medical officer Dr. John Tarr, “These types of cases will require sub-specialists and equipment not available at a Level IV trauma center and will almost always be sent out by helicopter.”
In addition, Campbell pointed out that some general surgery patients can wait to be seen at Dr. Bishop’s clinic during regular office hours. And being seen by an on-call general surgeon does not automatically mean patients would receive treatment in the valley.
In September last year, 13 patients were flown out of the valley for medical treatment, including a case the general surgeon recommended sending to another hospital. During September this year, the ER transferred 16 patients to other hospitals; three of those cases were related to not having a general surgeon available. That’s an increase of two.
Campbell also emphasized that as a recreation-based community, it is important for GVH to have orthopedic surgeons and general surgeons on call. Last year, the hospital had 951 surgeries, 418 of which were orthopedic and 368 of which were general surgeries.
“We need general surgeons and we need orthopedic surgeons,” Campbell said, indicating that GVH would continue to work on an agreement with Dr. Bishop and also review resumes from the temporary agency. Dr. Bishop did not respond to a request for comment.
In the meantime, the health system’s new CEO arrived on the job this week. Dr. Rob Santilli started work on Monday, October 15, and healthcare consultant Community Health Center is also on site this week to present its analysis of hospital needs. That information will be shared with staff and the public in coming weeks.