Nationwide, hospitals are struggling to retain emergency department doctors. But a recent piece in the Boston Globe is highlighting a particularly troubling case here in Massachusetts: Springfield’s Mercy Medical Center.
The hospital is facing what some are calling an impending exodus of its emergency physicians in its low-income community with high medical needs. In response, the hospital is turning to a private, for-profit medical staffing agency to help fill the gap.
But the solution may not be so simple — or reassuring — to the doctors still there. Shira Schoenberg, a Boston Globe editorial writer who authored the piece, joined GBH’s All Things Considered host Arun Rath to share more. What follows is a lightly edited transcript.
Arun Rath: Let’s start with the basics of the story. What is driving the exodus of emergency department physicians at Mercy Medical Center?
Shira Schoenberg: There seems to be a couple of things going on at the same time. One is that there’s this general national shortage of physicians and medical clinicians, particularly at Mercy Medical Center — it’s a high-needs population, as you mentioned. There is short staffing. And some of the doctors that I spoke to said that decisions by management about how to deploy the limited number of staff were done in a way that really caused burnout, and caused physicians to feel like they weren’t able to provide the best quality care for their patients.
Some of those staffing decisions seem to have led to the decisions by many emergency medical doctors, physician assistants and nurses to leave the hospital.
At the same time, Mercy Medical Center is trying to resolve the issue by bringing in this for-profit staffing agency called Vituity, but several doctors told me they’re not particularly happy about that switch, and that it might actually cause them to leave as well.
Rath: What exactly is Vituity promising?
Schoenberg: So, the idea is that you now have an outside company that’s going to come in, employ these doctors and, presumably, recruit new doctors, bring in doctors from elsewhere, and really focus on professional development and leadership opportunities. That’s the promise.
Right now, Vituity seems like it is a fairly successful company at what it does. Over the last couple of years, it’s been expanding; it had contracts over the last few years at hospitals in Wisconsin, California, Illinois — lots of hospitals, particularly ones that are struggling with staffing, have turned to Vituity.
That said, the challenge with any for-profit company, as we’ve seen clearly in Massachusetts, is that they need to be able to withdraw a profit. There’s no promise that they will add more staff and address the understaffing issues.
Some doctors are worried that, for example, if they work for a for-profit, they might lose eligibility for federal student loan forgiveness, which is a really big deal to physicians with an enormous amount of student loan debt.
Rath: Wow. I’ve got to imagine that’s a huge deal for a lot of these physicians.
Schoenberg: It is, and we saw, actually, that Vituity recently went into some of Trinity’s hospitals in Connecticut, and there you had physicians that were concerned about a lack of student loan forgiveness, physicians that were concerned about their visa status — if they have a certain immigration status.
A significant number — maybe 30% of physicians in these hospitals — actually decided to leave rather than work for Vituity. The doctors that I spoke to in Massachusetts say it’s similar — that this inability to qualify for student loan forgiveness was a really big deal for them.
Rath: Are these concerns you’ve heard from doctors something Vituity would be able to take on with its corporate culture?
Schoenberg: That’s really not clear to me. When I asked, Mercy Medical Center did tell me that they were committed to ensuring that clinicians who were in student loan forgiveness programs, or who had visa concerns, would be able to have those concerns addressed. But they weren’t able to explain to me exactly how that would work.
Would they continue to be employed by a nonprofit? Or would there be some other program to help them remain in these loan forgiveness programs? That really wasn’t clear to me.
Rath: I’ll add that we reached out to the hospital and Vituity for comment. In a joint statement, they wrote:
- All emergency medicine providers will be offered the opportunity to continue their work through Vituity, and emergency medicine physicians will have the opportunity to join Vituity as practicing partners and equal owners.
- Mercy administrators will work with Vituity to continue any visa and loan forgiveness programs that may already be in place for current emergency medicine providers.
Now, Shira, what are you hearing from doctors about what this will mean for patient care?
Schoenberg: There’s a lot of concern about what this means for patients. Obviously, if you don’t have enough staff, you just can’t provide the high-quality care that patients need and deserve.
Particularly in an area like Springfield, where patients have really high needs, it’s just so important that there is adequate staffing to care for patients. The physicians I spoke to said they’re concerned that the level of understaffing that will potentially be present if all these physicians do choose to leave could really endanger patients; it could require the hospital to limit how many patients it takes.
Obviously, we’re not there yet. Right now, all evidence shows that the care is perfectly safe, but there are concerns that if staffing is not addressed, that would certainly affect the quality of care.
