However, as more and more physicians practice as employees, they are discovering the nastiness in the guise of unreasonable patient case loads and unsafe work conditions, the oppressiveness and the contstraints that so doing has placed on registered nurses for decades.

I think one alternative is to use the framework of professional practice organizations as busines entities to directly contract professional services and staff to patient care institutions. In fact, self-governed organizations could feasibly be populated with registered nurse and physcian members and for example, contract all inpatient nursing, diagnostic imaging, emergency medicine, hospitalist and anesthesia services to a hospital. They (the SGOs) would be able to recruit their own clinical leaders, thus making nursing and physician leaders accountable to their colleagues instead of to an employing organization, and the power of large numbers of nurses and physicians would influence their ability to retain reasonable measures of autonomy over their practice, work conditions and patient safety and advocacy.

I blog about this at the link at my name, as well as at my dormant blog, Universal Health.

What is clear is that physicians and nurses require collective representation in order to practice safely and to be able to bring the appropriate resources to bear to effect desired patient outcomes.

Welcome to the June 30th 2008 edition of the Carnival of the Entrepreneur. At the Carnival of the Entrepreneur you will find articles submitted by authors from all over the internet relating to anything associated with being an entrepreneur. Topics ran…

Today, I work with many of the same anesthesiologists that I have known from my early days at this facility. They now represent a large anesthesia group covering many of the hospitals in our area. The downside of their survival in an industry that has many economic indices and hurdles is that they are no longer able to settle in at one facility for the entire day. They may start their day with us and then travel down the road for 2-3 cases at the end of the day. As our own group covers several area facilities, both acute care with inhouse population demographics and free standing surgical and gastro facilities we observe the daily maneuverings of our group to determine who goes to what facility at any given moment should there be an emergency add on case.

It seems that prudent physicians must seek to move to a demographic-based clientele that slices up the pie into percentages. Are they able to take a twenty percent Medicare/Medicaid demographic alongside an eighty percent standard insurance provider clientele? All of this will also depend on the facility in which they practice. Our own facility struggles with increasing numbers of self-pay clients and we are lucky to get a ten cent on the dollar reimbursement.

I do not have the wisdom to adequately address this issue. It has the complexity of Ariadne’s thread. The legal and economic passageways are too convoluted and gone are the days when the R.N. was the most valuable asset for a physician. His most cherished employee is the one who can code the Medicare reimbursment or insurance reimbursement efficiently.

Tammy Swofford

Physicians have moved closer to the plight of the average worker in the sense that they have less and less control over their practice and how and where they deliver care. So fundamentaly I support any group of people using the avenue of organizing and collective barganing.

I always thought there is power in numbers…. and if too many parties are controlling or influencing the delivery of medical care as its delivered by the physician, maybe docs have to take it back via unions?

I am very curious about the costs and benefits of unionizing to docs and would love to read more on this topic.