Mark Van Ess, DO, chair of head and neck surgery at Mercy Clinic Springfield (Mo.), recently joined Becker's to discuss the relationship between physicians and the hospitals they work for.
Editor's note: These responses have been lightly edited for length and clarity. If you would like to contribute to our next question, please email Paige Haeffele at phaeffele@beckershealthcare.com.
Question: How is the physician-hospital relationship changing in your market?
Dr. Mark Van Ess: The Springfield market is a unique market for a metro region of this size (about 500,000 patients depending on the service-line). Springfield is a highly constrained healthcare market with really only two major health systems providing care in the area. While there are some smaller systems in the region and some "outsourced" and partnerships as well for certain service lines, most local or regional physicians or advanced practitioners provide care as employees of Mercy or Cox Health.
We have a smaller number of employed professionals with the VA, the [Magers Health and Wellness Center at] Missouri State University and Jordan Valley Health as well. There are pockets of independent practice and some hybrid situations, but for the most part, our arrangements tie us in part or in whole to one of two hospitals. I don't anticipate the physician/hospital employment situation will change significantly in the near future (five years) or in the long term (10 years).
I am curious to see how erosion of noncompete agreements will play out in the future, but given the complexities of healthcare regulations, the type/expectations of physicians and advanced practitioners joining the workforce, insurance contracting, cost challenges and quality concerns, I don't see this as a big threat to the employment relationship of physicians and hospitals in this region of the country. Both major healthcare organizations in Springfield work well (enough) with the physicians and advanced practitioners to maintain a significant employed workforce. Many specialties work best — i.e. most efficiently — in collaboration and require support structures from ancillary services working within a hospital system: better access, population base, coordination of care, quality, cost containment, etc. Most physicians understand and appreciate or at least accept this. The employment model and relationships come at the personal cost of independence and autonomy, but most local healthcare professionals in the region seem to be at least OK — for the moment — with these arrangements.