Rex hospital in Raleigh has instituted a new program that no longer relies on self-employed surgeons to cover overnight shifts. Self-employed surgeons are to be replaced by staff surgeons that are employed by the hospital, known as surgicalists.
For hospitals, this means better leverage to negotiate with insurance companies. Hospital administrators claim that this will lead to fewer delays caused by on-call doctors commuting. In rebuttal, doctors argue that rarely does a commute take longer than prepping the patient or the surgery room and that this is rarely a cause for delay. Two separate studies, one a 2013 publication from the American Academy of Orthopedic Surgeons and the other a 2012 study published by the American Medical Association, concluded that the surgicalist model for employment could increase the number of ER surgeries by 50%, bringing in more revenue for the hospital. On the other hand, self employed surgeons would be excluded from these increased revenues, and would lose about $50,000 annually by missing just 1 weekly surgery to surgicalists.
For doctors, there is more pressure to be employed by the hospital for financial security. Surgicalists are paid a fixed salary, with bonuses for exceeding set surgery volumes. Surgeons will no longer be gambling their reimbursement on the patients insurance companies, nor will they be gambling that the patient is insured at the time of service. Doctors will see a dramatic change in their schedules, working 7 consecutive 12 hour shifts every other week for a total of 26 weeks. Compared to the typical 7AM to 7AM overnight shift at Rex, this is much more spread out and conducive to sleep. However, the surgicalists model is intended to solidify market share for hospitals; doctors employed by the hospital are only allowed to refer patients to that hospital for services.