It will come as no surprise to anyone reading this blog that hospitals can be extremely condescending to physicians. As a physician’s lawyer who spends his days reviewing and negotiating physician employment agreements, I am also frequently “treated” to this phenomenon.
Our firm, Physician Agreements Health Law, has coined the phrase “hospitalsplaining” to describe how hospitals routinely talk down to physicians and their lawyers. A recent example illustrates the problem nicely.
We were reviewing a physician employment agreement that provided, as many do, that “call coverage will be assigned by Employer.” Our review letter commented on several aspects of the call coverage requirements. First, we requested that call coverage be equitably allocated among all eligible providers (which didn’t seem unreasonable). We also requested some reasonable limitations on call. We had asked for 1:5, but our client probably would have accepted more call if it were required, so long as some reasonable limits were provided. The only other comment we had with respect to call coverage, based on our MGMA compensation analysis, was to ask for the MGMA median compensation if call exceeded the median unpaid hours per week in her specialty.
During the hospital negotiations the hospital’s representative was friendly and amicable. However, as we were discussing our firm’s review letter, she felt the need to “explain” why the provision regarding call could not be changed. You see, she explained, the hospital is a business. And, of course, a business needs flexibility. Therefore, although she certainly sympathized with the physician, she could not possibly consider altering that provision in any way.
I’m not sure what she expected our response to be. Presumably, she assumed that I would slap my head with my palm as the full import of this revelation was realized. I assume I was expected to instantly agree with the irresistible logic of her position and explain to my physician client that 24/7 call was eminently reasonable. “You see, Doctor, the hospital is a business.” I assume that the hospital expected that, having been duly educated on the nature of the health care system, my client surely would eagerly agree to whatever call was necessary.
You may be surprised to learn that our response was somewhat different. I tried to explain to the nice hospital lady that my client was one of the (presumably rare) individuals who was fond of sleeping some nights. Extensive additional negotiations were required. The end result was far from ideal, but we did get some assurances about call, and an agreement to provide reasonable compensation for excessive call.
Very few other professions are ever required to frequently give up sleep as an expected part of the job. Certainly, there is no other profession treated with such disdain by their employers.
How to respond if you become aware of hospitalsplaining
Hospitalsplaining is one of the more annoying symptoms of the general disregard that hospitals bring to their relationships with their most valuable assets – the physicians who work for them. Physicians must be aware of instances where they are the subject of hospitalsplaining and be prepared to stand up for their right to be treated as something more than an imbecile. (Even though at some point you may be led to ask: are hospitals evil?)
If you become aware that you are the subject of hospitalsplaining, it’s important to remain calm. Anger tends to escalate any situation. When dealing with the hospital administrator, I usually recommend politely requesting that you be referred to as “Doctor” rather than by your first name. The administrator is not your peer. A courtesy would then be to refer to the administrator as” Mr.” or “Ms.” Depending on how upset you are, you might want to continue to refer to the administrator by their first name.
It is generally more persuasive for you to argue your case based on patient care. It is not a stretch to state that you need personal time for yourself in order to provide the best care. Honestly, no hospital administrator cares about your personal life (or lack thereof). However, most administrators do recognize that a burned-out physician will not be giving optimal care to his or her patients. Calmly explaining that the agreement as written could lead you to burn out should spark some concessions.
Although I strongly recommend that you do not verbalize this thought, it is important to remember that every hospital administrator could have become a physician – except for the fact that they were not smart enough. Don’t let a big office and business buzzwords lead you to forget that you are the smartest person in the room.
Because of hospitalsplaining, many physicians choose to use an experienced law firm to review and possibly negotiate the agreement for them. If you have an agreement you would like us to review, you can start your physician contract review here. We can also provide a free consultation to explore how we can help.