Sunday, July 08, 2007
Chicago Tribune
by Judith Graham

Large numbers of demoralized physicians are planning to leave Stroger Hospital as Cook County cuts services in its beleaguered health system, according to a new survey conducted by Stroger's medical staff leadership.

If it materializes, the exodus could threaten clinical care at Stroger, the county's flagship medical institution, and undermine its reputation.

The survey was conducted last month; 178 of about 350 physicians at the hospital responded.

It documents doctors' widespread dissatisfaction with working conditions at Stroger and their concern that the hospital's mission of caring for the underserved has been severely compromised.

Almost one out of three physicians who responded said they had already found another job (6.9 percent) or were getting ready to do so (26.4 percent). An additional 31 percent said they were thinking about leaving, compared with 35.6 percent who said they planned to stay at the hospital.

"What this says is, the morale is rock bottom," said Dr. Peter Orris, immediate past president of Stroger's medical staff and a voluntary attending physician at the hospital.

"Absolutely, we are concerned," said Don Rashid, a spokesman for the county health system. "These are respected members of our organization."

The county hopes to reverse doctors' dissatisfaction by securing extra money from state and federal authorities and improving its financial operations. "We're struggling but we are hopeful, and we hope that will translate into physician retention," Rashid said.

Whether physicians will stick around long enough to give officials a chance to turn things around is an open question.

The Stroger medical staff survey asked doctors how their feelings about working for the county health system had changed in the last year. Slightly more than 82 percent of physicians said they now thought they were "less likely" to keep working for the county over the next one to five years.

Of that group, 73.1 percent said the "decline of the work environment" was a very important factor in their negative outlook.

Since dozens of doctors and nurses were laid off earlier this year, remaining providers are being asked to see more patients in less time -- a load many feel is unreasonable, Orris said.

Physicians are also finding it difficult to obtain the services patients need at overstretched clinics. Orris said he tried to schedule a surgery for a patient with a "large kidney cancer" this week but was told the renal clinic is prioritizing cancer patients because of a backlog.

In the new survey, only 22.8 percent of the respondents said the quality of care they were able to deliver was excellent or very good. Some 68.2 percent said the quality of care had worsened a little or a lot over the last year. A second round of survey responses is being solicited.

County administrators have a different perspective. Rashid cited a number of accomplishments, including a doubling in the number of patient exam rooms at the busy Fantus Clinic across from Stroger, a decline in wait times for phone calls to Fantus, and the addition of several new pharmacies.

Officials will be launching a new effort to "inform doctors of all the changes we are implementing," Rashid said.

One of the doctors leaving is Dr. Gordon Schiff, director of clinical quality research and improvement at Stroger Hospital. Come December, he'll become an associate professor at Harvard Medical School.

Schiff and his wife, Dr. Mardge Cohen, have worked at Stroger Hospital for more than 30 years.

In an e-mail to the Tribune, Schiff said he loved the hospital and its patients, "but this period of turmoil, of misguided leadership, or not listening to the patients and the staff, is destroying the hospital and what I love about it.

"It's too painful to see the best nurses and doctors I have ever worked with get laid off, cast aside with little regard for the vital services they provide. ... We had a vision of Cook County as a quality institution full of dedicated, caring staff who are advocates for the patients. These are the people who are being driven away."