Dr. Robert Safian
Dear Board of Directors and Board of Trustees:
There are many serious consequences of the “profit before patients” program of the current corporate leadership team; corporate leaders consider these consequences as “rumors”. Last week the CEO delivered a very explicit written report to the Donors and Trustees, detailing their impressions about physician relationships, physician departures, and other “rumors”.
According to the CEO report to the Donors and Trustees:
1. “There has been no large scale exodus of physicians as intimated in some media stories.”
2. “Some have postured that Beaumont believes physicians are easily replaced and somehow not valued. That is absolutely false and frankly makes no sense. “
3. “Experienced clinicians are extremely valuable and are very difficult to replace for some very obvious reasons. One, is it often takes a physician many years or even decades to develop a clinical practice and a strong regional referral base from other physicians. We are fortunate in having many tenured physicians with those types of practices, but that does not happen overnight. Losing one of those physicians really can negatively impact a clinical program for a protracted period of time and is something to be avoided if at all possible.”
4. “To the extent that we have lost valuable physicians, as indicated in the press, there were unique circumstances associated with each one of those physicians.”
5. “Clearly, multiple aspects of physician relationships had become strained this year:
- The low Michigan physician reimbursement [and] ongoing government regulation changes.
- 2018 legal settlement with the Department of Justice.
- The [COVID-19] pandemic.
- The non-binding letter of intent with Advocate Aurora Health.
- The combination of these factors…created a fragile situation.
- By carefully listening to all eight of our physician communities on each campus, we have made progress in hitting the reset button and addressing many concerns.
Our response are keyed to the numbers above:
- “Mass exodus” is an accurate description of the departure of over 50 physicians in 2020 and alignment of another 50 Beaumont physicians with local institutions.
- The physicians’ and nurses’ surveys speak to our perceived value by corporate leadership. We agree that devaluation of physicians and nurses does not make any sense, which is why there are irreconcilable differences between physicians and corporate leadership.
- We agree that physician experience is vital to Beaumont’s success and the value is built upon years of experience and hard work that cannot be replaced overnight. Yet large groups of anesthesiologists, surgeons, and cardiologists are being dismissed or dislocated by poor corporate decisions.
- It is remarkable that corporate leadership does not take responsibility for its actions; there aren’t any unique circumstances surrounding the loss of physicians, other than complete loss of confidence in corporate leadership.
- It is tiresome to hear the same refrain about compensation, the DOJ, and COVID-19, which have nothing to do with the loss of confidence in corporate leadership; reset buttons have not been hit.
The crisis in the Department of Anesthesiology was addressed in a separate section of the CEO report to the Donors and Trustees. These are the CEO’s explanations for the “Anesthesia Transition”:
- “It is essential for Beaumont Health to join the rest of the country in having a national best practice anesthesia service model... Our situation. ..did not allow Beaumont to achieve consistent best practices and impacted both the effectiveness and efficiency for our clinical services.”
- “NAPA could not meet our critical requirements, including no surprise billing for patients [and] a contract term of at least three years.”
- “We have retained over 70% of our legacy Beaumont anesthesiologists to stay at Beaumont.”
Our responses are keyed to the numbers above:
- Our Anesthesiology group is considered one of the finest in the country, and there have never been any issues about quality or consistency, either by our local standards of excellence or any national benchmark. The motivation to change anesthesiology service was based on “profit before patients”, and was not motivated at all by any desire to improve quality.
- NAPA agreed to the terms required by the hospital, and met all critical requirements. The decision to disrupt anesthesiology services was based on profit, and not on patient care, quality, or consistency.
- It’s a relief to know that corporate leadership acknowledges that 30% of our anesthesiologists are leaving, although the number is closer to 50%. We agree with the CEO’s comment that “losing one of those physicians really can negatively impact a clinical program for a protracted period of time and is something to be avoided”.
Physician departures from Beaumont in 2020 are delineated below; the list may be longer, since many physicians were reluctant to provide information for fear of retaliation:
Department of Anesthesiology: All of these doctors are leaving because of corporate leadership’s mishandling of the crisis in the Anesthesia Department, and all have lost faith in the corporate leadership team. All would consider returning to Beaumont under new corporate leadership but none will remain under current leadership. Most are taking pay cuts to go elsewhere to avoid the toxic environment at Beaumont, and distrust of corporate leadership.
Dr. B Pediatrics (Pending)
Dr. D Pediatrics (Florida)
Dr. L Pediatrics (Iowa)
Dr. M Pediatrics (Lapeer, MI)
Dr. C Pediatric (Arizona)
Dr. D Pediatrics (Pending)
Dr. L Pediatrics (Providence Hospital, Southfield)
Dr. A Critical Care (Henry Ford Hospital)
Dr. B Critical Care (Virginia)
Dr. B Critical care, Cardiac surgery, and liver transplant (Madison, WI)
Dr. F Critical Care and Cardiac surgery (University of Michigan)
Dr. V Critical Care, Cardiac surgery, and liver transplant (Henry Ford Hospital)
Dr. K Critical Care and Cardiac surgery (Madison, WI)
Dr. G Cardiac surgery and Liver transplant (Fort Lauderdale)
Dr. S Cardiac surgery and Liver transplant (DMC, Detroit)
Dr. G Cardiac surgery and Liver transplant (Indianapolis)
Dr. M Cardiac surgery (Petoskey, MI)
Dr. V Cardiac surgery (Grand Rapids, MI)
Dr. E Cardiac surgery (Pending)
Dr. P Obstetrics (New York City)
Dr. D Pain (North Carolina)
Dr. Y Pain (Henry Ford Hospital)
Dr. S Pain (St John Detroit)
Dr. F General (Henry Ford Hospital)
Dr. C General (Pending)
Dr. P General (Early retirement, won’t work for Beaumont corporate leadership)
Dr. M Pain (Pending)
Dr. S General (Early retirement, won’t work for Beaumont corporate leadership)
Dr. B Pediatrics (Early retirement, won’t work for Beaumont corporate leadership)
New hires who decided to go elsewhere because they didn’t want to work under the new provider
Dr. C Regional (Henry Ford Hospital)
Dr. M Cardiac surgery (Providence Hospital, Southfield)
Dr. M Pain (? University of Michigan)
Dr. S Cardiac surgery (Pending)
Department of Orthopedics: None are willing to provide names due to fear of retribution; many are concerned that their roles will be curtailed or eliminated if their names are shown. There are ~25 surgeons who expressed loss of confidence in corporate leadership regarding better coverage of nursing staff in the OR (which leads to delays or cancellations in procedures) and safety (sterilization of instruments, ready availability of ‘knee’ or ‘hip’ kits that specific surgeons need for their patients). A letter indicating their loss of confidence in corporate leadership was sent to the Chairman of the Board.
Cardiology: The largest cardiology practice at Royal and Troy (23 cardiologists) issued a letter to the Chairman of the Board indicating that none of the group’s concerns have been resolved. Names of the group and the cardiologists have been withheld by request.
Department of Cardiovascular Medicine: George Hanzel MD was the Director of the Cardiac Catheterization Laboratory and the Director of Structural Heart Diseases; George left Beaumont last week. Elvis Cami MD is the Director of Cardiac MRI and the Director of Structural Heart Disease Imaging; Elvis is leaving this week. Both are essential to the integrity of our department, and both of leaving due to their loss of confidence in corporate leadership. Letters from each were sent to the Chairman of the Board, delineating the reasons for their departures from Beaumont.
Department of Surgery:
Alan Koffron-100% of reason for leaving was lack of confidence in the executive leadership team, resignation of the Beaumont transplant anesthesiologists, and loss of confidence that new Anesthesia provider would hire competent transplant anesthesiologists
Julie Koffron-100% of reason for leaving was lack of confidence in the executive leadership team and loss of confidence in new anesthesia provider
Marc Sakwa-100% of reason for leaving was lack of confidence in the corporate leadership team (that’s putting it mildly). Marc NEVER would have left (and never would have looked for a job) if not for the corporate leadership team
Jeff Altshuler-100% of reason for leaving was lack of confidence in the corporate leadership team
Nick Tepe-75% of reason for leaving was lack of confidence in corporate leadership team. Nick was planning to back out of the OR and concentrate on critical care/intensive care, but he decided to retire due to the lack of confidence in corporate leadership
Urology: The Department of Urology has had a number of problems directly related to loss of confidence in the corporate leadership team and to the toxic environment they have created; these issues have been extensively documented with the Board of Directors, the Chairman of the Board, and the corporate leadership team. Five urologists left Beaumont this year to go to Henry Ford and other local area hospitals. Many urologists who were loyal Beaumont physicians have moved surgery to other hospitals. The Chair of Urology developed the Women’s Urology and Pelvic Health Center, which has been supported by major philanthropic donations and by federal research grants. This is a one-of-its-kind program that attracts patients for all over the world, to help women with pelvic pain syndromes and urinary problems. The success of the program required a truly unique and talented multidisciplinary team of urologists, anesthesia pain specialists, and skilled pelvic floor physical therapists, which the executive leadership team failed to support. In direct conversations, letters, and email communications to corporate leaders, Chairman of the Board and the entire Board of Directors, the Chairman of Urology has passionately detailed his concerns about how corporate leadership’s decisions have resulted in the loss of all key participants in the Pelvic Health Center, jeopardizing the quality of care and access to talented physicians and support staff, not to mention availability of unique educational and clinical research programs. All of these concerns have been dismissed by a consistent message that someone else will step in to take care of these patients. As a further indication of the lack of confidence in corporate leadership, the Chief Residents in Urology, who usually remain at Beaumont after completion of their training, refuse to remain at Beaumont under current corporate leadership.
Certified Registered Nurse Anesthetists (CRNAs): There are about 200 CRNAs at Beaumont Royal Oak, Troy, and Grosse Pointe. These professionals learned from corporate leadership by email that their employment contract with Beaumont was being terminated; the email was addressed to “Dear Physician”. The corporate leadership team did not make any effort to help the CRNAs with their transition, but coerced them to sign contracts with the new anesthesia service provider.
Others:
Brian Berman (Chair, Pediatrics)-fired after objecting to crisis management in pediatric ER; now at DMC
Emergency Room-fired after objecting to crisis in ER (name withheld by request)
Kelly Levasseur (Pediatric ER)-rising star, no confidence in corporate leadership; now at DMC
Internal Medicine-forced to leave prematurely due to his objection over firing of Brian Berman (name withheld by request)
Cardiology-premature retirement, no confidence in corporate leadership (name withheld by request)
GYN Oncology-2 physicians announced they are leaving due to no confidence in corporate leadership (names withheld by request)
Radiation Oncology- 1 physician is leaving due to no confidence in corporate leadership (name withheld by request)
These are the FACTS:
- At last count, there are 53 physicians who have left or are leaving in 2020, and at least 50 physicians are quietly bringing large numbers of patients to other systems, particularly for elective and outpatient procedures.
- Within the Department of Anesthesiology, 34 physicians have left or are leaving as of January 1, 2021; the names are delineated above. This represents nearly 50% of the department.
- The majority of physicians are leaving (or bringing patients elsewhere) because of irreconcilable differences with corporate leadership, and complete loss of confidence.
- Corporate leaders believe that all physicians can be replaced, despite their statement to the contrary. They are actively trying to replace half of our anesthesiologists, despite the CEO assertion that “losing one of those physicians really can negatively impact a clinical program for a protracted period of time and is something to be avoided” and despite the CEO assertion that “Experienced clinicians are extremely valuable and are very difficult to replace for some very obvious reasons.”
- Unfortunately, the physicians who have left are not going to return. However, we do have a very narrow window of opportunity to retain a substantial number of physicians, if there are immediate changes in corporate leadership. Stated another way, none will return under current leadership; many will return if leadership changes now.
It’s unfortunate that the information about the physicians is related to their departures from Beaumont and their disapproval of corporate leadership, rather than about their extraordinary accomplishments; I hope that will change in the near future. In the meantime, the longer corporate leadership remains, the greater our decline. Our sentiments for leadership change are widely held among physicians, nurses, ancillary staff, community leaders, and donors. In his own report, the CEO has provided the rationale for his own dismissal.
Respectfully submitted,
Robert D. Safian MD on behalf of so many
