Doctors Protest Productivity Report

Patient care and satisfaction would suffer if UCLA Healthcare pressures its primary-care physicians to increase their productivity in response to a consulting firm’s report, doctors who work for the system said.

“A doctor can be more productive either by spending less time with a patient or by seeing more patients,” said Dr. Martin Shapiro, UCLA’s division chief for general internal medicine and health services research. “You can certainly propose that you do that in a health-care system, but that does have implications for an individual patient.”

The Hunter Group told the faculty this week that UCLA Healthcare overpays doctors in its 18 primary care clinics on the Westside and that those physicians’ performance falls below national benchmarks.

UCLA, the largest medical system within the University of California chain, hired the group last fall for $1.9 million to help improve the bottom line at its three hospitals and expansive health-care network.

One doctor, who requested anonymity for fear of retribution, said the Hunter Group wants physicians to be like “those nodding donkeys in an oilfield.”

“You can say to anybody you’re not productive enough,” he said.

Among other things, the Hunter Group recommended that UCLA Healthcare cut 475 jobs over the next three years to save $31 million, send out patient bills faster, cut supply costs and renegotiate insurance contracts. UCLA officials have said most of the positions cut will be through attrition, not layoffs.

UCLA officials said no final decisions had been made on the consultants’ recommendations.

“Whenever an institution issues a report that has to do with change, people are going to wonder how its going to affect them,” said UCLA spokesman Max Benavidez. “That’s exactly what’s happening here. We’re trying to seek their input and be sure that they’re part of the process.”

Although UCLA has begun acting upon the Hunter Group’s recommendations and has circulated the report internally, officials have refused to release the document publicly, saying it is a working draft.

The contents of the report were described to faculty members at a meeting earlier this week.

Some physicians cautioned against drawing conclusions or painting grim scenarios until the university releases the Hunter Group report and it can be analyzed in depth.

“It’s a very emotional time,” said Dr. Matteo Dinolfo, lead physician at the Santa Monica-UCLA 12th Street Medical Group. “Any time people look at data and are told they’re not working hard enough, when they feel they are working hard enough, it’s difficult to absorb.”

What is clear is that UCLA’s financial position lagged behind the four other UC medical systems last year. In fiscal 2002, which ended June 30, UCLA Healthcare netted $7.2 million on operating revenue of $825 million. By comparison, UC Irvine earned $36.5 million, Davis $35.3 million, San Diego $30.3 million and San Francisco $29 million.

In addition, UCLA Healthcare had only $20,000 in the bank at the end of December and was forced to borrow $7 million from the chancellor’s office to pay bills.

Some doctors said they took offense at the university’s hiring of the Hunter Group, which has a reputation for recommending layoffs and program cuts.

“The $1.9-million fee to the Hunter Group could be better spent on our more immediate fiscal problems,” Dr. William Cunningham, a UCLA internist in Westwood, wrote in an e-mail to The Times.

“I hope the dean and chancellor here do not implement the Hunter Group recommendations,” he added. “I expect that it would result in the permanent loss of many patients and many good physicians from the UCLA system.”

Dr. Camelia Davtyan, who also practices in Westwood, said the Hunter Group report hadn’t taken into account the quality of patient care or the time spent by UCLA faculty teaching students and writing journal articles.

“I cannot comment on the quality of care and the amount of time community doctors spend with their patients, but I know that my UCLA colleagues practice very high-quality medicine and our patient practices are more complex,” Davtyan wrote in an e-mail to The Times.

Shapiro cautioned against turning medicine into an assembly line, recalling Charlie Chaplin’s 1936 movie “Modern Times,” in which the actor gets caught in the machinery when the assembly line’s speed is increased.

“Up to a point, you want to promote efficiency, but that’s not the only goal,” he said. “The goal is to provide high-quality medical care.”

Dinolfo said there are no data to suggest that increased productivity hurts patient care.

“Much of what you’re hearing is very emotional,” he said. “All of us have a responsibility to look at it rationally and reasonably and to not overstate the case.”