037 - Physician Ownership and Group Wisdom Prevail Through Crises

Christopher Obetz, MD, is the CEO of an organization which started with a handful of physicians 30 years ago, and now they have over 150 physicians and APPs. The group staffs nine emergency rooms in the Minneapolis St. Paul area. One year ago, Dr. Obetz was my guest on Episode #15 (Title: Emergency Care Consultants CEO: The Incalculable Value of Physician Careers). At the time, the ECC leader and his organization were faced with a trio of crises:
•The Covid pandemic and sequelae in Emergency Medicine
•Unexpected closure of a hospital with resultant overstaffing
•The George Floyd murder devastated the community around ECC’s flagship hospital

Patient volumes dropped by 40-50% during the early months of the pandemic as patients stayed clear of hospitals in order to avoid infection by Covid. ECC, which was already generously staffed, faced overstaffing as a result of reduced volumes and the hospital closure. When I spoke to Dr. Obetz last year, he wasn’t sure if the values of the organization or even the organization itself would survive. Could they get through an unprecedented nosedive in income? Could they honor the employment agreements with physicians scheduled to start in the spring of 2021? And in the aftermath of George Floyd’s death, could they examine their own biases and emerge as a trusted source of care in their stricken community?
Dr. Obetz describes how the impact of the pandemic evolved: from the initial emptied-out emergency departments to a swelling tide of patients overwhelming their EDs. The current “boarding crisis” resulted from greatly increased demand for ED visits and inpatient beds. One reason is the pent-up demand and more advanced disease because care was delayed for typical medical conditions. The second is prolonged hospital stays for critically ill patients suffering from Covid. Patients are “boarded” when there is no ICU or regular hospital beds available and they end up receiving critical care, sometimes for days, in the emergency department. The effect on doctors and nurses and others is “bruising” as they scramble to care for patients on ventilators or crowded in the hallways, still working behind N-95 masks, gloves, and gowns.
The organization has navigated through two years of an unpredictable and seemingly unending pandemic. Dr. Obetz describes the strategy that has underpinned their success: “We are democratic to a fault.” In fact, hiring decisions include an assessment of whether a physician will embrace the hard work, time investment, and collaborative nature of participative decision-making. Listen in as Dr. Obetz specifies how their three core values, their principles, have served the large emergency medicine group. And when it comes to the importance of physician ownership and physician leadership, Dr. Obetz is a believer.
In this episode:
•The expertise of previous podcast guest Alfie Kohn is invoked
•ECC’s prime directive is the overriding priority of outstanding patient care
•The importance of physician expertise in decision-making echoes the research of “friend of the podcast” and two-time guest, Dr. Amanda Goodall
•The real meaning of Shift Nirvana is spelled out
•Do ECC physicians defect to work for competitors? “It has never happened”

Meet Christopher Obetz, MD:
Dr. Christopher Obetz, an emergency medicine physician, is the President and CEO of Emergency Care Consultants (ECC) in Minneapolis, Minnesota. ECC is a “physician-owned, independent, and democratic” organization responsible for both outstanding emergency care and outstanding emergency medicine careers in nine hospitals in the Twin Cities area. Dr. Obetz has been leading ECC for the last decade, a period marked by significant organizational growth.
The organization is known for its consistent high quality care and service, excellent business outcomes and sustained high satisfaction among physicians and staff. Innovation is fueled