Med School Faculty Private Practice Causes Concern

              Med School Faculty Private Practice Causes Concern
By Margaret Martin
Of The Times Staff
The question of private
practice by faculty of the
LSU Medical School at
Shreveport has become an is-sue
of concern and con-troversy
among some mem-bers
of the Shreveport
Medical Society.
And his commitment to
a private practice plan for
the faculty may have cost Dr.
Clifford G. Grulee Jr. his post
as dean of the school.
Private practice is an
emotional topic which often
crops up across the nation as
the "town-gown fight"
whenever a new medical
school is established.
P r e s e n t l y — and
theoretically — medical
school faculty members see
patients privately only on a
consulting or referral basis
from local doctors. They can-not,
for instance, admit
patients to any hospital ex-cept
Confederate Memorial
Medical Center, the school's
teaching hospital.
And while everyone agrees
that for numerous reasons
there must be a professional
practice plan for the faculty
doctors, that kind has not
been established.
Explained simply, a private
practice plan for medical
school physicians is a salary
administration plan. The
amount the individual doctor
receives for seeing private
patients would be taken into
consideration as part of his
salary.
Such a plan would set up.
regulations for the private
practice, including a fee
scale.
Grulee was named vice
chancellor for the LSU
Medical Center. In
the position he will coordinate
the local school's activities
and report to the chancellor
Dr. Allen A. Copping of New
Orleans. But Grulee will have
nothing to do with the day-to-day
running of the institution.
Grulee didn't confirm or
deny rumors that he had been
removed from the deanship
because of his commitment to
the plan.
"I don't know. I don't think
so," he commented when
asked.
In one interview, the former
dean said concerning his new
post, "I have had several
calls asking if I have been
kicked upstairs, so to speak. I
hope not. I think there is a
job to be done."
But Grulee also said that he
felt the plan — which has
been hammered out over
several months by a 10-mem-ber
task force at a cost of
several thousand dollars —
could be implemented this
spring. And he said he hoped
that he would be involved in
its implementation.
Not so, said Chancellor Cop-ping,
who explained that
the plan would go to the desk
of the Acting Dean Dr. Ike
Muslow, who took over as
head of the school on April 5.
Referring to the plan,
Muslow said, "I don't know
the background I was not in-volved
in the planning of the
private practices plan.
"It is not logical to make a
decision right now. We should
sit down and go back."
Muslow said he thinks it is
fine for the medical school
physicians to see patients on
a consulting basis, "but to
make it a big part of their life
is one thing; to do something
to help the community is
something else."
He predicted, "there will be
no decision within a short
time. I am not one to jump on
something quickly."
Copping said there are cer-tain
aspects of the plan which
he doesn't like. He feels that
in general it is too complica-ted
and can be simplified.
"There will be no plan
within the next few months,"
the chancellor said.
But, he said he hopes there
will be one by the time the
new building is completed in
July or August.
Fees were paid to the con-sultant
on the private prac-tice
plan, John Kasonic of
Kasonic, Chappell and As-sociates,
Seattle, Wash., who
received $19,292, including
$14,805 for salaries, and $4,492
in expenses, secretarial fees,
copying costs and travel
reimbursement, according to
Robert R. Graves, assistant
to the dean for ad-ministration.
The money came from
$12,500 in private local funds,
and $13,500 in federal
capitation funds, according to
Graves.
The capitation funds, the of-ficial
explained, are given to
every medical school in the
nation on a per student basis.
The dean can use the funds in
the best way he sees fit for
development of the particular
school.
"We agreed to a minimum
and outlined the work in-volved,"
said the school of-ficial.
He said the Kasonic
team receives expenses and
$45 an hour. He has worked —
as of the interview — 306
hours. An associate is paid on
a lower scale, Graves said.
The present consultation
agreement, which is still on
the books, said the former
dean Grulee, was set up when
Dr. Edgar Hull was head of
the school. In theory, it allows
the physicians to see patients
referred to them by doctors in
their speciality field, and only
if the medical school man of-fers
a unique skill. (Grulee
also said that he felt services
of many local medical school
men were underutilized.)
Most medical school doctors
say they will not accept an
appointment from a patient
who just calls — or drops in.
Dr. Albert Bicknell,
president of the Shreveport
Medical society, said that he
had heard complaints from
local doctors about allowing
medical school physicians to
see private patients.
And, said Bicknell, the
society members are happy
about the appointment of
Muslow as dean.
"Numerous private
physicians do not like the
idea of these other physicians
practicing . . . with the state-paid
overhead. They feel
private practitioners should
pay their own expenses . . .
whatever part of their offices
are utilized for private prac-tice,"
he said.
But Bicknell admitted that
most physicians do agree that
some kind of private practice
plan is necessary to get a
qualified staff because of the
income requirements.
What kind of private prac-tice
plan is apparently the
problem, said several of-ficials,
who agreed that the
proposed one was not accep-table
to either the medical
school staff or the local doc-tors.
And Grulee admitted there
were objections to the plan,
"but we tried to correct
them."
A letter signed "The Ad
Hoc Committee, Shreveport
Practicing Physicians" listed
complaints against several
medical school physicians
who, the letter said, practice
private medicine.
There is no evidence there
is any Ad Hoc Committee and
Dr. Bicknell said he has
never heard of such a group.
Although it was addressed to
the chairman of the Louisiana
Commission on Governmental
Ethics, there is no evidence
the group ever received it.
No LSU official gave
credence to the validity of the
letter.
But, Grulee did confirm
that at the time of the inter-view,
several physicians had
been seeing patients on a
private basis.
Four medical school
physicians, Grulee said, did
see private patients at the
Linwood Apartment Complex
which is school property.
But the practice of private
medicine is not limited to
these members of the local
faculty, according to school
official Robert Graves.
"It is fair to say that there
is no question that there are
more than these four seeing
private patients.
"In fact, most of the clin-cial
scientists — the ones with
medical degrees — do some
private practice," Graves told
The Times.
"But to the best of my
knowledge the amount that
any do is very small. Com-pared
to most medical schools
I'm familiar with. This is a
most fulltime faculty," he
added.
Graves feels that most of
the medical school doctors
who do see private patients
see them on the weekend "or
at a time when it doesn't, con-flict
with their teaching
responsibilities.''
Grulee pointed out that the
one examining room used by
the doctors holds equipment
valued at $473 — an
examining table and light, a
stool a three-panel patient
screen, an intravenous stand
and a scale.
The room is underused, the
medical school official added.
If there have been abuses
in the area of private practice
among the faculty members,
Grulee said, it has been in the
use of clerical employes who
are state-employed.
In reality, though, said one
top medical school official,
the practice of private
medicine among medical
school doctors is widespread.
Referring to the four
physicians mentioned the of-ficial
said, "Sure private
practice among medical
school physicians is more
widespread than that. That's
such a little dab that it is in-significant."
It is important for several
reasons, Gurlee thinks, for
medical school doctors to see
private patients.
He feels that "more and
more we want students to see
the whole spectrum of clinical
diseases in their early stages
and in their uncomplicated
stages.
"No one hospital can offer
the full spectrum of patient
material."
The dean also thinks that
"if, for example, one expects
a surgeon to maintain his
proficiency in surgery . . . the
surgeon should be responsible
for a specific patient and take
care of the patient himself —
not take care of the patient
and take care of supervision
of residents."
"There's a difference," he
added.
Both Grulee and Chancellor
Copping also pointed out that
gone is the time when the
prevailing attitude was that if
you can't make it in the out-side
world, you teach.
There is no way to recruit
without a private practice
plan, said Copping.
Grulee explained, "The
state cannot afford to pay the
kind of salaries paid acposs
the country to top flight
academic people. The prac-tice
plan is a way of in-creasing
their earnings to a
limited extent with university
supervision and in accordance
with the rules and regulations
of the university."
Private practice for local
medical school physicians?
Everybody says it is
coming. How, and when con-tinue
to remain the unan-swered
questions.