MDs on Twitter Attacked Me For Empowering Nurses To Own Hospitals

Last week, I tweeted a suggestion that the U.S. is ready for a nurse group owned hospital - something that currently does not exist. Being the proud 23-year veteran nurse that I am, and considering the critical role nurses have had in the pandemic, I felt empowered to speak about the potential of a nurse group owned hospital and referenced that physicians had done this before. 

I didn’t expect that such an optimistic tweet would cause such a backlash that I was harassed and degraded on Twitter by accounts who identified mostly as doctors. 

• “I feel great about nurses. NPs aren’t nurses; they’re wannabe doctors” tweeted one account. 
• “This has got to be a joke. But, if you’re serious please build this hospital next to a regular hospital so transfers will be easy. We will be waiting next door!” said another.
• “There should be a connecting slide straight into a physician-led ICU. The f-ups and need for urgent transfers from this nurse hospital would overwhelm ambulance transport systems,” another user responded. 
• “Good luck getting malpractice insurance for that. But, you’ll have plenty of “fake” doctors that did a lot of nursing theory and lobbying classes so you should be all good. #medtwitter #NPslead patients to the grave,” tweeted another

Not all comments on the post were negative. In fact, a lot of people loved the idea and wanted to support it! 

• “Nurse lead health centers are very successful so a hospital model run by nurses would be interesting to see if they can duplicate that success,” someone tweeted.
• “Definitely agree we need to take the hospital away from the corporate CE0s—their capitalistic model is a fail for us at the bedside.  Covid uncovered the Just in time inventory system as a failure. Def think in the hands of the right nurses we could create something better for all,” tweeted one user.  
• “Hoooooeeeee!!!  How absolutely BADASS!!  NURSES OWNING THE HOSPITALS WILL IMPROVE CARE 500%!! And can we go back to 3-8/hour shifts?  We can work a double without it being 24 hours & have a staff rested enough to not make mistakes,” read another tweet. 

As for the users who were outraged. Well, some did not like my choice of words. Some thought nurses aren’t capable. And others seemed offended that I was suggesting something that would further elevate nurses. Many took to Twitter to spew negative comments about nurses and were implying that a nurse-owned hospital would compromise patient safety and care. 

Some tweeted that doctors’ hospitals no longer exist. They do. Others tweeted that doctors can no longer start hospitals. Which, they still can under certain conditions. 

So apparently people on Twitter were both misinformed and also possibly upset at the mere notion that nurses might actually open their own hospital. 

Bottom line. I felt disgusted by some of the comments on the tweets. You can read the full thread here. 

So when the Twitter fingers started coming for nurses, instead of me taking it personally, I decided to do a Michelle Obama and follow her mantra of “when they go low, we go high” and educate the misinformed medical colleagues. So here we go…

Physician-Owned Hospitals 

Historically physicians have been able to start and manage privately owned hospitals here in the U.S. It wasn’t until 2010, that it was referenced in the Affordable Care Act that placed limitations on the physician’s ability to do so because of the growing concern of doctors abusing their authority and positions for financial gain. The doctors that responded on Twitter seemed to think that all physician-owned hospitals had been abolished or that they are prohibited from expanding or starting new hospitals when that isn’t necessarily the case – there are just stipulations and they must apply for exemptions.

Under Sec. 6001 of the ACA, hospitals that are partly or fully owned by physicians are barred from expanding, and new ones can’t be established unless they forego Medicare and Medicaid reimbursement. Now let me explain the stipulations. 

Lawmakers inserted the ban into the ACA at the urging of the nonprofit community and for-profit hospitals that claimed doctors at physician-owned hospitals improperly referred patients to their hospital for financial gain. The ban was created because it was believed that many of these doctor-owned hospitals cherry-picked healthier patients and those who need specialized, profitable medical treatment, and ordered unnecessary medical procedures that resulted in higher costs to the government.

This left nonprofit communities and for-profit hospitals with patients whose care is less profitable, such as those who need emergency care or burn treatment. So as physician-owned hospitals began to expand, lobbyists from the American Hospital Association and the Federation of American Hospitals successfully pushed for the legislative ban.

A conflict of interest

I have seen first-hand some inpatient physicians refer and order patients for rehab, home health or other outpatient services that they (the discharging physician) owned. I recall telling a case manager when a patient I was discharging wanted to go to a particular rehab facility and not to where the doctor ordered. The case manager assured me the patient had a right to choose where they want to go provided their insurance covered it. So, we made arrangements for the ordered services at the patient’s particular facility of choice. Well, the doctor was not happy and said that the facility was not where he had ordered the patient to go.  The issue here is that the doctor didn’t have the authority to designate the facility, his order should have been for treatment and services alone. The patient had a right to choose. The case manager then told me no one had ever challenged the doctor on the matter until I did.  She further explained to me similar examples of his conflicts of interest that were to his financial gain which are aligned with the same issues as to what warranted the creation of Sec 6001 of the ACA. 

If the federal government noticed a problem and had to step in to stop doctor-owned hospitals from taking financial advantage of patients and federal healthcare dollars – I can only imagine why some doctors might be upset if nurses owned hospitals. Some don’t think we are capable of leading such business ventures and quite frankly some would have issues with the reporting structure. 

Nurses, We ARE Capable

Let me be clear - the old days of nurses giving up their chairs and computers to doctors is long gone. We are no longer “just the nurse,” some people still try to make us believe. We deserve to be at the business table just like anyone else. Nurses are fully capable of creating, designing, and owning hospitals responsibly. To me, it’s not a matter of if, but when we pull the trigger and get it done. 

According to the American Association of Colleges of Nursing, there are approximately three nurses to every one physician in the United States. Can you imagine if we as nurses came together and decided to build and manage hospitals? We already know how to take care of patients, now let’s step things up a few notches. It’s time to break glass ceilings. No longer is being a manager, director, or even chief nursing officer enough. We don’t want to just work there. No, we want to OWN the building. We want to OWN the business. If we can change lives at the bedside, just imagine what we could do in administration, the business office, and the C-suite. 

An Interdisciplinary Team

An interdisciplinary team is still needed to provide care to patients. I am not at all implying we get rid of doctors and that nurses do it all. We still need to work with doctors, surgeons, RTs, lab, and all other healthcare workers to provide quality, safe and appropriate care. 

I’m also not suggesting that ALL doctors were engaged in behaviors like the example I gave previously or have taken advantage of the federal financial healthcare dollar leading to the ACA legislation sect 6001. What I am suggesting is that some nurses step up to lead the business of healthcare by owning hospitals. This would be a complete game-changer when it came to being able to make changes in the hospital. 

Why Aren’t More Businesses Founded By Nurses?

Nurses need to be more involved in the business and technology startup communities. Why aren't more of these businesses founded by nurses?

The primary reason is that we as nurses aren't accustomed to thinking about business. When nurses have ideas, we tend to think locally to our units or nursing community. Our improvements and ideas become that of the hospital and we lose ownership in them. We are on the front lines of patient care and medical technology, which gives us the prime advantage when it comes to new ideas. Outside of managing a world pandemic, we are in a season where there are more opportunities than ever before for nurses. And our advanced education and training can make us very effective leaders in both healthcare and non-healthcare environments. Nurses who are considering leadership positions should not be afraid to speak up, get involved and feel empowered to be leaders across all areas of healthcare and business.

Let’s Support Each Other  

If you’re supportive of the idea of nurse-owned hospitals, please share this article with others, and let’s begin having these types of conversations.  Let’s talk about how we can grow and make this happen. And feel free to join the conversation on Twitter to share your thoughts - make sure to tag me @asknursealice

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