More doctors seek to leave Shock Trauma Elite orthopedic unit could lose all 6 of its surgeons

February 18, 1993|By Eric Siegel | Eric Siegel,Staff Writer

The Maryland Shock Trauma Center, embroiled in controversy for much of the past year, is facing an "exodus" of doctors from its nationally esteemed orthopedic unit.

Two doctors on the six-person staff have already resigned -- one last August and another effective in April. And the other four say they are actively looking to leave Shock Trauma, citing lack of support by the new administration and uncertainty over the center's future.

"An elite unit at Shock Trauma is essentially being disassembled in the space of a year. With the exodus of people I trained, it is no longer a joy to come to work," said Dr. Andrew R. Burgess, who has headed the unit for the past 10 years.

Dr. Burgess, who said he is "seriously looking" for a new post, predicts that at least one of the four remaining surgeons will "almost definitely" leave and says the others may depart as well. Until this past year, he said, only one orthopedist had resigned in the last decade, while the unit grew from three to six physicians.

Dr. Kimball I. Maull, the head of the Maryland Institute for Emergency Medical Services Systems, which runs Shock Trauma and a statewide network of emergency care, yesterday praised Shock Trauma's orthopedic doctors as an "exceptional group" and said he hoped that "they remain dedicated to our program and stay at the Shock Trauma Center."

"However, when positions become vacant, they will be filled by qualified individuals from across the country," he said in a written statement issued in response to a reporter's inquiries.

Dr. Maull, who took over a year ago, said that "changes in physician staff are taken seriously." But he added that such changes "occur frequently at academic medical centers" as faculty get recruited elsewhere or go into private practice.

Also, the Johns Hopkins University orthopedic department has decided to end as of June 30 a five-year agreement under which it sent residents to Shock Trauma for training. That decision was prompted by Shock Trauma's move last summer to accept shooting victims as well as accident victims, reducing chances for residents to work on complex multi-bone injuries, according to Hopkins officials.

Shock Trauma receives the same amount of accident cases as before, said a spokeswoman.

The resignation of two veteran Shock Trauma orthopedists and the possible departure of others has caused consternation elsewhere.

"I'm dismayed," said Dr. Peter G. Trafton, who is in charge of orthopedic trauma at Rhode Island Hospital and an associate professor at Brown University.

"This is a unique group with a level of clinical research probably unparalleled in North America. To see it shattered, for whatever reason, is a blow for all of us," Dr. Trafton said.

The defections come after a tumultuous year in which administrators at the University of Maryland Medical System, of which Shock Trauma is a part, have attempted to end the autonomy that Shock Trauma enjoyed for years.

During that time, three physicians were fired and another was demoted. In addition, some trauma care at Shock Trauma and the University of Maryland Medical Center was consolidated. A gubernatorial commission suggested an independent board be created to oversee statewide emergency medical services.

Also, University of Maryland officials accused doctors at Shock Trauma of improperly diverting $2.5 million in patient care fees, which were later restored, and an independent study showed Shock Trauma had low patient survival rates compared with 70 other trauma centers.

Members of Shock Trauma's orthopedic department complained bitterly that top administrators failed to publicly defend them or their work.

"I'm dissatisfied with our leadership and the integrity of our leadership," said Dr. Michael J. Bosse, who joined Shock Trauma 18 months ago after 17 years as a Navy surgeon and said he is returning for second interviews at two institutions.

The orthopedic doctors said their decisions to seek other employment ware directly related to the turmoil.

"There's no way you can be there and not wonder what it would be like to go somewhere else. Morale is very low," said Dr. Robert Brumback, a 10-year veteran of the unit and a nationally renowned authority on femur, or thigh-bone, fractures.

All of the five doctors expressed ambivalence at the prospect of leaving the orthopedic unit, and emphasized that there would be no immediate fall-off in the quality of patient care. But some said that it would take years to re-create the cooperative environment that has existed and that they worry the unit will have trouble attracting top talent.

And they agreed it could be difficult to improve the level of care at a time of rapid staff turnover. "We need to build on what we have, not tear it down," said Dr. Burgess.

In August, Dr. Attila Poka, a 10-year veteran of the unit, left to join the staff of Grant Medical Center in Columbus, Ohio. Dr. Poka could not be reached for comment.

Last month, Dr. Howard Bathon, who has been at Shock Trauma since 1986, said he will go into private practice in April.

Despite the problems of the past year, Dr. Bathon said, "It will be difficult to leave" but he added, "The feeling of camaraderie that existed is definitely gone."

Dr. Carol E. Copeland, who trained at the University of Maryland and joined the staff of Shock Trauma in 1991, said she wished she "didn't have to" look elsewhere but said she was job-hunting in part because "there's a good chance most of my partners are leaving."

"This is not the kind of place where one or two people can run a service. I'm concerned about their ability to recruit people" as replacements, she said.

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