Physician-Staffed Helicopters

["Paul M. Wright, Jr." <pmwright@home.com>]

I was going to sit on the sidelines for the discussion that started with the
posting of the article from the Cleveland Plain Dealer but I just couldn't
do it.

I'm not close enough to the situation there to comment directly on it, nor
am I going to address the clinical efficacy of the physician-nurse staffing
model.  But what I thought did merit some comment was the thought that none
of the folks demanding the return of their physician-staffed helicopter were
those who would be bearing the costs of its operations.

>From what I recall of the Metro operation (please correct me if my
recollection is incorrect), it would seem to have a very high cost structure
due to the type of aircraft operated and the chosen staffing model.  I also
recall a presentation at AAMS a few years ago where the financial model was
described as recovering those costs in full by charging the member hospitals
the full pro-rata cost of operations.  At that conclusion of that
presentation, I asked the speaker if she saw any competitive threat from
flight programs approaching their member hospitals and offering to transport
the patients at less cost.  She rather strongly stated that the quality of
their product was such that no member hospital would consider bowing out [no
matter the cost].  I have only the information in the article to go on, but
it seems that some hospitals DID bow out because they could no longer afford
the costs assigned to them by the Metro program.

The question is not whether a physician-staffed air ambulance model has some
marketing and operational advantages over other staffing models; it clearly
does, particularly with respect to marketing.  The question is the extent to
which a community should be able to demand a resource it cannot afford.  I
would estimate the incremental costs of a physician-staffed model as at
least a half-million per year per aircraft as compared to a nurse-paramedic
staffing model.  The benefits of a physican-staffed model are unclear, but
the costs are not at all unclear.  It is likely that a rational cost/benefit
ratio would find that a physician-staffed air medical model does not
represent good stewardship of severely limited healthcare dollars.

regards!

paul









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