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ER docs in Detroit strike over long wait times, low staffing

Kate Wells
Michigan Public
Dr. Michelle Wiener and Dr. John Bahling are both emergency medicine physicians at Ascension St. John. "A lot of people who might not be sick when they first walk through the door, after 12 hours, are getting a lot sicker," Wiener said. "And it's getting harder and harder to walk through and try to identify who those people are and just to get them back and provide them basic care."

Emergency room doctors at Ascension St. John in Detroit began a 24-hour strike on Thursday, citing what they say are 10 to 15 hour patient wait times and intentionally low staffing levels under the management of a private equity-owned staffing company.

“Every day here, we see people, in extreme pain or with an infectious disease or concerns for heart attack or stroke or anything else that you come to the emergency room for, waiting many, many hours out there,” said Dr. John Bahling, a pediatric emergency medicine physician at St. John, as his colleagues picketed on the hospital sidewalk, waving signs and chanting about safe staffing. Behind them, ambulances pulled into the hospital, transporting patients on stretchers who are being cared for by supervising physicians during the strike.

“And then when they get back into the emergency department and they do see a doctor, sometimes a doctor is taking care of up to 30 patients, where the national average is somewhere around 8 to 12 at a time. So the idea of emergent care is not possible, given the level of staffing we have right now. And people deserve better than that.”

Doctors say this began when TeamHealth, a Tennessee-based physician staffing company owned by private equity giant Blackstone, received a contract in 2015 to staff the ER at St. John. It’s an increasingly common practice for hospitals looking to lower costs, with “private equity-owned physician staffing groups operate nearly one-third of all emergency departments across the country,” according to an ongoing investigation by U.S. Senator Gary Peters (D-MI), Chairman of the Homeland Security and Governmental Affairs Committee.

TeamHealth did not respond to questions or requests for comment Wednesday or Thursday, but its website says it is “15,000 clinicians strong” and offers hospitals “the highest quality staffing, administrative support and management across the full continuum of care, from hospital-based practices to post-acute care and ambulatory centers.”

But the St. John ER doctors, who unionized last year, say that hasn’t been their experience. There were 57 people in the waiting room at Ascension St. John Hospital in Detroit on Wednesday night, at least one of whom had been waiting for 18 hours, Bahling said. Only 40 people were actually receiving care, even though there are 80 beds in that ER.

“So that means 40 of the beds were sitting empty, while 57 people are out there suffering, where we have enough doctors that want to come in and work,” Bahling said. “But somebody has decided in the private equity world that it's not worth the expense to fully staff it.”

A spokesperson for Ascension said the ER at St. John’s “will remain open and fully operational for anyone seeking care during the one-day strike of TeamHealth’s emergency medicine physicians and mid-level providers.

“The safety and well-being of our patients, visitors, associates and physicians is our first priority. TeamHealth has a comprehensive contingency plan in place with the hospital that will ensure these contracted provider services, and safe patient care, will be uninterrupted.”

TeamHealth’s response: doctors’ claims are “unequivocally false” 

While TeamHealth did not respond to questions and requests for comment sent Wednesday and Thursday, on Friday morning a spokesperson sent a statement via email, which read in part:

“We have negotiated in good faith with the union, and any statement to the contrary is false. We invite the union’s leadership to return to the bargaining table and secure a resolution on reasonable and sustainable terms.”

TeamHealth’s statement also asserted that the union “has made several public claims that are unequivocally false.”

“The median door to doctor time at Ascension St. John Emergency Department in 2023 was 25 minutes,” according to the statement. “In 2024, wait times dropped to 15 minutes, far less than the 10 to 15 hours the union claims.”

But Bahling says that’s not the case. He says what TeamHealth means by “door to doctor time” is the time between when someone enters the waiting room, until their medical chart is reviewed. It’s not the same thing as actually being physically, personally evaluated by a doctor who provides that patient’s follow-up care, he says, but is instead meant to provide stats that make the ER look good when being evaluated by the Centers for Medicare and Medicaid Services (CMS).

“What they’re doing is they have a nurse practitioner who sits outside the waiting room, [who] doesn’t see the patients, [and] when the [patient’s] chart pops up, they review the vital signs, they click the name on the chart, and that stops the [door-to-doctor] timing,” Bahling said Friday. “The patient isn’t seen. Medications aren’t ordered. Tests, x-rays aren’t ordered. It merely [means] an advanced practitioner or provider has clicked on their chart, and said they have ‘reviewed the complaint.’ … And then you sit in the waiting room. The average [wait time] today is 13 hours.”

Bahling also took issue with TeamHealth’s assertion that the “Ascension St. John emergency department is fully staffed today.”

Another TeamHealth contention is that its "clinicians are spending more time with every patient that comes into the emergency department.”

“While clinicians saw an average of 2.6 patients per hour in 2014, before TeamHealth took over the St. John emergency department, TeamHealth in 2023 had successfully reduced this to 1.9 patients per hour,” a TeamHealth spokesperson said via email.

Bahling says that’s not true, either. Take what happened on Wednesday night, he said: TeamHealth had dozens of people in the waiting room needing care, but didn’t open 40 of its 80 beds, because that would have required additional staff. “They closed down 40 beds, and fully staffed the other 40, while 60 patients waited in the ER.”

The daily reality, Bahling said, is closer to the experience of a patient who he described approaching doctors picketing outside the ER on Friday. She told them she had just left the ER, after vomiting in the waiting room for 13 hours, waiting to be seen. “She said, ‘I’m glad you guys are out here.’”

Editor's note: This story has been updated to include comment from TeamHealth, which arrived after Michigan Public's deadline for publication.

Kate Wells is a Peabody Award-winning journalist currently covering public health. She was a 2023 Pulitzer Prize finalist for her abortion coverage.
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