Haugh, Richard, Hospitals are feeling 'niche d to death', H&HN: Hospitals & Health Networks, 10688838, Apr 2002, Vol. 76, Issue 4 This article is about a small Louisiana town where a dispute between the sole hospital and its largest physician group. The hospital is a 160-bed facility in and is going to be losing a big part of its surgery business to the Green Clinic, a 35-physician multi-specialty group that is building its own specialty hospital a few miles down the road. The doctors serve the vast majority of patients in the town of 25, 000. Independent surgery centers, boutique short-stay hospitals, imaging centers and other physician ventures are popping up all over the country.

This is because doctors are looking for facilities where they can schedule surgery and not have to be bothered by emergency cases and unexpected situations. Also these outpatient surgery centers and other niche services can generate a good return for the doctors who own them. According to the article a physician generates on average $1. 54 million a year in inpatient and outpatient revenue for his or her affiliated hospital. This money goes to the hospital and by opening a facility outside of the hospital the physicians can make more money for themselves. More money for the doctors means less money for the hospital.

So what can the doctors in theses hospitals do when their business is taken from them? Do they join the outpatient centers at the expense of the hospital? The doctors opposing the surgery center say there will be less money for the hospital and fear they may lose their jobs all together. The ones opening the surgery center say that's not true. They say there is plenty of business to go around. Either way I see the surgery center making money and the hospital losing money. If you take customers away from any business they are going to lose money. There are only a finite number of surgeries that are going to be preformed in that town, and there may not be enough to go around.

I knew there were surgery centers, but I did not realize the impact that they could have on the local hospitals. I can also see the doctor's point. They want an environment they can control. The hospital setting is always changing; the schedule is written is play dough.

Things can happen at any time, emergencies and such. I think surgery centers are a good idea, they may be better if they are created in conjunction with the hospital, so they wouldn't be losing so much money.