Q&A
Council Member Marmorato questions Dr. Katz on physician workload and recruitment challenges
1:42:49
ยท
4 min
Council Member Kristy Marmorato questions Dr. Mitch Katz, CEO of NYC Health + Hospitals, about recent changes in physician responsibilities, specifically regarding pre-authorization submissions. They also discuss the resignation of rheumatologists at Jacobi and North Central Bronx hospitals, as well as strategies for recruiting and retaining doctors in the H+H system.
- Marmorato expresses concern over physicians now being required to submit pre-authorizations themselves, which she views as an inefficient use of their time.
- The discussion touches on the mass resignation of rheumatologists at Jacobi and North Central Bronx hospitals, with Katz describing it as a "no fault divorce" due to fundamental disagreements.
- Potential solutions for doctor recruitment and retention are briefly explored, including the possibility of using vacant apartments at Jacobi for doctor housing.
Kristy Marmorato
1:42:49
Thank you, chair.
1:42:50
So I just wanted to ask you, when did this begin where you're not, where these doctors and PAs are actually pre authorizing treatment and medications?
1:42:59
When did this practice begin in health and hospitals?
Mitch Katz
1:43:03
Submitting prior authorizations or allowing people other than doctors to submit?
Kristy Marmorato
1:43:07
Them submitting them themselves.
Mitch Katz
1:43:09
So they they I would say we've been doing it for several months.
1:43:14
Okay.
1:43:15
We we always do it on behalf.
1:43:17
I mean, they're clear they don't no one's impersonating anyone.
Kristy Marmorato
1:43:21
No.
1:43:21
But it's this is a new practice that it's the physicians are actually submitting the pre authorization.
Mitch Katz
1:43:26
Yes.
Kristy Marmorato
1:43:27
Okay.
1:43:28
Because I've never experienced that.
1:43:29
We've always had a team of people that took care of it for the physicians.
Mitch Katz
1:43:33
I see.
Kristy Marmorato
1:43:33
So they wouldn't waste their so they wouldn't have to waste their talent making phone calls and they can focus more on their patients.
Mitch Katz
1:43:39
So You were ahead of us, sweet.
1:43:41
What?
1:43:42
You were ahead of us.
Kristy Marmorato
1:43:43
Well, no.
1:43:43
I've I've always, yeah, I've always worked in a a setting whether it was a private facility or a hospital.
1:43:49
We always had teams that would do that for the doctor.
1:43:51
So it wouldn't tie them up, you know, that they can really focus on the patients and let them allow them to do what they needed to do.
1:43:57
So, I just wanna touch on Jacobi.
1:44:00
So Jacobi and North Central Bronx have been without any full time rheumatologists since the entire division resigned in 2 2023.
1:44:08
And this is an extreme example of how the system's failure to recruit and retain doctors have no negatively impact patients.
1:44:15
Do you agree that health and hospitals failed the Bronx patients who need rheumatologists?
1:44:19
Or
Mitch Katz
1:44:23
It was a complicated moment.
1:44:27
Many people have a variety of explanations of what happens.
1:44:33
I feel bad.
1:44:34
I mean, it's very unusual that a whole division leaves.
Kristy Marmorato
1:44:37
Yeah.
1:44:37
That's like it must have been very bad for that to happen.
Mitch Katz
1:44:40
It was, I would say, it was not a disagreement about money.
Susan Zhuang
1:44:47
Okay.
Mitch Katz
1:44:48
Can you It was a disagreement.
1:44:51
And I I don't be at the end of the day, I sort of see it as a no fault divorce.
Kristy Marmorato
1:44:57
Okay.
1:44:57
So you're saying it had nothing to do with the contracts and, like, like, pay and no.
1:45:05
Okay.
Mitch Katz
1:45:05
It was a fundamental difference of opinion among good people.
1:45:10
And I happen to know the people on both sides of that, and I have good things to say about both, but there was a fundamental disagreement.
Adedayo Adedeji
1:45:18
Okay.
Kristy Marmorato
1:45:19
So moving forward, how do you, plan on recruiting doctors and retraining them?
Mitch Katz
1:45:24
Well, again, as we mentioned, and I appreciate your question, rheumatology is one of the areas where we've had trouble.
1:45:31
The more specialized, the more difficult it has been for us to, recruit.
1:45:37
I think salary is one aspect, but it isn't the whole aspect.
1:45:42
It's trying to create, you know, positive work environments.
1:45:46
And, clearly, at Jacobi with Room, for whatever reason, it didn't succeed.
1:45:51
We did offer and just, again, to tell you how odd situations are, I have a excellent rheumatologist at Metropolitan who is currently underused.
1:46:06
Not her fault because she's in a full time position in a hospital that doesn't generate a full time amount of work.
1:46:15
We said send the patients from Jacobi to her.
Kristy Marmorato
1:46:19
Well, that's not
Mitch Katz
1:46:19
the case.
1:46:20
Don't wanna do it.
1:46:21
We don't we we're not a city that does that.
1:46:23
And I get it.
1:46:24
Although I'll say rich people, they always ask you, where do I have to go?
1:46:27
Do I have to go to Mayo Clinic?
1:46:29
Do where should I go?
1:46:30
You know, I always feel like we we we're blessed with a great subway system, but but we're as New Yorkers, we don't do that.
1:46:37
No.
1:46:38
We we it does not happen.
1:46:39
I'm totally I'm totally with you.
1:46:44
We have to hire a good a good rheumatologist at Jacobi.
1:46:48
Okay.
1:46:48
I agree.
Kristy Marmorato
1:46:49
And I just wanted to say I know you had mentioned about housing.
1:46:52
So, you do have on the property of Jacobi building, 278 vacant studio apartments.
1:46:58
That would be a really nice bonus and blessing to your your 525 doctors that could possibly walk out on a strike.
1:47:05
So that would always be a bonus or a plus to help them with the housing and the affordability problem here in New York City.
Mitch Katz
1:47:11
Understood.
1:47:11
Thank you.
1:47:12
Thank you.