Big Hospital System vs. Independent Hospital: RTs Have Differing Views

Young RT Volunteers

July 2, 2018

Once upon a time nearly all respiratory therapists worked at independent hospitals where policies and procedures were developed in-house.

No more. These days big hospital systems have swallowed up many independent hospitals and the trend shows no signs of stopping. But there are still plenty of independent hospitals out there, so RTs have choices when seeking out employment.

Which type of hospital do therapists prefer? We found a range of answers to that question.

Resources at her fingertips

Donna Tanner, MBA, MHA, RRT, RRT-ACCS, is an RT education coordinator in the Anesthesia Institute at the massive Cleveland Clinic in Cleveland, OH, and she comes down squarely in favor of the large hospital system.

“When you work at a small independent hospital and encounter a very sick patient, your role changes into stabilizing and transferring them to a large center where all the resources are available to treat them,” she said. “I have all the resources at my fingertips.”

She says she sometimes hears people say they would prefer to have their loved one in a smaller and more intimate place where they won’t be treated like a number and will be given more personal care.

That just doesn’t make good sense to her.

“When your loved one is about to have any procedure or surgery, the idea of being ‘treated like a number’ holds to the fact that we do so many of these that we are skilled and experienced and move you out and home quickly,” she said. “Smaller hospitals remember you because of the infrequency of the procedure and/or operation.”

That just isn’t the situation she would want her loved ones to be in.

“Give me all the resources available if and when I need them,” Tanner said.

More aggressive care

Nikki Barrett, MBA-HM, BSRT, RRT, adult manager of respiratory care at WakeHealth in Winston-Salem, NC, agrees.

“I prefer to work for the big health system versus the independent hospital because of the vast difference in resources,” she said. “Some of the independent hospitals are so far behind in technology and equipment that it makes it a bit more difficult to care for the sickest of patients in the same manner as compared to the big health system.”

She says she’s witnessed patients from independent hospitals being received at her facility who were extremely ill and near death, only to see them be turned around with a good prognosis.

She credits these turnarounds to the hospital’s advanced technology and other factors like more sophisticated care plans.

“The big health system is more aggressive in the care provided,” Barrett said.

For-profit vs. nonprofit

Fred Scharf, BS, RRT, has watched the independent hospital/big health system debate play out over his 21 years working in the same hospital in Sunbury, PA.

“From 1996 through 2005 we were an independent, nonprofit, small community hospital,” said Scharf, who is the supervisor of respiratory therapy and emergency management coordinator. “Financially we were unsustainable as a standalone facility, although we had a great work environment.”

Then in 2005 the hospital was sold to a for-profit, multi-state organization, where it seemed like everyone was simply working for the company’s shareholders. Last year the facility was taken over by UPMC Susquehanna, the largest health care system in Pennsylvania and a non-profit organization with ties to the University of Pittsburg medical school.

“This particular health care system has a philosophy that is patient and community centered while having more resources available to us than you would see with a standalone facility,” Scharf said. “This, in addition to the system’s buying power, will lead us to becoming a more successful community hospital.”

Missing the RT focus

Recently retired RT Tom Colley, BS, RRT, has also worked at both types of hospitals but reports much better experiences at the independent facility, which in his case was an academic medical center.

“I thoroughly enjoyed my 18 years at the teaching hospital,” he said.

Unfortunately, he found the big hospital corporation he went to next less friendly to RTs.
“Management was resistant to any change in how man-hour stats and productivity were calculated. We made very good and repeated attempts at incorporating the AARC Uniform Reporting man-hour standards, to no avail,” Colley said.

He also found the for-profit system to be more “nurse centric” and says capital acquisitions seemed to shrink every year for RT.

“With some exceptions, RTs were not enjoying the same recruiting incentives, pay raises, and call back pay,” Colley said.

Everyone knows your name

David Pogue, RRT, sees significant advantages for the independent hospital as well.

“In a large hospital most of the RT staff get pigeonholed into one unit or another for good or for bad,” said Pogue, who is the clinical supervisor at Major Hospital in Shelbyville, IN. “In a small hospital every staff therapist, from the manager to the newest member, has to know every area of the hospital and be able to carry their own weight in each.”

He likes the personal feel at his smaller hospital too.

“When I worked in the larger hospitals, my name was—to anyone outside of the department—‘hey RT,’” Pogue said. “In the smaller hospital, within six months of full time service, everyone, including the CEO, knows your name and how valuable or not that you are to the hospital.”

He says he never saw that kind of accountability at the larger hospitals he worked for.

The bottom line

Some RTs, though, see advantages and disadvantages in both types of facilities.

Marlene McKinley, BA, RRT, manager of respiratory care and neurodiagnostic services at Saint Joseph Hospital in Lexington, KY, specifically cites the big system’s ability to foster collaborative efforts as a positive when compared to the independent hospital’s tendency to leave clinicians to “blaze the way” on their own.

Conversely, she believes big systems have more red tape that must be gotten through to bring new equipment on board than independent hospitals.

But the bottom line for her is pretty simple.

“I like the additional resources with the big hospital system, but I like the independent ‘family’ atmosphere,” she said.

That might sum up the feelings of many other RTs who have experienced life in the respiratory care departments of both types of facilities too.