Edward Farmlett: Staffing changes at Concord Hospital do not live up to its mission

The recent firings of three internists in Laconia are not isolated incidents but are symptoms of a larger problem at Concord Hospital which needs to be rectified by the board of trustees. I am a recently retired physician and worked with these doctors in Laconia for decades. I agree with the many people writing to The Laconia Daily Sun that these are competent and compassionate physicians.

Over the last few years, I have talked to many physicians and nurse practitioners, both in Laconia and Concord, and heard a consistent story. The Concord Hospital administration has created a toxic culture and work environment for primary care providers and others that is negatively impacting patient care. These PCPs are being forced to see follow-up patients every 15 minutes, which may be adequate for a quick antibiotic prescription, but is often not enough time to discuss their multiple complex medical problems, let alone for the practitioner to type a summary into the electronic medical record. Struggling to fit every follow-up patient into the same 15-minute timeframe has the practitioners feeling that they are going too fast and they worry about patient safety and making a mistake. Many PCPs work overtime into the evening filling out the medical record and returning phone calls. Some have even felt forced to resign. Others have been complaining to the administration for years, to no avail. The office practice managers and others, such as Vice President of Operations Bill Dooley, Chief Clinical Officer Dr. Matt Gibb and Chief Quality Officer Dr. Christopher Fore, are described as unsympathetic, aggressive, confrontational task masters who respond with statements like “if you can’t manage your patient load, you’ll have to leave.” The CEO Robert Steigmeyer is described as not relatable, remaining unresponsive in his corner office, preferring his henchmen to do his dirty work. However, this hostile work environment is felt to descend directly from the top office. In addition, the office work environment is further deficient, in that the office nurses and ancillary staff are underpaid, understaffed and stressed, resulting in frequent turnovers, inexperience and additional diminished patient care. Furthermore, the PCPs are expected to cover their own patients while on vacation and even must use their earned time during holidays. Not surprisingly, currently employed primary care providers are unwilling to speak out on record for fear of retribution.

Concord Hospital acquired LRGHealthcare assets at a steep discount through bankruptcy proceedings on May 1, 2021, no doubt to secure access to the patient referral base in the Lakes and Twin Rivers regions to support existing programs in Concord such cardiothoracic surgery against competition from larger medical institutions such as Dartmouth, HCA and Massachusetts General Hospital. Health care has often become another big business, losing sight of its primary mission to care for patients the way you would want to be cared for. The mission statement for Concord Hospital is “to meet the health needs of individuals within the communities it serves.” Firing three internists “without cause” in the face of an already existing PCP shortage before hiring replacements abandons thousands of patients from primary care and disregards that mission statement. The one physician they intend to hire next month cannot handle all those patients alone. For the foreseeable future, many of these patients will crowd into the emergency department, further straining the already overstretched emergency system and creating even longer wait times in the ED. To push PCP productivity, in terms of revenue per unit time, regardless of the negative impact on the quality of care, is unethical.

Providers are concerned that the emphasis on profit over quality care unveils an underlying plan, by the end of the 5-year review period during which the administration pledged to keep the Laconia hospital open, to deplete the referral base, limit services in Laconia and shift patients and services to Concord. After that, the Laconia facility would be largely an outpatient one.

The leaders of Laconia city government should also take these issues seriously. The hospital in Laconia is currently one the largest employers in the area, which could change, reducing the working population and tax revenue. The city council is also anticipating the construction of thousands of homes on the old State School property over time. But marketing and sales of such development depends on adequate infrastructure, including a full service and convenient health care system.

It doesn’t have to be this way. By many independent accounts, CEO Steigmeyer’s predecessor Mike Green created a positive work environment and good relations between medical staff, ancillary staff and the administration. He had an open-door policy that fostered communication, and the hospital flourished under his leadership. Many Concord Hospital providers encourage the board of trustees to stand up and replace the problem leadership in the hospital administration, foster a positive work environment, allow its providers to care for their patients appropriately and invest in competitive salaries for its employees. This would help restore employee and patient confidence and ensure adherence to the mission of Concord Hospital at all its locations.

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Edward Farmlett of Laconia joined the staff of what was then Lakes Region General Hospital as a radiologist in 1987, retiring from Concord Hospital-Laconia in May 2023.