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Doctors vs. Nurses

Posted

Has 2 years experience.

I work in a large teaching hospital that is affiliated with a med school, which means residents and med students account for a large number of those we share our work spaces with daily. Up until recently, my unit had a designated area at each station for staff drinks. As long as they were named, dated, lidded, and remained in the designated area, it was okay to have them there. It is a very large unit and some stations are far from the break room.

A few weeks ago, JCAHO visited and determined this was was not permitted as it poses a risk to staff safety. This I understand...in fact, I had always known this but was informed that JCAHO approved our designated areas the last time they came.

Now, although staff are forbidden from having drinks outside of the break room, physicians are exempt from this (per management), and often do their rounds with beverage in hand. Yesterday I nearly spilled JP fluid into an open coffee cup on a sink ledge left by a doctor while he was talking to the patient in that room.

I'm still just a Tech, but the disparity between what doctors can do and get away with and what staff do (namely nurses) has been bothering me since I first entered the hospital setting. Drinks are one thing. I've witnessed doctors take a WOW computer from a nurse while she was logged in about to pass meds as her back was turned. The response to the RNs who ask management to inform doctors not to run off with WOWs during their crucial times: "Find another WOW." The response to doctors who complain: "We will order more dedicated physician computers." Then there are patients who complain about nurses claiming they were unavailable, were not attentive, did not provide quality care, etc., and you better believe those nurses will get reprimanded. Yet a doctor rounds for a few minutes, never smiles, doesn't address patients' concerns appropriately, and acts self-entitled and he is viewed upon gloriously by patients and management alike. As professionals, shouldn't we all be held to the same standards across the board?

Maybe I'm just naive, but I thought that the notion that nurses are beneath doctors and are not entitled to the same level of respect was a thing of the past. I guess I can understand how society has a doctor vs. nurse mentality, but why can't it stop being perpetuated from within the healthcare setting?

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 27 years experience.

How appalling. Actually, the rule about not having beverages or any other food items at work areas is an OSHA regulation that TJC (JCAHO) enforces. Nevertheless, nobody should be exempt from complying including the CEO.

I'm disappointed that those in nursing management at your institution are allowing physicians to be non-compliant. I also work at an academic medical center and the all our physicians from the top (attendings) all the way to the bottom (interns) know the rules and are not immune from being reprimanded by anyone (even by a housekeeper) when caught with a cup of coffee while rounding.

Workstations on wheels are another story. At our ICU, these are dedicated for use during rounds by the provider teams. Nurses have their own workstations (2 of them, one inside the room and another one right outside by the door). Pyxis stations also have an attached workstation. There is no reason why a nurse at our institution would even need to use a WOW. Maybe, the issue is that there is not enough workstations (wheeled or not) for nurses to use at your institution and that should be addressed by nursing management.

There's got to be some serious issues with nursing's voice in your institution. Academic medical centers should become champions of nursing excellence (as many are in fact affiliated with schools of nursing) and that includes recognition of nurses as professionals and colleagues in healthcare not as a subservient class of technicians.

RNperdiem, RN

Has 14 years experience.

I think it varies by hospital culture as well.

I never did understand the drinks thing. I do not understand the need for adults to walk around with drinks in their hands like toddlers and their sippy cups. Still, everyone should be held to the same standard.

dudette10, MSN, RN

Specializes in Med/Surg, Academics. Has 10 years experience.

I am so glad that there is a more collaborative, respectful environment between nurses and doctors where I work. I've seen attendings walk into the computer area completely filled with nurses and doctors, and he/she has never once expected a nurse to give up a seat. I have routinely walked into an isolation room to find an attending not gowned up, then when I hand over a gown and gloves, I get a "Thank you." I've even told the MD director of the telemetry department that he has to wash his hands in a Cdiff room, rather than gelling out, and I got a "Thank you." If I'm in a room during rounds, the doctors always ask to log me out before just taking over the computer.

The only issues I've ever had with disrespect were with a couple of surgical attendings. In one case, the surgeon had discharged a patient, but after reviewing labs, I knew the patient shouldn't be discharged. When I called him, he was copping attitude with me about my assessment findings (which were, admittedly, borderline by themselves), but when I got to the labs (assessment + labs = no discharge), he backed off considerably, cancelled the discharge, and ordered internal medicine to take over the patient.

What he didn't know was that he is my son's doctor, and you better believe I will tease him about our exchange when I am in the "mother of his patient" role!

Pangea Reunited, ASN, RN

Has 6 years experience.

I see it like this:

My unit is my "home". I'm there for 12+ hours at a time. The MDs stop by and I treat them like guests. If they need a computer, I let them use mine. If they need a chair, I let them sit down. I've never had someone "steal" a computer from me, but then, they would have no reason to...

As for not making a fuss about the drinks, that probably has to do with the fact that doctors make money for the hospital by opting to admit and treat patients there. As nurses, we simply cost money and have a much more direct employer/employee relationship. Our cup-of-coffee "sins" are also less transient and more noticeable as we're around for greater lengths of time. Is it right? Maybe not ...but it's a very small thing in the grand scheme of things.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

I'm sorry for your,experience, OP. I also work at a large teaching institution. When it's a day to throw out everyone's drinks ... everyone's drinks get thrown in the trash. A physician sitting idle in front of a workstation ... will be asked to move so that I can use the workstation.

JP drain contents spilled into an unlidded cup? I'd pay money to observe that *teachable moment*.

So why are we not allowed to have drinks? I always carry a cup with a lid on my cart because I hardly ever have a chance to sit down in the break room during my shift. I have been told not to leave drinks around the nurses station because day shift doesn't like it, but never been told it's an actual rule everywhere. And all of night shift drinks and eats at the nurses station. We just clean up before shift change. At the place I work the doctors will most definitely sign u out or ask for a computer when you're using it. Another question, what about caps in the sharps container? I see people to this all the time, but I know we're not supposed to. I'm wondering why my hospital gets away with so much.

MsPebbles

Has 2 years experience.

I'm sorry for your,experience, OP. I also work at a large teaching institution. When it's a day to throw out everyone's drinks ... everyone's drinks get thrown in the trash. A physician sitting idle in front of a workstation ... will be asked to move so that I can use the workstation.

JP drain contents spilled into an unlidded cup? I'd pay money to observe that *teachable moment*.

And I'd pay to see someone ask a physician move to use a computer! Especially the countless med students who hog every single one at the nurses stations, including the ones used by the charge nurse and secretary! As a nursing student, we are told that we must always relinquish our computers if staff needs them, and to try to not use the ones at the nurses stations. After all, we are "guests." It's apparent the med students at my facility are not encouraged to have the same courtesy.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

And I'd pay to see someone ask a physician move to use a computer! Especially the countless med students who hog every single one at the nurses stations, including the ones used by the charge nurse and secretary! As a nursing student, we are told that we must always relinquish our computers if staff needs them, and to try to not use the ones at the nurses stations. After all, we are "guests." It's apparent the med students at my facility are not encouraged to have the same courtesy.

As a nursing student, you are a guest -- I'm very happy to hear that you're told to relinquish a computer if staff needs it. Medical students, pharmacy students, RT students and PT students are no less "guests" and also expected to relinquish computers if staff needs them. As a charge nurse, I'd be speaking to those medical students and pointing out the designated workstations for providers. If they didn't immediately take the hint, I'd be speaking to their supervisors.

Things may be different when you're staff.

I'm still just a Tech, but the disparity between what doctors can do and get away with and what staff do (namely nurses) has been bothering me since I first entered the hospital setting.

I think one of the things that is missing is the difference between the working conditions and employment style of nurses and physicians. As a resident, I can have up to 10 patients (total of 20 for the entire team) spread out among between any of the med/surg or tele units (3 floors, 3 units per floor). If I'm really unlucky, it might include an ICU downgrade that hasn't made its way out of the ICU (so 2 more units on seprate floor, so 10 patients between 11 units on 4 different floors). That's a far cry from having all of my patients on the same unit like a nurse has (and while less patents, nursing duties requires more time per patient. I can follow up labs and write orders from any computer in the hospital or even at home, the same can't be said for med passes or assisting with ADLs).

So, do I often have a bottle of soda or water that I take with me on units? Sure, however I don't have a lounge that I can duck into for a few minutes like the nursing staff does. It doesn't help if I have a bottle of water in a lounge 2 floors away. That's a big deal when I've had days where I'm running 12+ hours straight without a chance to see a bathroom or the cafeteria.

In regards to bad physicians (and there are bad ____ in every field), the simple fact is that the nurse manager isn't my manager. If it's a heads up ("hey, you could have handled it better"), then the reality is that the nurse should be the one bring it up and not them hiding behind their manager. If it's something serious or repetitive enough to require formal discipline, then it should go to the nurse manager, who then goes to the department chair or chief medical officer (or, as a resident, my attending, or for med students, the attending or resident for that team and at this level no need for the nurse manager). Similarly, I wouldn't expect a nurse to accept a formal reprimand from a physician. The proper chain of command would be for the attending to go to the nurse manager.

This ignores that often problems can be taken care of directly as there can easily be a miscommunication regarding the medical plan and/or nursing assessment/concerns that shouldn't be disciplinary in nature.

The other thing to realize is that often physicians aren't hospital employees. They're either independent contractors or employees of medical groups that contract directly with the hospital. This further skews things in regards to the nursing chain of command compared to the medical chain of command in regards to management and oversight.

In regards to computers and students, at least at my hospital, it really depends on the service the student is on. Again, there's a huge difference between a medical student and ____ students. Medical students are a part of the medical team for a month often keeping the same hours. When I was a medical student, I could easily be in the hospital for 60+hours a week. Surgery? I clocked over 80 hours one week and 13 days straight (M-F with 30 hour call starting Saturday morning). My progress notes where cosigned by the attending and stood as the official progress note for the medical team. How often are nursing students writing directly into the chart? How often are nursing students in house for 80 hours a week? How often are nursing students assigned to the same nurse for a month at a time?

Similarly, if the team is rounding, often it's the medical student who is grabbing a computer to update labs if labs weren't done by the time the residents and students were "pre-rounding." This doesn't justify anyone being a jerk or kicking someone off of a computer, but if the only open computer is the charge nurse computer (which, in my observation, is often the least used computer), then it's more than justifiable for the med student to log on for a couple of minutes to see if labs are back yet.

This doesn't, of course, given license to physicians and medical students to be a-holes. However often times the complaints on how medical staff is treated different from nursing staff (and other hospital employees) fails to take into account the stark contrast between how each side does their work and is employed.

Edited by JPINFV

I think one of the things that is missing is the difference between the working conditions and employment style of nurses and physicians. As a resident, I can have up to 10 patients (total of 20 for the entire team) spread out among between any of the med/surg or tele units (3 floors, 3 units per floor). If I'm really unlucky, it might include an ICU downgrade that hasn't made its way out of the ICU (so 2 more units on seprate floor, so 10 patients between 11 units on 4 different floors). That's a far cry from having all of my patients on the same unit like a nurse has (and while less patents, nursing duties requires more time per patient. I can follow up labs and write orders from any computer in the hospital or even at home, the same can't be said for med passes or assisting with ADLs).

So, do I often have a bottle of soda or water that I take with me on units? Sure, however I don't have a lounge that I can duck into for a few minutes like the nursing staff does. It doesn't help if I have a bottle of water in a lounge 2 floors away. That's a big deal when I've had days where I'm running 12+ hours straight without a chance to see a bathroom or the cafeteria.

In regards to bad physicians (and there are bad ____ in every field), the simple fact is that the nurse manager isn't my manager. If it's a heads up ("hey, you could have handled it better"), then the reality is that the nurse should be the one bring it up and not them hiding behind their manager. If it's something serious or repetitive enough to require formal discipline, then it should go to the nurse manager, who then goes to the department chair or chief medical officer (or, as a resident, my attending, or for med students, the attending or resident for that team and at this level no need for the nurse manager). Similarly, I wouldn't expect a nurse to accept a formal reprimand from a physician. The proper chain of command would be for the attending to go to the nurse manager.

This ignores that often problems can be taken care of directly as there can easily be a miscommunication regarding the medical plan and/or nursing assessment/concerns that shouldn't be disciplinary in nature.

The other thing to realize is that often physicians aren't hospital employees. They're either independent contractors or employees of medical groups that contract directly with the hospital. This further skews things in regards to the nursing chain of command compared to the medical chain of command in regards to management and oversight.

In regards to computers and students, at least at my hospital, it really depends on the service the student is on. Again, there's a huge difference between a medical student and ____ students. Medical students are a part of the medical team for a month often keeping the same hours. When I was a medical student, I could easily be in the hospital for 60+hours a week. Surgery? I clocked over 80 hours one week and 13 days straight (M-F with 30 hour call starting Saturday morning). My progress notes where cosigned by the attending and stood as the official progress note for the medical team. How often are nursing students writing directly into the chart? How often are nursing students in house for 80 hours a week? How often are nursing students assigned to the same nurse for a month at a time?

Similarly, if the team is rounding, often it's the medical student who is grabbing a computer to update labs if labs weren't done by the time the residents and students were "pre-rounding." This doesn't justify anyone being a jerk or kicking someone off of a computer, but if the only open computer is the charge nurse computer (which, in my observation, is often the least used computer), then it's more than justifiable for the med student to log on for a couple of minutes to see if labs are back yet.

This doesn't, of course, given license to physicians and medical students to be a-holes. However often times the complaints on how medical staff is treated different from nursing staff (and other hospital employees) fails to take into account the stark contrast between how each side does their work and is employed.

Just because your lounge is 2 floor away and you have patients on multiple floors doesn't mean the beverage policy should not be applied to physicians, if the policy was put in place for a patient safety issue.

Moreover, I do not think the medical student is any more part of the physician team than a nursing student is part of the nursing team. Your 80 hours a week during the surgery rotation is part of your medical education, and if during your education you also help out by getting labs, then that is great but it doesn't entitle the medical student any rights to a computer more than any other staff. Conversely, if a nurse, charge or otherwise, prevents someone else from using "nursing designated" computers, I consider that an impediment to patient care.

In the end it comes down to the greed of the original poster's hospital CEO. Hospital administrations realize that physicians are providing the expertise that brings in the patients, and (especially in private practice), physicians have the choice of which hospital they want to send their patients to in order to deliver that expertise.

Last year, I realized I brought in millions in revenue to a hospital from my surgical volume as a surgeon, and I cost the hospital only the equipment I ask them to buy for me. There is no other worker at that hospital that brings in anything close to that amount except other surgeons. I can easily take my patients to the hospital down the street and make them millions of dollars richer instead.

That realization alone by the CEO is what gets physicians the best parking spots, the upscale attending lounges, and the ability to drink beverages on rounds. The business and greed of healthcare is unfortunately what turns an ideal healthcare working environment where everyone is held to the same standards for the patient's sake, into one that bends over backwards for those that can most line the CEO's pockets.

Just because your lounge is 2 floor away and you have patients on multiple floors doesn't mean the beverage policy should not be applied to physicians, if the policy was put in place for a patient safety issue.

As stated, it's an OSHA issue.

Moreover, I do not think the medical student is any more part of the physician team than a nursing student is part of the nursing team. Your 80 hours a week during the surgery rotation is part of your medical education, and if during your education you also help out by getting labs, then that is great but it doesn't entitle the medical student any rights to a computer more than any other staff. Conversely, if a nurse, charge or otherwise, prevents someone else from using "nursing designated" computers, I consider that an impediment to patient care.

I fail to follow the logic that a student grabbing labs for a team actively rounding on the floor at that instant is any different than a resident grabbing labs for a team actively rounding at that moment. I agree that the student, when acting as a part of the entire medical team, has no more right than any other staff member. However, I will also put forth that they have no less right either when the team is actively rounding on the floor. The conversation was regarding a student vacating for a nurse (direct quote, "As a nursing student, we are told that we must always relinquish our computers if staff needs them, and to try to not use the ones at the nurses stations. After all, we are "guests." It's apparent the med students at my facility are not encouraged to have the same courtesy."). It's absurd for me to think of a med student being kicked off of a computer when the entire team is on the floor because it's a med student, but not if it's a resident. I also think the same way regarding nursing students. I don't kick nursing students off computers if I need a computer. There's generally a computer available at one of the three stations (our units are triangle in shape with 2 small 1-2 computer stations at the other points) because I've got 2 good legs and need the exercise anyways.

There also aren't any "nursing designated" computers at my hospital any more than there are "physician designated" computers with the exception of the charge nurse computer, which is a sign taped over it (and I try not to camp out on those computers, but sometimes it's any port in a storm). The lack of computers is a recognized problem since the hospital wasn't designed as a teaching hospital, but now has over 100 residents in various programs, thus causing a well known computer shortage (I actively try not to need a computer at 7am because of the sheer number of physicians and nurses needing computers for pre-rounds and sign out respectively). Now if we want to be specific, the hospital does encourage bedside charting for nurses with the in-room computers, but even I recognize that as a stupid idea for numerous reasons, including the lack of efficiency when constantly logging in and out.

In the end it comes down to the greed of the original poster's hospital CEO. Hospital administrations realize that physicians are providing the expertise that brings in the patients, and (especially in private practice), physicians have the choice of which hospital they want to send their patients to in order to deliver that expertise.

Last year, I realized I brought in millions in revenue to a hospital from my surgical volume as a surgeon, and I cost the hospital only the equipment I ask them to buy for me. There is no other worker at that hospital that brings in anything close to that amount except other surgeons. I can easily take my patients to the hospital down the street and make them millions of dollars richer instead.

That realization alone by the CEO is what gets physicians the best parking spots, the upscale attending lounges, and the ability to drink beverages on rounds. The business and greed of healthcare is unfortunately what turns an ideal healthcare working environment where everyone is held to the same standards for the patient's sake, into one that bends over backwards for those that can most line the CEO's pockets.

The funny thing is that I'm at a county hospital. Heck, we don't have an attending lounge. We have a resident lounge that's normally infested with med students from the slower services (not IM or gen surg). No one is coming here because of "Dr. So and So."

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

This is still AllNURSES, right? How did we get a bunch of physicians arguing amongst each other?

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

I think one of the things that is missing is the difference between the working conditions and employment style of nurses and physicians. As a resident, I can have up to 10 patients (total of 20 for the entire team) spread out among between any of the med/surg or tele units (3 floors, 3 units per floor). If I'm really unlucky, it might include an ICU downgrade that hasn't made its way out of the ICU (so 2 more units on seprate floor, so 10 patients between 11 units on 4 different floors). That's a far cry from having all of my patients on the same unit like a nurse has (and while less patents, nursing duties requires more time per patient. I can follow up labs and write orders from any computer in the hospital or even at home, the same can't be said for med passes or assisting with ADLs).

So, do I often have a bottle of soda or water that I take with me on units? Sure, however I don't have a lounge that I can duck into for a few minutes like the nursing staff does. It doesn't help if I have a bottle of water in a lounge 2 floors away. That's a big deal when I've had days where I'm running 12+ hours straight without a chance to see a bathroom or the cafeteria.

if the only open computer is the charge nurse computer (which, in my observation, is often the least used computer), then it's more than justifiable for the med student to log on for a couple of minutes to see if labs are back yet.

This doesn't, of course, given license to physicians and medical students to be a-holes. However often times the complaints on how medical staff is treated different from nursing staff (and other hospital employees) fails to take into account the stark contrast between how each side does their work and is employed.

Yesterday, I walked onto the unit to get report on my patient, and there were two people on the nurse-designated computer outside the patient room. There were two open (no lids) containers of steaming hot coffee perched right next to the keyboard and the paper chart. There was a physician-designated WOW right behind them, close enough that it was touching the back of the nurse-designated chair they were sitting on. And yes, they were a physician and a medical student. Interesting thing is, the work room full of computers that we'd designated for providers was a mere six feet away, directly across the hall and empty. No reason for drinks, open or otherwise, to be endangering my work station or that patient's paper records from an outside hospital. No reason for them to be at the nursing workstation on the nursing computer or in the nurse's chair. They were just being oblivious. And when the person I was taking over the patient from tried to gently educate them on shift handover, they were rude and dismissive.

The charge computer is for charge nurses, the secretary's computer is for the secretary. If we have to wait for a med student to finish what he's doing and get out of our way every time we need to look something up, it significantly slows the work process. That can be a patient safety issue. It's definitely an issue when the surgeon wants to know something and I can't tell him because there's a medical student on MY computer!

Yesterday, I walked onto the unit to get report on my patient, and there were two people on the nurse-designated computer outside the patient room. There were two open (no lids) containers of steaming hot coffee perched right next to the keyboard and the paper chart. There was a physician-designated WOW right behind them, close enough that it was touching the back of the nurse-designated chair they were sitting on. And yes, they were a physician and a medical student. Interesting thing is, the work room full of computers that we'd designated for providers was a mere six feet away, directly across the hall and empty. No reason for drinks, open or otherwise, to be endangering my work station or that patient's paper records from an outside hospital. No reason for them to be at the nursing workstation on the nursing computer or in the nurse's chair. They were just being oblivious. And when the person I was taking over the patient from tried to gently educate them on shift handover, they were rude and dismissive.

...and if your hospital has enough computers for such niceties, then yes, the physician should have been using the physician designated computers. Similarly, I recognized that medicine, like every field, does have a-holes in it.

The charge computer is for charge nurses, the secretary's computer is for the secretary. If we have to wait for a med student to finish what he's doing and get out of our way every time we need to look something up, it significantly slows the work process. That can be a patient safety issue. It's definitely an issue when the surgeon wants to know something and I can't tell him because there's a medical student on MY computer!

...and it's a patient safety issue when a team is rounding and no one can get updated labs because a medical student was asked to get them instead of sending a resident or attending and there's a distinct lack of computers available on the unit.

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 27 years experience.

Not knowing how the OP's hospital is set-up, it's really hard to tease out the issues other than the reality of the OP's preception of lack of respect towards nursing in her workplace which is a valid point based on her post. What drew me to this conversation is the fact that the OP stated that the institution is an "academic medical center", yet it sounds so atypical from what I experience where I work.

I am an ICU Nurse Practitioner at an academic medical center on the West Coast (Top Medical School + Top Residency programs). While we have big names in our physician and surgeon faculty roster (who do bring revenue for sure), they are all part of the same closed medical group. I also feel that as an institution, the value of interdisciplinary collaboration and mutual respect between disciplines are well realized here. There are exceptions for sure, but certainly not the norm. I feel that it has something to do with the fact that though the medical school is well recognized, the schools of nursing, pharmacy, and others bring just as much prestige to the institution's name.

I would say that we rarely if ever have an issue with sneaky, prohibited beverage-carrying issue among physicians and nurses here. There are designated areas on the units where all employees (regardless of profession) can leave covered beverages with a name label on it. There are ice and water dispensers on all the units accessible to anyone - I could easily excuse myself, grab a cup of water and toss the empty cup on the trash bin, then return to rounds. BTW, they are not styrofoam cups and are actually biodegradable so I'm not killing the environment.

The struggle for workstations can be hectic early in the morning as every member of the provider teams (residents, interns, sub-interns/med students, NP's, NP students) try to log in to pre-round on patients. However, there are enough designated provider workstations in the units, so when I say "struggle", it's really finding that comfortable spot close to your patient's room so you won't have to walk far to see the patient you're reading about. Needing to Look up labs at a pinch? come on, you have an iPad or iPhone right? well Epic has apps available on those devices so go look it up that way. We may be spoiled here.

Edited by juan de la cruz

RN., MSN, RN

Specializes in Perianesthesia. Has 30 years experience.

To the poster who implied the CEO thinks he is the money making machine of the hospital: Last time I checked, the patients came to the hospital for NURSING care.

To the poster who implied the CEO thinks he is the money making machine of the hospital: Last time I checked, the patients came to the hospital for NURSING care.

Yes, the patient comes to the hospital for both nursing care as well as for the inpatient delivery of physician expertise/surgery.

However, as a paid employee of the hospital, you deliver the "product" that the hospital is selling to its patients, and therefore the nurses are an expense they hospital must pay in order to deliver their product. If the hospital does not like your performance or if you do not comply with its policies, they can simply replace you with someone else who does.

However, physicians, unless they are hospital employees, bring the patients to the hospital to which the hospital can sell its "product" (nursing care, facilities, OR equipment). Therefore, the nurses are not directly generating revenue for the hospital, even though they are providing a vital service that cannot be provided in an outpatient setting. They indirectly bring business to the hospital by providing quality nursing care, which improves the reputation of the hospital, making patients and physicians want to come there.

Since physicians bear the role of direct primary revenue generators of the hospital, and the hospital administration/CEO knows the physician often times has a choice in which hospital to send their patients to, the administration will often do what it takes to keep the physicians happy, in order to maintain the flow of patients and revenue.

I believe this is the basis for the preferential treatment of physicians at some hospitals. I would think this would less likely be the case at academic institutions or hospitals that employ their physicians. Therefore, I am a little surprised the OP notices this differential treatment at an academic center, unless it's a hospital affiliated with an academic center to which an academic group provides services where hospital needs the services more than the physicians need that hospital.