Decorahnews.com special report continues: "Why have so many doctors left Winneshiek Medical Center?"

decorahnews.com's Paul Scott

(Editor's note: For the past two months, following the firing of Winneshiek Medical Center Chief Administrative Officer Dan Werner, decorahnews.com's Paul Scott has been approached by readers asking, "What the heck is going on at the hospital?"  He has interviewed dozens of people during that time in an attempt to answer the readers' question.

The following is NOT a news story, but Paul Scott's opinion--his attempt to give the best possible answer to the question, "What's going on at the hospital)

Mayo Clinic is acknowledged as the best medical system in the entire world.  Decorah residents are fortunate to have such good facilities little more than one hour away.

So when Mayo Clinic Health System signed a Management Services Agreement with Winneshiek Medical Center to provide the four top administrators at the hospital, it naturally sought to use "The Mayo Model" in Decorah.  That's when the clash of cultures started.

Because when people go to Mayo Clinic, they're going because their local hospital and local physician do not have the specialized services that Mayo Clinic does.  So people head to Mayo Clinic, not to a particular doctor.

It was surprising to us—and might be surprising to you as well—that several sources say Mayo Clinic Health System does not pay physicians quite as high a salary as some other health systems do.  But when you think of it, this bit of information makes sense—doctors (especially young doctors) would be willing to take a "Mayo salary discount" to work at the best medical system in the entire world.  And Mayo—knowing that it is the best medical system in the world—could get away with offering slightly less money to doctors.

Which could easily lead to a feeling by administrators that if one doctor leaves, there will be dozens of others waiting to take their place.

In Decorah, many people head to their local health care provider because they have established a relationship with them.  Their kids go to school together.  The families attend church together.  The doctors know who the patients are and what their medical histories have been.

In short, people head to a particular doctor, not to an institution.

So a management style that says, "Do as we tell you because you can be replaced" might work for regular employees, but it has its drawbacks when dealing with doctors.

This is why statistics about the number of Winneshiek Medical Center employees who have left during the past two years—hospital officials say it averages 45 employees a year, or 11 percent of the hospital's workforce—have little meaning to people in the Decorah community.

In the past two years five family practice physicians, one surgeon, one orthopedic surgeon, a radiologist and several other high profile hospital employees have left the hospital.  From the viewpoint of raw numbers, these former employees represent a small percentage of the hospital's workforce.  But they represent dozens of years of service and strong ties to the Decorah community.  They also represent the reason the public wants to go to a clinic or hospital.

The reaction of the Mayo administrators has been that if one doctor leaves, there will be dozens of others waiting to take their place.  There have been problems with that model, however.  It's not as easy to attract new doctors to Decorah and Winneshiek Medical Center as it is to attract new doctors to Rochester and Mayo Clinic.  Additionally, the reputation of Winneshiek Medical Center has suffered as other doctors see Decorah's doctors leaving the hospital to go to work for other health care organizations.

Decorahnews.com has talked with dozens of people in the last month, past and current hospital employees alike.  They have used words like "confrontational," "abusive" and "toxic" to describe the attitude of the hospital administration.  When administrators tell employees not to say anything to the public about what's happening at the hospital, it's a very telling sign that administrators know there are problems, but are trying to keep employees from discussing them in public.  Numerous current employees have told decorahnews.com that they do not want their names used in news stories because they fear they would be fired.

This "toxic" atmosphere at the hospital has made it more difficult for the hospital to make money.  As long-time veteran doctors have left, they have been replaced by fill-in doctors called "locums" until permanent replacements can be found.  That increases costs.  And even the arrival of a permanent replacement is not always the solution, since at least one of those has left shortly after starting.

Retaining good doctors, especially well-known and well-liked doctors and most especially doctors in specialty areas such as orthopedics, surgery and radiology, is the secret to making money for a hospital.  In Decorah, it's not how many employees are leaving that's important, it's how many doctors.

At this point, however, hospital administrators do not think this is a problem.  The experienced doctors have left "for a variety of reasons," they say.  Keeping doctors happy does not seem to be a priority.  Using the "Mayo Model," they think if one doctor leaves, another one can be hired.  Meanwhile, the hospital's financial situation is not as good as budgeted and members of the public continue to ask "What's wrong at the hospital?"