HJBR Jul/Aug 2026

HEALTHCARE JOURNAL OF BATON ROUGE I  JUL / AUG 2026 39 most people don’t think about until they need it? Littleton Well, we are here to serve the com- munity when and if there’s a problem. The best care for burn care is not to get burned in the first place. And so, what we want peo- ple to know is, although I enjoy what I do and we are good at what we do in the hos- pital and the burn center program since the ’70s, ideally, we would not treat anybody for a burn. But, unfortunately, we see plenty of burn patients from the community and out- side the community as well, whether they’re hurt at a crawfish boil or in a house fire or in industry. We are there to serve our patient population and like I said, this is certainly one of those fields where you don’t know much about it and don’t think much about it until you need it, and when you need it, you want it and you want it timely and with excellent care, and we think we provide that here at Baton Rouge General. Editor Over the past two decades, the rela- tionship between hospitals and physicians has changed dramatically with more doc- tors becoming employed by hospitals or health systems. What has been gained in that shift? What may have been lost, and where do you think the right balance should be? Littleton Yeah, this has been a sea change over the last 20 years. I’ve been in prac- tice 26 years and I remember going to the American College of Surgery conference where the moderator asked the question, “How many physicians in the audience are employed by the hospital system?” And when I first started practice — in the first five years of my practice — [the number in pri- vate practice] was probably 90%, and then in the last 10 years, I would say certainly the last five to 10 years, it’s probably the inverse, where I’d say close to 90% of providers are employed. What I found — and I was one of that change as well; I was in private practice for almost 15 years in a small group practice and the upside of a small group practice is that you’re nimble and can kind of pivot on a dime and make decisions quickly with- out a whole lot . . . I mean have discussions with the two or three doctors involved or if it’s a larger group, you know, 15 or 20 doc- tors involved, without a whole lot of red tape and a lot of hassle and if decisions need to be made, or as far as personnel or policy, it’s something easy to do. The downside of a small group is that it’s just progressively more expensive and you lose the economies of scale when it comes to health insurance and billing and collecting and interacting with patients. It just becomes progressively more difficult and burdensome on a small group to main- tain all the quality metrics and the require- ments on the EMR basis, and it’s so expen- sive for malpractice insurance and liability insurance and just even office space — all those things, they all add up. And so, when I made the transition, and as so many pro- viders have done across the spectrum of healthcare to become an employed physi- cian, there’s pros and cons to that. Probably the biggest upside, it takes the hassle of the day-to-day running of a prac- tice out of my hands and puts it into an administrator’s hands who trained and went to school specifically for that, and then the hiring and firing and policies and the com- pliance issues and all those things that kind of go on in the background without me nec- essarily having to worry about those things. Now the cost of wanting to practice is just different. It’s just kind of shifted when you have a hospital system that maybe employs a hundred doctors and a hundred mid-lev- els. The economies of scale and how the rents and the overhead and all those things get kind of spread out across the organiza- tion as opposed to being on two or three individual docs and maybe four or five employees. It is certainly a different day and age and there’s pros and cons to it. I do think there’s certainly a role for indepen- dent practitioners in this community. We do have some very strong and solid indepen- dent practices in Baton Rouge and I think they will be here for years to come, but there is a growing role for the employee provider as well. When you’re in the employed model — as far as the referral base — is just kind of easier because it’s kind of understood that within this family of Baton Rouge General, if a pri- mary care doctor sees a patient with gall- stones who needs gallbladder surgery, then they’re going to refer to the provider who’s in this network and so it just becomes easier for the providers and kind of more conve- nient for the patients and so that makes the continuum of care probably more effective and streamlined. Editor What are the biggest issues physi- cians are bringing to you right now? Littleton Well, there’s always the next best tool, so to speak, and wanting access to dif- ferent technology in healthcare, whether it be a robotic platform for pulmonology or a general surgery or what have you, or some orthopedic issues in orthopedic technology and cardiology. There’s always the latest, greatest, next, best thing in technology that providers want access to and they want their patients to be able to have access to the best quality care. So, that’s an issue. Also, the ris- ing price of the cost of medicine is an ongo- ing issue, whether it be malpractice or just the cost of individual practices of overhead or what have you. Ongoing rising inflation- ary costs are ongoing issues as well. Editor How’s the burnout rate these days? Littleton Well, that’s a real problem. I’m 57 and I’ve been doing this for 26 years and I don’t feel old. I feel seasoned, but I don’t feel old, but I can tell you that there’s a number of providers that I know that have had to make a change that are younger than me and that have had to change either within medicine or completely out of medicine into a whole different field because they just have had enough, and I think that’s unfor- tunate because we need our providers to stay in for the long haul, but understand- able because this field does weigh on you and it wears on you over time. I think that there’s a change in the mindset