SENIOR STAFF: LOSE POSITIONS UNDER MANAGED CARE, MERGERS

      "As hospitals merge and shrink under pressure from managed
 care, a large and growing number of senior doctors and nurses
 have found themselves suddenly dismissed or demoted at the height
 of their careers," NEW YORK TIMES reports.  According to experts,
 older doctors and nurses, who have "high salaries and roots in
 old-style medicine ... are natural targets for hospitals trying
 desperately to economize."  Thousands of senior-level staff
 members have lost their jobs or administrative positions,
 according to industry experts, while some "swallow demotions and
 accept lower salaries."  Others have sued the institutions,
 "citing slander or age discrimination."  TIMES reports that age
 discrimination complaints from health care workers filed with the
 federal Equal Employment Opportunity Commission "have nearly
 doubled since 1989, from about 500 to nearly 1,000 in each of the
 last three years."
      FAMILIAR TREND:  Janet Coffman, a researcher at the Center
 for the Health Professions at the University of California at San
 Francisco, said, "We're certainly hearing about this all over,
 but it's hard to know just how extensive it is."  She said,
 however, that "it parallels what's happened in other industries. 
 In the 80s, lower-level folks got squeezed; in the 90s, it's
 upper-level folks and management."  
      CUT OR PINCH?:  While hospitals "deny any systematic efforts
 to weed out senior staff members," lawyers "say they see
 evidence" of discrimination and labor leaders charge that
 "hospitals are dismissing highly paid employees for minor
 errors."  According to the TIMES, "[w]hatever the reasons, a
 number of health experts say the exodus of experienced workers
 deprives sick people of the expertise that comes from years of
 practice, and robs young doctors and nurses of mentors."  Anna
 Gilmore, director of labor relations for the American Nurses
 Association, said, "This is a quick-fix, shortsighted solution to
 a budget problem.  We're losing the history and knowledge that
 the older nurses and doctors have."  Karen Davis, executive
 director of the Commonwealth Fund, said that while "[a]ge
 discrimination should not be tolerated," she was "ambivalent
 about hospitals' cutting back on high-paid personnel."  She said,
 "If you are running an institution and you need to save money,
 it's sometimes just a matter of, here's the salary we can pay,
 and you are way above that" (Rosenthal, 1/26).