Employed Physicians by Ted Bacharach MD (retired)
Optimum performance of any employee requires diligence and commitment on the part of the employee but also on the part of the employer who must utilize every means at his disposal to create the proper environment as well as inculcate in the employee the desire and the need for complete dedication. These principles are especially noteworthy in the case where you are dealing with intelligent professionals. The first order of business requires that all ideas of independence must be routed out. Failure to follow this simple principle may result in defection. Fear can be instilled rather easily especially if the employee has no substantial sum available at his disposal. Debts incurred prior to employment are a great asset. In the choice of employees it is always best to hire those with the greatest degree of indebtedness. In the case of physicians the above is especially true. Contrary to popular opinion few physicians are independent thinkers. By virtue of many years of subservient behavior required by the medical schools for both applicants as well as potential students, physicians become very tractable employees.
Once hired it is important to continue to foster the impression that they have an obligation to comply, and failure to do so can result in demerits. To the employed physician demerits are abhorrence and any form of criticism is taken to heart. Thus it is obvious it is not necessary to beat them into submission, they have been properly prepared to do as they are told and will subject themselves to any kind of self-discipline with very little corporeal encouragement, promises of partnerships, bonuses and even retirement programs can help to secure the bonds quite effectively, even it they are rather ephemeral.
Once they have been properly “prepared” the rest is simple. They are used to written exercises and can easily fulfill all of the requirements in the paperwork department. While many are not inherently speedy this can be altered easily. If the required scheduled patients are not seen promptly a small wage deduction is justified (since they are already overpaid, this is a minor problem). More stringent methods like chaining them to their desks are usually not necessary but remain a viable option. For the peripatetic physician who wanders too frequently a catheter can be inserted the first thing in the morning making his needs considerably less pressing. Patients that are hospitalized can easily be managed by an in patient associate, a “hospitalist”.
Escapees from this system must be taught a lesson. They must be inculcated with the conviction that escape is impossible. Probability of a successful escape must be depicted as more difficult that an escape from Alcatraz, or Devil’s Island. While there are no swimming sharks out there, creatures and institutions that are far more deadly and vindictive are just waiting for a palatable juicy morsel.
Recurrent remonstrations as well as promises of future treasure and rewards are mandatory to prevent those employed from looking through the looking glass and possibly discovering another world that might enjoy their presence if they had sufficient self respect and “cahones” to become liberated.
Those remaining in captivity, obviously the majority, are left to frequently ponder the reasons they may have had for choosing a medical career, a goal they have not achieved to date. In the interest of sanity they had better give up and replace their lofty ideals with a more practical, realistic down in the dirt type goal.
Frequent looks into a mirror are not advised as they could cause insomnia, ulcers and emotional distress.
Sorry, Much-Afraid, that you don’t like government. In the U.S., it’s hard to say how much medical care costs because our system is such a Gordian Knot, thanks to all of the cost distortions imposed upon it by “big insurance.” As I’ve written before, here, a CT scan (three years ago — haven’t been able to afford the follow-up one my doc is after me to get for my lungs, which are filling up with scar tissue thanks to rheumatoid arthritis) costs $1,200 if you are an insurance company. If you are a “self-payer,” the cost is $3,600. Huh? Who is subsidizing whom? Doctors rarely know what diagnostic tests cost — my rheumatologist wanted me to have one that he was sure wasn’t TOO expensive — it was $1,100! After that, I always tracked down the cost, which invariably takes several days and lots of phone calls, because no one knows (and we are lectured about being good “health care consumers.” Yeah, right. If you can get the information.
“By virtue of many years of subservient behavior required by the medical schools for both applicants as well as potential students, physicians become very tractable employees.”
Thanks for this, Dr. Bacharach. Only too true; I see lots of this ‘obedience training’ on the wards every day. A respect for hierarchy is helpful for doctors in emergency situations, but being seeped in this culture certainly makes doctors ready to be more controlled by administrators as well.
I happen to be in the somewhat unusual situation of graduating without debt. This is fairly rare, and as you point out, it implies that I should be more willing to accept more risk than the average employed physician. Do you have any strategic thoughts on how I can best leverage that risk-non-aversion, particularly as a potential radiologist?