Change in the healthcare system seems like a good thing we don’t know yet whether it will be worth it.  Like a new drug on the market we may end up seeing terrible side effects that hurt a lot of unsuspecting people.   A recent article in the USA Today  proves again to me the one major problem going on all around us.  If you are in the healthcare field you see it every day.  What, you ask?  The answer and horrible trend is the ever increasing number of administrators.  They are growing faster than Tribbles (Star Trek reference).  In fact, we should call them Administribbles.  Here is another reference from KevinMD that talks a little more about it.   The summary from the USA Today piece goes as follows:

  • New Hampshire cut Medicaid funding and 5% of its medical workforce cut (nurses and other caregivers) yet they are still hiring administrative workers!
  • Hospitals are creating more jobs in an era of cutbacks.  This year was 95,000 of them and growing.  Health care has created 20% of all new jobs in the country.
  • These new jobs are not driven by patient demand but by law!  This includes the 2010 federal health care law, the 2009 federal stimulus funding, and new government regulations!
  • They are being hired to deal with new technology, new services, new regulations, electronic health records and government reporting requirements on quality.
This should horrify all of us.  These people produce NOTHING.  No doubt a few are helpful but to increase a workforce that produces no revenue and does not directly help the customer (patient) means it is just wasted cost.  This bureaucratic bulge causes undue bureaucratic drag that will just sink us all.   As one typical administrator says in the article:
“We are trying to balance the need to cut costs with the need to grow”.

Grow what?!  You are cutting those of us, doctors and nurses, who actually help people while reproducing yourselves and draining the system.  For those that read this, please send me your experiences on this trend.  I think the you can enlighten a lot of people about what is really going on in healthcare.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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6 Responses

  1. Mike says:

    Our rural hospital has undergone a sea change over the past 10 years. It used to be run largely by the troops in the trenches (MDs and RNs) and we provided great care on a shoestring budget. The local hospital district then raised taxes, got more money, and now we have an army of administrative personnel crowding out the real providers.

    Last year we had a budget crunch and what was the response? Freeze pay for all the worker bees, lay-off several receptionists, janitors, and low-level care providers. Force other workers to combine positions so they were doing 1.5 FTEs worth of work in 40 hours (no overtime was allowed but everyone was expected to do the 1.5 FTEs worth of work within the allotted 40 hours).

    Then, (get this) during these same employee cuts, they hired several more administrators and assistants to the administrators! So now we have patients complaining about the long lines in front of the reception desks, the sad state of cleanliness in the clinics and hallways, but, our medical executive meetings are filled with people giving Powerpoint presentations of all the cool “data” they have collected and how well we are doing financially. As an MD in practice for over 20 years, I have no idea what most of this “data” means nor do I much care (it’s irrelevant in my day to day practice of medicine). Our executive meetings used to be filled with patient care concerns, now they are filled with IT updates, Powerpoint presentations, and Excel spreadsheets. We’ve gone from a hospital caring for patients to a corporate boardroom! Now they are telling us we need to be more and more efficient (despite a cludgy EMR that wastes scads of our valuable time) since overhead is rising. I’m counting the days until I can get off of this crazy treadmill…

  2. m says:

    In my hospital we called the nursing administrators “white coats”. They came over from the administration wing, told us how to do our job and then went back into their dens. When I started as an RN (22 years of service) there was the director of nursing and the head nurses with supervisors on the off shifts. Now there’s the director of nursing, clinical managers, nursing managers, assistant (or as we called them “junior”) nurse managers and supervisors. All of these people would fall over in a dead faint if you asked them to take patients and help out–it’s hard to do nursing care in spike heels. I haven’t even counted the number of administrators over the rest of the hospital.

  3. Bridget Reidy MD says:

    I’ve had two recent jobs where administrators didn’t even administrate. I define their job as to take in information, make decisions, let their decisions be known, and ideally reevaluate decisions. I don’t know how they define their jobs but it had nothing to do with the above. I’ve actually had two jobs recently where no one can tell me how we do things here, except to make sure I understand I can’t do them the way that I think makes sense.

    When I ran my own practice I did the patient care and the administration, but now organizations think they can do without the people who do patient care and keep the people who don’t do either. I don’t get it.

  4. Nick says:

    At my medical school, they offer an online master’s degree in healthcare administration and management. I thought I might learn a thing or two about practice management so I signed up. I dropped out in my second quarter, however, because the classes were mostly devoid of content. We were assigned what amounted to busy work, and the only reason I lost points was because I didn’t format my papers properly (calling it “Works Cited” instead of “Bibliography,” not using a title page on a 3 page paper, etc.) I think I learned everything I needed to know about healthcare administrators from that one incident.

  5. DrPhil says:

    A bit like the “Shoe Event Horizon” (Hitchhiker’s guide to the Galaxy) where the only job available will be bureaucrats.

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