Wanted: Physicians Who Will Submit
This is what it has come to. Here is the article entitled Hospitals seeking to hire doctors who “play well with others”. The subtitle goes on:
As more health systems form accountable care organizations, they are putting a premium on the ability to work alongside physician assistants and nurse practitioners.
So what are they saying? There is no more chain of command. Doctors, with all their education and experience, are not to be in charge. Hospital administrators, who somehow think they run the healthcare system, want only sheep to work in their building. It makes their lives so much easier when docile doctors do what they say and have no opinions. They call it being “team oriented” which is a smoke screen. Speak up and you’re labeled a “disruptive physician”. Here are some more quotes from the linked article:
- “There are certain personality attributes and characteristics that, unless it was for a physician leadership position, I don’t think most places have really asked for before.”
- The health systems in the survey expressed optimism about finding doctors who are flexible in who they work with and when they work.
- We’ve been looking for quite a while for physicians who would at least play well with others.
So what is going on here? The is about breaking the will of doctors. This is about setting us up for NPs to be in charge of the ACOs and forcing hired physicians to comply. This is about control and power. Hospital administrators want it and need to covertly change the landscape of the healthcare system in order to get it. This is what they meet about all day while we are working. Physicians are too busy seeing patients to see what is going on and even when they do they just roll over. It is called learned helplessness. What the world forgets, however, is that if an administrator goes missing for a month, no one notices. If a doctor goes missing for a day, there is utter chaos. So who is more important?
It is about power and control, but as a “seasoned” nurse, what I see is that nobody plays well in the sand box- “My way is the only way. Physician teams that can’t share because they won’t get all the credit-eg: God forbid a surgeon consult Pulmonology or Cardiology post op because it would mean they don’t know everything.
As an NP who has been reading Authenthic Medicine since I was a trainee in Central Maine with Dr. Farrago’s colleagues, I’m dismayed at this vitriolism towards mid-level providers. I am proud of my job and do it well. I collaborate with my physician colleagues and do not replace them. This article is off-base and I expected more from you.
I apologize for nothing. I stand by what I wrote here 100%. Doctors in charge. That is the only way it should be. NPs and PAs can work collaboratively but it has changed to a competitive environment. Your profession’s choice…not ours. Game on.
Nature abhors a vacuum, but it treats high concentrations the same. There is too much money, prestige and power in medicine to escape increasing entropy. Even excluding the “Tragedy of the Commons” phenomena in Garrett Hardin’s essay, dispersal seems inevitable. Deregulation changed the primary product of medicine irrevocably to political and economic profit first, and healthcare second. Focusing on the moral and intellectual failures of the personalities involved is a distraction; the problem is of process, not personalities.
Enjoy your blog Douglas. Agree that the Administrators are looking for a certain personality type that is apathetic, unwilling to challenge authority, complacent, and too distracted by the everyday practice of medicine to attend the mindless meetings that administrators populate. Unfortunately for us all the “control” of our medical lives (decision making) has been taken over by “The Borg, resistance is futile” crowd. I met with an administrator recently ( he is an MD convert). I expressed my distaste of becoming a manager of midlevel providers, I simply want to practice medicine as I was trained to do. He told me ” get used to it, the future of primary care is a physician managing several midlevel providers”. Primary care devaluation continues in the form of a job description change. Victor Laslo are you out there?
This piece highlights perfectly what medicine is about in the post-individual era. “Patient-centered care” is as big an Orweillian joke as could ever be in this job. This demonstrates why I quit teaching med students, and will not allow them any longer to shadow me at work. From Pay-for-Performance to coding to core measures, to this demand that doctors participate in their own devaluation – medicine is a fundamentally dishonest business which is degrading to the practitioner, and not something I wish to fake enthusiasm for. Society’s do-gooders, lawyers, politicians, and patients want to enjoy a doctor’s passion for work without his troublesome personality, or capacity for self-evaluation, or self-interest. Remove the man/woman from the mission, and see how that works…
When asked in a survey question why I continue to practice, my answer was truthful: it’s the only way I know to make a living.
amen dr pat.
The AAFP with disappear in 10 to 15 years if this keeps up.
Can hang out the new shingle AAFNP.
They think we can be replaced with all “cheap” N.P.s. They have their place but can’t match the education experience of the M.D. I tell all students now to specialize with the current state of affairs. Sadly, I don’t foresee a time when I can change my tune.