How to be an Authentic Doctor #1: Don’t Be Employed By A Hospital


It has been 20 years since I graduated from medical school.  I have seen lots of patients over those years.  Let’s say I saw 100 patient visits a week for 50 weeks during that time then I would have had seen 5000 patients a year for 20 years.  That’s roughly 100,000 patients during that time, as an estimate.   That doesn’t count call, weekends, etc.  This is just an an estimate.  I think I am a pretty good doc.  Not the greatest doc, mind you,  but I think I hold my own.  I have also been through my fair share of administrators and hospitals and I think I know their inner workings pretty well.   I have had some great medical partners, staff, patients as well.  Lastly, and mostly importantly, I have been thinking about and writing about the crap that goes on in healthcare for 13 of those 20 years.   For ten years I lampooned it with the Placebo Journal, which was the only print medical journal that made you laugh (on purpose).  For twelve years I have been writing this blog and e-newsletter.  I can’t even stop.  I just tend to obsess about this stuff a lot because it drives me crazy.   So I have decided that I am going to vomit it back up to you….slowly.  I have decided to keep an ongoing list (my goal is 100) on “How to be an Authentic Doctor” here, which I may eventually expand into some type of book for prospective medical students, residents, young docs, etc.  Please add your thoughts in the comments section or email me some other pointers!

Let’s start with number ONE but these are in no specific order:

1. Don’t Be A Hospital Employee

What?  How else will I get a job a job?  That will be discussed at another time but it doesn’t matter.  The fact that saying this sounds like heresy shows how bad things have gotten.  Right now, administrators are reproducing at an unbelievable and alarming rate.  They are like the Tribbles from Star Trek.  They are Administribbles. The present economics cannot sustain them so they must pay doctors less while also making them work harder in order for their species to survive.   In nature, parasites normally don’t kill their host but, you know, sometimes they do.   And administrators are killing us.  Do not be a host for these parasites.

Can you imagine the doctors in the old days, who were our heroes, being employed by their hospitals?  They would turn over in their graves.   “The hospital makes money when patients are there and you’re job is to keep a patient out of the hospital.  Do you not see that as a conflict of interest?”, I would see them asking.   And they would be right.

Here is a running list of other reasons not to be a hospital employee.  There are so many more.  Please add to them in the comment section:

  • Once the honeymoon period is over they don’t want to hear a peep from you again.
  • You are their bitch, plain and simple.  Like in a chess set, you are just a pawn that can be moved around wherever they want, sacrificed at a moment’s notice and easily replaced at any time.
  • Your contract means nothing.  Once they sign you and get you settled in then they will continue to try and cut your salary, incentives, etc.
  • You are as happy in life to the degree of control you have in life.  Hospitals and administrators control you.  Hence, you will not be happy.
  • They lie.  They bullshit.  They hide information.  Their job is to keep you working and producing bills.  Remember, a hospital is just a building with walls.  Without doctors and nurses, no one makes money.  That being said, they will continue to convince you that YOU are nothing without THEM.  And you will be believe them because that is the definition of “learned helplessness”.
  • They do not respect you.  They may do the “Administrator Dance” in front of you but behind closed doors and in meetings they talk about you like you are just a commodity.  And you are because you sold your soul to them.
  • Almost every level of administrator thinks you are a pompous prima donna in need of getting your ears slapped back.  Forget the fact that you gave your life and youth to this career and they have a fresh little hospital administration degree (online?).  So they talk about you with disdain, like you are a pain in the ass.
  • This will never change unless doctors declare their independence again. Once that happens then a funny thing will happen.  These same administrators will kiss your ass because they want your business.  Until then, you are the cause for your own suffering.  And you will suffer.


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] 

  5 comments for “How to be an Authentic Doctor #1: Don’t Be Employed By A Hospital

  1. sylvia mustonen DO
    March 14, 2014 at 9:48 am

    add this to your list please, King, about hospital administrators:
    -they don’t want to hear your silly… complaints. Nor do they want to hear your suggestions no matter how worthwhile or timely. They are a top down organization, ruling from the top down to you. Even when they tell you they want to hear from you, they will only take your good ideas, and turn them into mush or take the ideas and never give you credit for them. Remember, if you are their hired doctor tool, you are just their silly fool.
    Keep up the good comments, get your book going.
    Duchess Illin Inthehood.

  2. Gehl Davis
    March 12, 2014 at 7:58 pm

    You are so right. But the new docs don’t see it since that is all they have known. Will it ever come back? I believe it will because eventually someone will wake up. Then they will organize and build their own places as you said. Then the then-new docs will fill in the old slots and the process will begin again.

  3. Pat
    March 12, 2014 at 8:48 am

    Years ago I needed to transfer a patient because the critical care pulmonologist was not on call and could not be persuaded to come in…the hospital administrator blustered “But dammit, he took an oath!”

    That spoke volumes over the presumptions by which physicians are controlled. The administrator like the rest of society merely assumed that his or a patient’s need automatically required the physician to be their bitch. No doctor I ever met took any such oath that obligated “when” to work (as oposed to “how”). It is axiomatic that those who throw the “Oath” in your face have never themselves taken it.

  4. DrPhil
    March 9, 2014 at 3:55 am

    What about work to rule, max sick hours (like you couldn’t find a doctor to sigh your sick certificate),
    take holidays during (radial idea) holidays! If they say you have to work either the christmas shift (3 days long) or the New Years shift (4 days) then they can offer you triple time or more…. If they don’t like it suggest they hold a meeting on Boxing Day or similar – poor administrators might have to tear themselves away from their families.

    The problem is we are suckers for a sob story, they use our desire to HELP people against us, “if you don’t work Christmas Eve then your colleagues will be stressed out, and what if they have a major trauma, they will need all hands on deck”, suggest they roll their sleeves up and pitch in…

    Remember these are the same people who do their bit for the public good by sitting on the Medical and Disciplinary boards.

  5. DrHockey
    March 8, 2014 at 8:19 am

    Years ago, at Mega University Medical Center, I was in an elevator with the Head Hospital Administrator and 4 of his yes-men (they were all men back then). They started to discuss the salaries of the hospital administration interns.

    Yes-Man #1: The hospital administration interns make $15,000 this year (remember, I said “years ago”). I think we should raise them to $17,000 next year.

    Me, wearing my Resident uniform of white pants and short white coat supplied by the hospital confirming my status of R-3 or lower: Do you know how much I make?

    Yes-Man #2: No.

    Me: Only $8,000 per year.

    Yes-Man #1: But you don’t understand. These people are college graduates.

    Me: (I couldn’t say anything. I started shaking and thought I would have a grand mal seizure right in front of them, so I got off the elevator before my stop.)

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