The Covert Plan by Hospital Administrators to Control Doctors


I have worked for multiple administrators.  I have worked for multiple hospitals.  I am scarred for life from both.  Then I read the Health Care Blog’s entry “How to Discourage a Doctor” and it basically affirmed the suspicions I have had all along.  I am going to put it here in it’s entirety but I cannot validate the source nor author.  You be the judge (I put in bold what I think is critical):

How to Discourage a Doctor

Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.

Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me – in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets – feel out of place.

Within a minute, an administrative secretary came out and escorted him into one of the offices. Exhausted from a long call shift and lulled by the quiet, I started to doze off. Soon roused by the sound of my own snoring, I started and looked about.
That was when I spotted the document on an adjacent chair. Its title immediately caught my eye: “How to Discourage a Doctor.”

No one else was about, so I reached over, picked it up, and began to leaf through its pages. It became apparent immediately that it was one of the most remarkable things I had ever read, clearly not meant for my eyes. It seemed to be the product of a healthcare consulting company, presumably the well-dressed man’s employer. Fearing that he would return any moment to retrieve it, I perused it as quickly as possible. My recollection of its contents is naturally somewhat imperfect, but I can reproduce the gist of what it said.
“The stresses on today’s hospital executive are enormous. They include a rapidly shifting regulatory environment, downward pressures on reimbursement rates, and seismic shifts in payment mechanisms. Many leaders naturally feel as though they are building a hospital in the midst of an earthquake. With prospects for revenue enhancement highly uncertain, the best strategy for ensuring a favorable bottom line is to reduce costs. And for the foreseeable future, the most important driver of costs in virtually every hospital will be its medical staff.
“Though physician compensation accounts for only about 8% of healthcare spending, decisions that physicians strongly influence or make directly – such as what medication to prescribe, whether to perform surgery, and when to admit and discharge a patient from the hospital – have been estimated to account for as much as 80% of the nation’s healthcare budget. To maintain a favorable balance sheet, hospital executives need to gain control of their physicians. Most hospitals have already taken an important step in this direction by employing a growing proportion of their medical staff.

“Transforming previously independent physicians into employees has increased hospital influence over their decision making, an effect that has been successfully augmented in many centers by tying physician compensation directly to the execution of hospital strategic initiatives. But physicians have invested many years in learning their craft, they hold their professional autonomy in high esteem, and they take seriously the considerable respect and trust with which many patients still regard them.

As a result, the challenge of managing a hospital medical staff continues to resemble herding cats.

“Merely controlling the purse strings is not enough. To truly seize the reins of medicine, it is necessary to do more, to get into the heads and hearts of physicians. And the way to do this is to show physicians that they are not nearly so important as they think they are. Physicians have long seen the patient-physician relationship as the very center of the healthcare solar system. As we go forward, they must be made to feel that this relationship is not the sun around which everything else orbits, but rather one of the dimmer peripheral planets, a Neptune or perhaps Uranus.

“How can this goal be achieved? A complete list of proven tactics and strategies is available to our clients, but some of the more notable include the following:

“Make healthcare incomprehensible to physicians. It is no easy task to baffle the most intelligent people in the organization, but it can be done. For example, make physicians increasingly dependent on complex systems outside their domain of expertise, such as information technology and coding and billing software. Ensure that such systems are very costly, so that solo practitioners and small groups, who naturally cannot afford them, must turn to the hospital. And augment their sense of incompetence by making such systems user-unfriendly and unreliable. Where possible, change vendors

“Promote a sense of insecurity among the medical staff. A comfortable physician is a confident physician, and a confident physician usually proves difficult to control. To undermine confidence, let it be known that physicians’ jobs are in jeopardy and their compensation is likely to decline. Fire one or more physicians, ensuring that the entire medical staff knows about it. Hire replacements with a minimum of fanfare. Place a significant percentage of compensation “at risk,” so that physicians begin
to feel beholden to hospital administration for what they manage to eke out.

“Transform physicians from decision makers to decision implementers. Convince them that their professional judgment regarding particular patients no longer constitutes a reliable compass.

Refer to such decisions as anecdotal, idiosyncratic, or simply insufficiently evidence based. Make them feel that their mission is not to balance benefits and risks against their knowledge of particular patients, but instead to apply broad practice guidelines to the care of all patients. Hiring, firing, promotion, and all rewards should be based on conformity to hospital-mandated policies and procedures.

“Subject physicians to escalating productivity expectations. Borrow terminology and methods from the manufacturing industry to make them think of themselves as production-line workers, then convince them that they are not working sufficiently hard and fast. Show them industry standards and benchmarks in comparison to which their output is subpar. On the off chance that their productivity compares favorably, cite numerous reasons that such benchmarks are biased and move the bar
progressively higher, from the 75th

“Increase physicians’ responsibility while decreasing their authority. For example, hold physicians responsible for patient satisfaction scores, but ensure that such scores are influenced by a variety of factors over which physicians have little or no control, such as information technology, hospitality of staff members, and parking. The goal of such measures is to induce a state that psychologists refer to as “learned helplessness,” a growing sense among physicians that whatever they do, they cannot meaningfully influence healthcare, which is to say the operations of the hospital.

“Above all, introduce barriers between physicians and their patients. The more directly
physicians and patients feel connected to one another, the greater the threat to the hospital’s control.
When physicians think about the work they do, the first image that comes to mind should be the hospital, and when patients realize they need care, they should turn first to the hospital, not a particular physician. One effective technique is to ensure that patient-physician relationships are frequently disrupted, so that the hospital remains the one constant. Another is. . . .”

The sound of a door roused me again. The man in the three-piece suit emerged from the office, he and the hospital executive to whom he had been speaking shaking hands and smiling. As he turned, I looked about. Where was “How to Discourage a Doctor?” It was not on the table, nor was it on the chair where I had first found it. “Will he think I took it?” I wondered. But instead of stopping to look for it, he simply walked out of the office. As I watched him go, one thing became clear: having read that document, I suddenly felt a lot less discouraged.

If you go to The Health Care Blog’s site and read the comments, the author doesn’t respond.  Does this document exist?  Or was this a parable of some type?  If it does exist than ALL doctors need to revolt.  If it doesn’t exist and it is just one person’s reflection about what is going on in healthcare then I say cheers to you sir because that is EXACTLY what is going on and…ALL doctors need to revolt.

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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4 Responses

  1. Mamadoc says:

    Made up or not this is EXACTLY what has happened and is happening. I have practiced 30 years in a corporate hospital thought not thank all that is holy as an employee. This year our group gave up inpatient medicine due to the forced adoption of an obsolete EMR to be used in the hospital. That was the straw that broke these workhorses backs. Thanking our lucky stars we never let them talk us into employment

  2. Java Doc says:

    Having been an employed physician for 12 years I can say that initially I had excellent rapport with patients and senior physicians. I had even become a midlevel manager and then I realized that the goal of administrators was to keep tightening the screws on physicians: “Make them responsible for things that they cannot control” . Every year they bring out Press Ganey or other feedback and then tell physicians they have to do more. In one survey the ask about the cleanliness of the facility. What the hell can I do about the cleanliness of the facility? Another survey asked if the patient was kept informed of delays. I always go back and inform my patients of a delay… but why is there a delay? Usually delays have to do with someone else not doing their job or having technical difficulties. Anyway, I feel that highly qualified physicians feel disgusted that they have to grovel to get working ophthalmoscopes or basic supplies while administrators are going home to work on their golf game. Ridiculous !

  3. Joe Smegma says:

    Hello Douglas. A good day to you sir. I am sick reading this article. Whether it is real or fabricated does not matter. The events described are EXACTLY what I have experienced in 20 years as a family doctor working for 2 hospitals. I am convinced that the hospitals understand that the doctor/patient relationship is not only dead. It is a hinderance or obstruction to their business plan. The doctor/patient relationship is the foundation for which we all became doctors. Without this bedrock principle all of what we do is meaningless. Enter the corporate entity and for profit hospitals that we all work for. As mentioned, reduced reimbursement, government regulation, quality initiatives and EMR scrutiny and you have BIG BROTHER managing your patients. Yeah, you still fill their scripts……if you use their drugs. But…..they are now controlling more and more of the healthcare pie and they are affecting the doctor/patient relationship. I am fully convinced that the hospitals that employ physicians want to establish a patient /hospital relationship instead of the traditional doctor/ patient relationship we all love and know. Mid levels are on the rise… yes. They are in line with hospital and managed care goals. We primary care doctors are dinosaurs. The doctor/patient relationship is becoming obsolete. Sad.

  4. Steve_O'_ says:

    All these elements fit under the principles of American Public Medicine, which is the goal of US healthcare by 2020. Like the American Public School system and the (fast) food franchise industry, this is a cookie-cutter approach to business – which is why America is a tottering dinosaur among the world’s manufacturing environment. [Like the late USSR, we have preserved military manufacture as top-notch. That did not save the USSR, and it may not save us for long, either.]
    Medicine is being branded and sold. The restaurant that you are going for lunch at has a McName; you do not know the McEmployees, who are working a miserable, entry-level job. This is the operational model for American Public Medicine.
    One of the embarrassing truths in American medical care is that it persists in a very antiquated model – the engagement of a highly-educated person in service of the Average Joe, and in a position of personal fidelity and trust, no less. In the modern world of the hermetically-sealed community, the Average Joe is not going to run across the hedge fund investor nor his client; he cannot afford the greens fees or the neighborhood association costs. He may bag their groceries; they do not have to listen to the Average Joe.
    In the Third-World model, MD’s are reserved for those of the elite set; the one-percenters. In such a model, there are far too many doctors in the USA. In third-world countries, they go to the pharmacy to buy drugs directly; or just die quietly far from the important people. American Public Medicine, like American Public Education, is controlled by disparaging and demoralizing those who have contact with the “test subjects” – patients and children. They must learn that they are disposable and unordinary; barely worth the money spent to teach and heal them.
    Once we get over our fundamental principles of human justice learned to be the birthright of all Americans, then we can make it happen. May God save us when it does.

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