Letter from a Specialist

This came to me from a loyal reader of this blog:
Not a primary care doc, so the details are different, but cut from the same cloth.
Here, with a few adjustments, is the meaty part of an email I sent to a colleague who is a senior member of the Department of Medicine at a major (redacted) University teaching hospital. It was written in response to his observation that he and many of his colleagues find themselves trudging through the day looking at the floor, having fundamentally lost control of their professional lives and at risk for losing control of their souls.

The question: Cui bono (To whom go the benefits?)

The answer: Senior management – grotesquely disproportionate salaries and benefit packages, short workdays spent schmoozing, leaving abundant time to work on paid side jobs, go on junkets, attend fundraising dinners, etc. Health system chiefs (names redacted) pulling down serious seven figures, for what value created? I consider it obscene for an officer of a nonprofit to be paid anything above mid-six figures; that is plenty for a very comfortable lifestyle, and beats the hell out of anything I have managed. Not to mention that the administrative big shots have multiplied like maggots on a corpse; when I came on board at the (Redacted) in 1974, there were two vice presidents, and now that level is at least 30, and none of them is breaking a sweat.
As for the worker bees, throw out the experienced senior people and pretend that beginners can run a complex patient care area, in the name of saving money. Make sure that everybody is in full compliance with the rules, no matter how arbitrary and destructive. See to it that the physicians understand that their real job is not taking care of their patients, not even writing papers, but pulling in funding for their chiefs to use to aggrandize their fame and power. Call the ever-changing bedside flash mobs “teams” when they hardly know each other’s names, much less have any feeling for the patients upon whom they are employing their truncated cookie-cutter skill set designed to stuff the check-boxes of a billing-centric EMR. Call the individualists, dissenters, moral traditionalists and deep thinkers “out of touch” or “disruptive,” and get rid of them.
I believe that medicine is a great profession and a great calling that has fallen upon hard times in the deep and icy shadow cast by the enormous superstructure of the American healthcare system, and in our case and specifically the corrupting influences of big business medicine run for the benefit of its overseer class and an academic hierarchy based on fame and fortune rather than doing hands-on good in the world.
Keep smiling, and keep your moral compass true
LS
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