Full Metal Administralian: The Language of Distraction

The biggest hospital system in central Maine is having major issues and I have some things to say about it.  I worked there for five years and know some inside information. It seems a new CEO came in two years ago and began changing things to make it more profitable.  I also hear he is not a good communicator and is not well-liked, which is causing physicians to leave in droves.  “Most of the doctors you knew have left, Doug” is what I have been told.

Central Maine Healthcare oversees three hospitals and all three had medical staff meetings whereupon each gave the CEO a “no confidence” vote.  That is an amazing statement as doctors hardly ever work together to come to a consensus.  In other words, it is really hard to piss off enough doctors to cause them to push for your ouster.  I don’t know all the details of what this CEO did but the rule of thumb is that if administrators could get rid of all doctors then they would.  It would just make their lives easier and they would save money.   If I had to bet then I would say that this is going on here but it doesn’t really matter.  What I really want to talk about is what I call the language of Administralian.  Some say it was created decades ago by the first businessmen who ran hospitals.  I have no proof of that.  All I know is that these two articles, about this system in Maine, use the art of bullish%t to the extreme.

Exhibit #1: Central Maine Healthcare leaders will ‘carefully consider’ no-confidence vote on 7/31

This article came out after ALL the hospitals gave the “no confidence” in the CEO.  Read it for the full flavor but here are the prototypical ADMINISTRALIAN language phrases used:

  • “Importantly, it reflects a divided medical staff and speaks directly to the importance of communication and collaboration between senior leadership and our medical staff on how best to move CMH forward,” the statement read.
  • “We have a deep respect and appreciation for the many contributions of our medical staff and will carefully consider this feedback as we work through next steps.”
  • “These are challenging times for community hospitals and we are no exception. The CMH board takes its fiduciary responsibilities very seriously. Last night’s vote by the CMMC medical staff affirms their frustration and concerns with issues impacting our organization and required system changes. Importantly, it reflects a divided medical staff and speaks directly to the importance of communication and collaboration between senior leadership and our medical staff on how best to move CMH forward. We have a deep respect and appreciation for the many contributions of our medical staff and will carefully consider this feedback as we work through next steps.”

How brilliant is that!!  Let me translate for you.  The first sentence is a bogus acknowledgement and means nothing. It is the famous “I hear you” line. The second sentence is intended to blow smoke up the doctors’ asses. The doctors are made to think, “Great. They get us.”  The third sentence is the old switcharoo whereupon they place the blame on something else, that being communication.  It takes the attention off the CEO whom the majority of doctors hate and places it on an inanimate object.  It is also another acknowledgement that they “hear” the doctors and they are really racking their brains to fix everything.  This is all a set up.

Exhibit #2: Central Maine Healthcare board backs CEO on 8/1

This article came out ONE DAY LATER! Good thing they really thought about things.

  • “The board’s action is guided by our fiduciary responsibility to CMH and its mission, meaning that it is our responsibility as board members to act in the best long-term interests of CMH including ensuring that it remains financially viable,” Avasthi wrote.
  • She said the board also agreed to add more doctors to the board and to allow seats for the chiefs of staff of Bridgton Hospital, Rumford Hospital and Central Maine Medical Center in Lewiston. It also agreed to create a joint council composed of senior leadership, board members and hospital medical staff in an effort to improve communication among those groups.
  • “We believe these are significant changes providing the medical staff substantial input into governance of the system,” the memo read. “In addition, the board will continue our engagement with an independent consulting physician to monitor and update the board on physician feedback.”
  • “We have heard the concerns and frustration voiced by some,” she wrote. “We recognize that this has been a tumultuous time. We know that these concerns are voiced out of dedication to your work, your patients and your hospital.”
  • “We also recognize that it is a difficult time in health care, particularly for community hospitals. We must adapt to ensure the long-term viability of the system and that means change — sometimes difficult change.”

Let’s translate.  The first sentence means the obvious.  Fiduciary = money. The second proclamation is a peace offering that, once again, means nothing.  They are just placating the doctors.  The third sentence uses big words like “governance” and “engagement” to confuse the physicians. I have mocked the term “engagement” for years as it is a garbage term that no one understands.

I do like the idea of a pro-physician consultant but most, if not every, consultant is pro-administration and the doctors can smell a rat immediately.   The last two sentences are great because they use the cliche “I hear you” and throw in the old “recognize the tumultuous time”, which is music to my ears.  They are almost a caricature of someone spoofing administrators.  They finish it off with the cherry on top by closing with “and that means change — sometimes difficult change”. Perfect.

This whole thing is textbook ADMINISTRALIAN.  I coined this term for the Placebo Journal years ago because it is pervasive in this industry.  These two articles prove it.  Hardly any doctor likes this CEO, yet the board keeps him and their statements show they are playing one big shell game trying to confuse anyone trying to follow along.  Do they think doctors won’t see through this?  I guarantee that any doctor who was on the fence about leaving this system will be leaving now.  It will also make it very hard for patients in that area of Maine.  This is the saddest part.

Now for some fun facts.  Two of the hospitals voted unaminously in the no-confidence.  The third, and biggest hospital, had a 6 hour meeting where those physicians standing up pleaded for anonymity in case the CEO was not fired.   He wasn’t.  The vote went 100-66 against the CEO. How scared are some of these 100 doctors now because I guarantee some of these 66 will snitch?   Oh, and which doctors do you think will be chosen for those board seats? I bet it won’t be one of those 100.

Good luck recruiting doctors to this hospital.  Maybe they will just replace them all with MLPs?

All in all, the Administralian used here was a case study that could be taught for generations to come.  Lastly, it shows how little the opinion of the medical staff means to the powers that be.  Isn’t it about time this changes?

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] 

  7 comments for “Full Metal Administralian: The Language of Distraction

  1. Dick Carlson
    August 11, 2018 at 2:10 pm

    There is no communication problem. The doctors hate the CEO and communicated that very, very clearly.

  2. Elizabeth Latimer
    August 5, 2018 at 6:12 pm

    This was entirely predictable and is occurring all over the country.

    The c suite is a product of their training, cut costs and expenses at any price to become profitable.

    The Doctors are trained to take care of their patients at any cost.

    There is no middle ground and the Doctors seem to have forgotten that they have all the power. Don’t write any orders for anything unless it would put a patient in danger.

    The CEO’s can’t write orders.

    I’m happy to be in private practice.

  3. Terri
    August 5, 2018 at 8:57 am

    I used to work in a large hospital system that periodically hired consultants to help make us more profitable and more efficient. Each time they would rearrange administrative staff into some new organizational chart and make recommendations that ALWAYS made my job more burdensome. Then the consultants got paid a giant consulting fee, left the building and nothing really changed for the better. In my next life, I want to come back as a healthcare consultant!

  4. Mario Villegas
    August 5, 2018 at 7:45 am

    Please correct me if I’m wrong. First they do away with private practice. Essentially taking away a doctors “base” and by extension fiduciary power. Then they, in essence, make doctors employees. So the only leverage we have is our “services” that require extensive training. First they offer to support our training, making the training facilities dependent. Now they block any further training by controlling money. Creating a crisis of physician shortage. By encouraging and supporting lesser trained, inadequate shitty care, MLPs they essential take away our training to traditions. I found out that there is now a “Department of social medicine” in universities. I need a tinfoil hat…..

  5. August 5, 2018 at 6:50 am

    Hospitals – horse and buggy industry trying to take over outpatient services before they shrink.

    We spent 32% of 2016 health dollars on these appx 5500 businesses.

    • Susan
      August 5, 2018 at 9:27 am

      Dr Kordonowy,
      You are so right!

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