College Bureaucratic Bloat versus Hospital Bureaucratic Bloat

The title of the Wall Street Journal article caught my eye. It was a month-old edition that I didn’t get to read due to my vacation. As I was tossing the paper out something stopped me from throwing it in the bin. It was the title: “Stop Feeding College Bureaucratic Bloat“. The following paragraph says it all:

A 2014 analysis by the New England Center for Investigative Reporting found that from 1987 to 2012, the higher-education sector added more than half a million administrators. Their numbers have doubled relative to academic faculty. Financed in large part with federally subsidized tuition, this rise of administrators siphons money from the core functions of academic institutions. Colleges and universities have shifted teaching duties from full-time professors to part-time nontenured adjuncts who earn paltry wages.

Does the sound similar to you? Put in “medical system” for “higher-education sector” and see how that works. And put in “doctors” for “full-time professors” and “not doctors” for “part-time nontenured adjuncts”. It is eerily the same.

Here is another one:

Governance of academic institutions traditionally rested with the faculty, especially full-time tenured faculty. But the relative decline of faculty has shifted the balance of power toward administrators, who increasingly control academic policy.

It’s no accident that as they have hired more administrators, these institutions have veered toward indoctrination and censorious intrusions into speech, opinion and personal life. These heavy-handed policies are often incompatible with traditional educational ideals, such as academic freedom, freedom of speech, open-mindedness and dispassionate judgment. To be sure, many faculty support such policies, but the most consistent pressure for them typically comes from the administrative bureaucracy. Congress should recognize that its funding helped create this threat to education.

The author recommends the following as a fix:

When authorizing student loans, Congress should take into account the ratio of administrators to full-time tenured faculty. The amount of a student loan, and the interest rate payable on it, should come on a gently sliding scale dependent on the ratio of administrators to full-time tenured faculty at the institution that will benefit from the loan. 

This would be very interesting to do for hospital systems. I would love to have a proper ratio of doctors-to-administrators. Less administrators would force doctors into governing ourselves, which is what we want. Right now there is a 10-1 ratio. Why don’t we change that? Any thoughts on a number?

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 “College Bureaucratic Bloat versus Hospital Bureaucratic Bloat

  1. Dave
    July 6, 2019 at 4:45 pm

    What we need is a zero to one ratio! Docs back in control!
    And since that’s a wet dream….while we’re on the wish list, how about a cap on administrative salary!!! Even the highest up administrator should either make either: 1) no more than the highest paid physician, OR: 2) no more than 10 times the salary of the lowest paid hospital staff… yeah, I know, back on the wet dream bandwagon….

  2. Paul
    July 6, 2019 at 2:48 pm

    By extension, “threat to education”, the administrative bloat is a threat to our democracy when free speech at US college campuses is limited and students don’t learn to form arguments and debate skills in a constructive manner. I like your solution. Great notice Doug on the parallels with medicine. Btw, loved your appearance on zdog !

    • Douglas Farrago MD
      July 6, 2019 at 2:59 pm


  3. Rick
    July 6, 2019 at 2:36 pm

    A new term. I can’t keep track: the Academic-Industrial Complex.
    Yep Doug, it does mirror the Medical-Industrial Complex.
    The guys who know how to generate revenue discern where the cash is. Then they pilfer until there is nothing left. Like the “bust-out” of the sporting goods store in The Sopranos.

  4. Pat
    July 6, 2019 at 1:52 pm

    What do education and health care have in common?
    1) The majority of citizens think they have a right to both.
    2) Neither are appropriate areas for federal government involvement, and so…
    3) … both have gotten horribly expensive far beyond the rate of inflation.
    4) Both are being offered as “free” by those who claim spending more on each will make each more affordable.

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