Pretend I’m a Hospital Administrator
Reading my posts on this blog and the anti-hospital administrator posts I follow on Twitter (before it totally collapses in a few days), you would think I have no respect for hospital administration. Hospital administrators tend to look at me, listen to my comments and see my cartoons and say things like “I really respect you… I really do,” which is what you say when you really hate someone and wish they were dead or gone.
In a previous life, more than two decades ago, I found myself as a physician “department head,” with the task of helping to run a large physician group of many specialties. It was a nightmare and it led me to leave the group and start out on my own.
Here are the things administrators did which made it a nightmare:
- They never spoke English. I joke about administration speak, but they really have a different language.
https://youtu.be/NIQZywd3bng
https://youtu.be/7kCraXH6umw
2. Major changes are made at a clinic site, administrators rarely visit the workspace for more than a few minutes. More often than not, significant changes create huge chaos and dissatisfaction for doctors, staff and patients. Administrators rarely even poke their head in to say “hello” and they are shocked to hear, months later, the place is not running well. When a group of doctors or staff complain, the response is: “Oh my! That’s the first I’ve heard of that!” If you never look, you will never see things.
3. When a doctor is not performing well, either from a quality of care standpoint or due to poor productivity, administration tends to make excuses to avoid early direct doctor feedback. I don’t blame them. These are often not good discussions. I would rather eat doughnuts at some boring meeting. This means bad habits for new hires become more developed and problems grow to ugly proportions before they are addressed. Instead of trying to guide someone, the interaction turns more confrontational.
4. All systems have parts that need frequent monitoring and maintenance. Administrators need to leave their meetings and personally get out and wander the floors every day.
5. When a doctor brings up a problem and asks it be addressed, stop acting like the doctor is the problem.
Here are things doctors do that make management a nightmare:
- You, the doctor, cannot have ten assistants to help you. Sure, your job will go easier, but you don’t bring in enough money to support such a thing. You’ll get one assistant and you might have to share the person. Deal with it.
2. Sign your notes off on the same day you see the patient. When you wait and do it days later, you wreck everyone else’s ability to help you when patients call. Handle the refills on the same day. Return calls the same day. It’s a pain, but it is also your job! When you leave it for days later, everyone around you gets burned out.
3. You do understand basic business principles in healthcare, right? That means, you charge $100 for a visit, but insurance pays $80 or less. Half of that is $40 and it goes to pay your building and staff. That leaves $40 to cover your pay, insurance, etc. If you are not very productive and see fewer patients, that number, after expenses, may be quite a bit less. In other words, you have to pay for your overhead first. The fraction of your overhead will go down as you become more productive. Maybe you will get $60 for the visit if you work hard. But, if you don’t work enough, you may actually get $0. Math is important!
4. Yes, the hospital makes money by having you on staff and sending patients to them for testing. So… Guess what! The hospital would get those patients anyway if you were in private practice. Yep! You’re not so valuable after all.
5. Insurance and patients can be very frustrating. Requested tests may bounce back as unapproved. Find a legitimate diagnosis code and try again. If you really believe in your plan of care, do the peer review and try to be logical and reasonable.
Drugs require prior auth work. It’s a nightmare. It’s not your employer’s fault. Deal with it. If you ignore the extra work, either patients get billed and sent to collections or care is simply not delivered.
6. If you don’t see “X” number of patients a day with a level of care code of at least “XXX”, you don’t bring in enough money to justify your presence. Yes, you need to work hard. Deal with it because we can’t keep subsidizing you. You want to spend an hour with every patient visit? That’s nice but you won’t succeed as an employed physician. Go set up your own practice and see how the numbers run. Yes, you want it and you gave an inspiring speech to try and get it, but “You can’t have it!”
7. When you say: “I am working so hard! I am trying so hard!’, step back and think for a while because maybe you really aren’t.
Both sides have to work together. Administrators and doctors are from different planets. We don’t have to be friends.
Well written.
After many years in healthcare administration, I’ve found upper administration is only interested in the bottom line….profits!!
Satisfaction among physicians, staff and patients isn’t a high priority.
Quality and continuity of care has been compromised by replacing physicians with non-physician providers who just don’t have the skill sets and talent. They’re cheaper to hire, that’s all!
Insurance companies gave a stranglehold on healthcare. Clerks are overriding decisions made by physicians and patients suffer.
Healthcare is imploding and there’s no relief in sight!!