Large hospital groups, as a physician employed in one, are barely trudging on. Our hospital was recently acquired by a large conglomerate and it added an entire new layer of bureaucracy headquartered in a city 200 miles away.
Not a single local administrator was fired, they just had another layer added on top. Meanw…
Large hospital groups, as a physician employed in one, are barely trudging on. Our hospital was recently acquired by a large conglomerate and it added an entire new layer of bureaucracy headquartered in a city 200 miles away.
Not a single local administrator was fired, they just had another layer added on top. Meanwhile, the bedside is collapsing. Rules created by medicare administrators and enforced by regional and local administrators means patients die of infections we are not allowed to treat, lest the administrators are angry. Rules placed by billing departments means doctors can no longer tell NPs/PAs that what they're doing is wrong/harmful, because the only real harmful thing in a hospital is violating an administrator's rules. Death, life, outcomes? Matters not.
I hear 50-60% of our hospitalists are refreshing their CVs. Meanwhile the CEO sent an email saying the hospital group had a 5,000,000$ loss instead of a 2,000,000$ profit (how a system with 5,000 beds has such tight margins, I don't know.) What did the CEO blame? 'Staff pay'.
Doctors and nurses saw the writing on the wall. Smaller hospitals are paying triple.
That is horrifying, and interesting. Because this is an instance where clearly economies of scale should work, but by our insistence on added bureaucracy we have overcome its benefits.!
Entire specialties have been degraded by regulatory bodies attempting to enforce algorithmic monotony. Cardiology has been turned into the most algorithmic field, and the poor outcomes are visible.
They created a nice algorithm with debatable evidence and presented it as fact. Then they unleashed an army of NPs/PAs and told them the algorithm is gospel. My core memory now that I exceed my first year practicing medicine in the US is my MD/pHD boss getting told by a Nurse Practitioner she knows more medicine than him as she confidently applied the algorithm he tried to get her to back off from. As expected, patient had a stroke.
In my big hospital? No recourse. Heck, the cardiologists who 'oversee' the NP lament not being able to discipline her because it has to go through an army of administrators who think they know medicine better than doctors. (Everyone knows medicine better than us, it seems).
In a small hospital? Discipline is at the bedside, not in an HR office. When systems outweigh the individual in a hospital, people die. (Also when the individual outweighs the system, to be fair) You need a very finely tuned balance.
It gets worse. Productive members of the organization are locked out of these meetings, which are by nature non-productive.
Our hospital has a private pulm/crit group that they contract. These docs work 12 hours a day for 6 weeks; with only 4 days off total. They're paid handsomely for this work, but the hours are still insane. One of the doctors in that group also makes a point to sit on a bunch of committees to have the ICU's voice heard. He says if he didn't spend these 2-3 hours a day, the ICU would get destroyed by admin.
This is the ICU that is forbidden from doing basic ICU stuff by administrators leading to poorer outcomes. A represented one. A non-represented ICU likely does worse. I asked the good doc how he has time to do all this crap, and he matter of factly answered 'Some things I have to sacrifice, like sleep'. A 49 year old man who I mistook for a 60 year old.
I'd also add hospitals.
Large hospital groups, as a physician employed in one, are barely trudging on. Our hospital was recently acquired by a large conglomerate and it added an entire new layer of bureaucracy headquartered in a city 200 miles away.
Not a single local administrator was fired, they just had another layer added on top. Meanwhile, the bedside is collapsing. Rules created by medicare administrators and enforced by regional and local administrators means patients die of infections we are not allowed to treat, lest the administrators are angry. Rules placed by billing departments means doctors can no longer tell NPs/PAs that what they're doing is wrong/harmful, because the only real harmful thing in a hospital is violating an administrator's rules. Death, life, outcomes? Matters not.
I hear 50-60% of our hospitalists are refreshing their CVs. Meanwhile the CEO sent an email saying the hospital group had a 5,000,000$ loss instead of a 2,000,000$ profit (how a system with 5,000 beds has such tight margins, I don't know.) What did the CEO blame? 'Staff pay'.
Doctors and nurses saw the writing on the wall. Smaller hospitals are paying triple.
That is horrifying, and interesting. Because this is an instance where clearly economies of scale should work, but by our insistence on added bureaucracy we have overcome its benefits.!
They absolutely don't work; not in medicine.
Entire specialties have been degraded by regulatory bodies attempting to enforce algorithmic monotony. Cardiology has been turned into the most algorithmic field, and the poor outcomes are visible.
They created a nice algorithm with debatable evidence and presented it as fact. Then they unleashed an army of NPs/PAs and told them the algorithm is gospel. My core memory now that I exceed my first year practicing medicine in the US is my MD/pHD boss getting told by a Nurse Practitioner she knows more medicine than him as she confidently applied the algorithm he tried to get her to back off from. As expected, patient had a stroke.
In my big hospital? No recourse. Heck, the cardiologists who 'oversee' the NP lament not being able to discipline her because it has to go through an army of administrators who think they know medicine better than doctors. (Everyone knows medicine better than us, it seems).
In a small hospital? Discipline is at the bedside, not in an HR office. When systems outweigh the individual in a hospital, people die. (Also when the individual outweighs the system, to be fair) You need a very finely tuned balance.
Algorithmic monotony is a great phrase
It gets worse. Productive members of the organization are locked out of these meetings, which are by nature non-productive.
Our hospital has a private pulm/crit group that they contract. These docs work 12 hours a day for 6 weeks; with only 4 days off total. They're paid handsomely for this work, but the hours are still insane. One of the doctors in that group also makes a point to sit on a bunch of committees to have the ICU's voice heard. He says if he didn't spend these 2-3 hours a day, the ICU would get destroyed by admin.
This is the ICU that is forbidden from doing basic ICU stuff by administrators leading to poorer outcomes. A represented one. A non-represented ICU likely does worse. I asked the good doc how he has time to do all this crap, and he matter of factly answered 'Some things I have to sacrifice, like sleep'. A 49 year old man who I mistook for a 60 year old.