Wondrous Elasticity: The Bottomless Pit That Is Doctors’ Good Will And How Administrators Are Exploiting It

Wondrous Elasticity: The Bottomless Pit That Is Doctors’ Good Will And How Administrators Are Exploiting It


Leonard Zwelling

When two doctors who I respect immensely both refer me to the same op-ed piece in The New York Times, you know it has got to be important.

This happened over the weekend of June 10 when the above article appeared in the Sunday Review section of the paper.

In short, the question raised is are the administrators who have taken control of American medicine using the good will and altruism of the dedicated professional doctors and nurses in their systems as a means of having a never ending reservoir of work for free and increasing their profits?

The short answer is: you bet!

In essence, nurses first and doctors second have been asked to do more work without a commensurate increase in personal or professional resources while the resources dedicated to administration have increased dramatically. According to the article, the number of administrators in medicine has increased 3200 percent from 1975 to 2010. The major argument made to solve this problem is to decrease the number of administrators and increase the number of caregivers. What a concept!

I have been an advocate of this strategy at MD Anderson since I was one of those administrators. I knew what I was supposed to do when I was asked to serve on the “dark side.” Drs. Mendelsohn, Hohn and Kripke had made their wishes quite clear with regard to the need for increased efficiency in research administration and a shortening of the cycle between the time a clinical research protocol is thought up and when it is activated. They wanted grants to be submitted to funding agencies faster with less review time at the institution. We had great numbers to prove we had done just that and had done it using alternative revenue streams (charging big pharma for using our protocol approval system) to pay for the office.

I truly believe that there are literally thousands of people working at Anderson right now who do not add value to the patient care, education or research yet are amply rewarded in their paychecks. Contrary to accepted wisdom, everyone is not MD Anderson.

I continue to believe that a wholesale institution-wide review of the administrative burden to the bottom line and to the faculty is in order and cannot happen soon enough. New president; new opportunity.

There is no place where this unbalance of physician work and reward is more obvious than in the use of the electronic medical record. The EMR has essentially burdened all of the caregivers with the role of clerk and billing officer for the leaders of the institution. There can be no question that the concept of having a permanent and easily accessible record of all patient encounters is a great one, but not at the expense of the physicians and nurses serving as scribes and coders and billers for the coders and billers already on the payroll.

American medicine has for a long time assumed that whatever necessary work that is generated by the sicker patients, more complicated diseases, and greater array of diagnostic testing that new knowledge creates, doctors and nurses will, as the article says, suck it up and do the work. It is time for this to end and for doctors and nurses to take back control of medicine for the good of their own sanity and for the well being of their patients.

The remaining question is how. Either there needs to be a careful assessment of the need for all of this administrative bloat and to rid institutions of that bloat in favor of more direct patient care personnel or the docs and nurses will have to stop sucking it up and have white flu to echo blue flu.

If you have ever seen the MD Anderson clinics on Sunday, you know that there is nothing to see. Only emergency care is provided on the weekends, for the most part. Well, do that on Wednesday one week and see what happens. I have been an advocate for this as a means to stop the administrative bloat, redo the EMR to service the faculty, nurses and patients, and look hard at the role of lawyers, compliance personnel and HR in the running of the cancer center.

One of my friends who sent me the article asked what would I do?

My answer is from one of my favorite movies, Brian DePalma’s The Untouchables, when Sean Connery says to Kevin Costner, “What are you prepared to do Mr. Ness?”

Doctor, what are you prepared to do? No one is going to do it for you.

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