The Rise of the Machine: How Hospital/Practice Administrators Have Assumed Control Over Healthcare

In the past, physicians were responsible for both the business and practice of medicine.  While administrative personnel played an important and complementary role in practice and hospital management, physicians were the cornerstone.  In comparison, today the leadership structure in medicine is now an entirely foreign landscape.  Administrators DOMINATE medical practices today and, according to the New York Times, their salaries are responsible for a high percentage of medical costs.  While the numbers of physicians that are entering the workforce has trended toward a constant number (with little or no growth) the numbers of administrators has risen nearly 3000 percent over the last 30 years.

growth in administrators

Certainly medicine has evolved into more of a business–Physicians that are well versed in business and understand the role of the physician executive are much more successful.  It is clear that there is a role for administrators–they are necessary to coordinate and support the clinical work of physicians and those in the hospital or practice.  However, now administrators have evolved into the overlords of medical practice and are now dictating how and when and where physicians and other healthcare providers work.  Most of these administrative overlords have zero relevant clinical knowledge or experience.

The rise of the administrators has further complicated the healthcare landscape during this period of reform.  The ACA has expanded the numbers of insured and has promised to provide affordable, accessible care for all Americans.  Unfortunately, declining reimbursement and increasing reams of meaningless paperwork, documentation and “core measures” [All created by administrators or legislators] have resulted in the development of a pending physician shortage crisis in the US today.  Much like the fictional SkyNet began to control the world in the Terminator movies thru atomization, administrators have assumed control of medicine and have begun to automize the art of medicine thru protocols and algorithms–all with a complete disregard for real clinical trial proven outcomes data.  As you see in the graphic above, the numbers of new medical students continues to remain steady—very little growth.  Bright young minds are choosing other professions.

So, you may ask, how are we going to provide care to the newly insured?

Administrators will suggest that cheaper and less well trained alternatives to physicians will be the answer.  In Minnesota, for example, Nurse practitioners are now allowed to practice independently without ANY physician oversight or supervision.  Minute clinics such as those hosted by CVS and others have spread throughout the nation.  These clinics have no physician presence and are expected to make clinical decisions based on protocols and algorithms. Now, physicians appear to be a cog in the wheel and must conform to the dictums of those in power.  NO longer are physicians autonomous scientific entrepreneurs.  Creativity in medicine has become suppressed and frowned upon by those in power.  We have become worker bees in the factory of the administrative overlords.  The evolution of the administrator driven practice has left me with more questions than answers—

What has happened to the “art” of medicine?  What about clinical intuition?  IF we are eliminating this component of care completely then why don’t we simply create an army of IBM Watson computers to deliver care at the direction of the “Administrators” ?

At this point in my career, I expect the practice environment to become increasingly hostile for doctors.  For example, just this week, Congress passed a “fix” to the Medicare reimbursement schedule in order to avert yet another 20% pay cut for services.  This “fix” rolls back the antiquated formula by which doctors are paid BUT it further empowers non clinical administrators (and politicians) to determine exactly how doctors should be reimbursed.  While adding payments based on Quality (which I think is certainly a great idea) it stops short of defining quality and will ultimately allow CMS and DHHS to determine what measures will be applied. I expect that these measures will remain clinically irrelevant and lead in no way to improved outcomes for patients.

Physicians must take a stand.  We must advocate for our patients and for our profession.  Medicine cannot survive and continue to innovate without committed, caring and compassionate physicians who are allowed to do what they do best–Practice Medicine.  We must retake control of healthcare and limit the scope of power of hospital and practice administrators.  Or, as Schwarzenegger says–it will be “Hasta la vista, Docs”

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6 responses to “The Rise of the Machine: How Hospital/Practice Administrators Have Assumed Control Over Healthcare

  1. Pingback: The Rise of the Machine: How Hospital/Practice Administrators Have Assumed Control Over Healthcare

    • Thanks so much for taking the time to read and respond to my post. It is essential that the “administrative” class be held to the same high standards as physicians I very much agree with your premise. For now, the administrators are being paid higher wages and the metrics by which they are judged have nothing to do with patient outcomes–only dollars–Physicians are left holding the bag–again.
      Best
      kevin

  2. Dr. Campbell, I am working on a similar blog post I would like to share with you in more detail. I am a PM&R physician in Utah. My premise is Healthcare administration does realize they are part of healthcare delivery in the patient, payer, provider/delivery model. They are contributing to sky rocketing cost. The saddest part is those dollars come straight from tax payer and patient pockets, no where else. Just as I may be penalized for ordering an expensive study or drug or not following “best practices”, administrators should be penalized for inefficient, expensive administrative practice. There needs to be “administrative” best practices if we are going to have “clinical” best practices or you are exactly right, we as docs will simply be implementers (not a word) of protocol. I love your post. We need to stand up for this, refuse to accept it and clean house. I feel educating the patients and public on this excessive waste is the first step. We need to swamp the press and social media with this. Along those lines comes the myth of population management. This will not save patients a dime, but rather put money straight into the pockets of payers and hospitals for the efforts of our patients to live a healthy lifestyle. This will also only serve to expand healthcare administration. It is self serving. Please contact me if you’d like to collaborate and I appreciate your post.

    • Thanks so much for taking the time to read and respond to my post. It is essential that the “administrative” class be held to the same high standards as physicians I very much agree with your premise. For now, the administrators are being paid higher wages and the metrics by which they are judged have nothing to do with patient outcomes–only dollars–Physicians are left holding the bag–again.
      Best
      kevin

  3. Cleveland C. Cleary, MD

    I have long thought that we let the AMA, our own organization, stop representing us to the insurance industry and government programs, and instead allowed the AMA to represent the insurance companies and government programs to us. I know others have felt the same and have quit the AMA in such numbers that only 13% or so of doctors are members. Yet everyone (but doctors) still think the AMA is or voice. The author here is correct, we need to stand up and say”NO” at tiems.

    • Thanks so much for taking the time to read and respond to my blog. The only way we are going to effect change is thru grassroots action. We must stand up to those who claim to represent the needs and interests of Physicians–ie the AMA and the ABIM.
      Best
      Kevin

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