Spreadsheets, Meetings, Lunches, and Paychecks
Regular readers of Sensible Medicine will understand that this post by Rebecca Silverman needs no introduction.
Adam Cifu
Every 5-7 years, we each have to renew our licenses and passports, take our cars for inspections, replace major home appliances, or hire a contractor to fix a broken pipe. These tasks are usually annoying, and possibly redundant, but necessary to keep your legal standing/cars/home functional. These types of things exist in our jobs, too; everyone has tasks in the office that they feel are “beneath them.” However, if I complained to my colleagues that I had to do normal hospital things and, further, noted that I resented these same colleagues because my proximity to bodily fluids makes my job nobler than theirs, no one would want to work with me. I may even get put on a performance improvement plan for my negative attitude. The fact that we tolerate this behavior from physicians and not from staff highlights a respect gap.
When I first started working in medical education, I was trained to refer to all physicians by “Doctor Lastname;” I was trained to be gracious even when they did not respond to my third email that said “Response Needed” in the subject line; they may be dealing with true life-or-death situations, I was told. I was trained not to complain when they were busy even though their calendar said they were available; because, of course, they did not keep their clinic hours on their Outlook calendar. I learned to respect the hierarchy of professorships and ensure every physician’s title and degrees were correct on every posting.
Do doctors learn our degrees, where we studied, what our specialties are, why we chose to work in healthcare?
We administrators are here to work WITH you, not against you. We actively pursued jobs at hospitals and medical centers because we wanted to affect patient care without being a physician. And we do—we implement new digital health tools, we ensure our quality ratings stay competitive enough to draw in new patients and earn incentive dollars, we manage your paychecks, run your residency programs, create all the materials for board meetings, and implement EHR efficiencies. We know more about hospital governance than most doctors do. Sure, sometimes we ask you to do a fit test. (That is a federal regulation, and if your patients cannot survive while you do one, that’s a larger problem that your hospital needs to address.)
There are parts of all our jobs that are annoying or “below us”; we deal with them because we are adults. We do not adopt a holier-than-thou tone with our colleagues, because medicine is a team sport and we are all on the same team. We accept the parts of our job that are “not at the top of our license,” because they usually require minor amounts of time and do not take much brainpower. We can be annoyed that some people we work with do not know our patients as well as we do and might have opinions on patient care that differ from ours. We use these annoyances as opportunities for learning and discussion. We can roll our eyes at some of the bureaucratic inefficiencies that come with running a large organization, but we can also feel a sense of pride that we are ultimately helping our patients.
The providers who make my job harder and make me feel useless insinuate that we administrators follow rules blindly, as if someone like me were part of a herd of sheep and not an adult with a master’s degree. It might be true that an empire of people who don't touch blood, shit, piss, or pus is being built, though I find that hard to believe during an era of “reductions in force” and budget cuts. I admit that I don’t want to touch those bodily fluids. However, I touch other nasty things that the doctors I work with find repulsive but are essential for running hospitals: spreadsheets, slide show drafts, data requests, Grand Rounds lunch orders, notes that haven’t been signed for a month, the inboxes of stubborn doctors who cannot seem to make time for the simplest of administrative asks required by OSHA.
The physicians with whom I enjoy working treat me like a partner instead of an antagonist: they thank me for setting up a meeting (an especially hard task when it involves finding shared free time between five providers with mirrored clinic schedules), praise my attention to detail, appreciate a spreadsheet I put together that shows them the data they requested, or a slide show that flatters their work. They know that I am a helpful part of their team, and treat me like an equal, even when I only have a sense of what their patients are going through. They teach me things about their job in a way that is illuminating and gracious, and are not resentful that I do not know every facet of their life in patient care.
I love most of the doctors I work with. But there are a few who lack humility for their closest administrative partners while actively preaching humility for their patients. Our health systems would be kinder workplaces if that changed.
Rebecca S. Silverman has worked in undergraduate, graduate, and continuing medical education over the past decade at an academic medical center. She has a Master’s in Public Health. If you want to know, she studied English at Washington University in St. Louis and public health at the University of Illinois – Chicago.
Photo Credit: Romain Dancre
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Well-written article - and reveals a heart in the right place. I’ve no doubt that Ms Silverman would be a great administrator to work with.
However, I must say that this reply to Dr Prasad seems deaf to what he is really saying, or to the spirit behind his complaint. Ms Silverman uses platitudes like “medicine is a team sport” to convey the impression that physicians (and nurses, and other people involved in direct patient care) and administration are all doing the same thing, and that thing is called “medicine”. But that misses the point entirely. Administrators, for all the good they may do (or not), are simply not practicing medicine! At its core, medicine is a covenant between physician and patient, between someone whose vocation is (or ought to be) health and healing, and someone who is ill. It is beyond guidelines and metrics. It is a human journey undertaken together. I cannot imagine something more inimical to spreadsheets and PowerPoint decks.
It’s true that in today’s environment, administrators do necessary and important work. But it’s well documented that the metastasizing of these administrative tasks into the physician workday is a leading cause of burnout. So while it may be true that many of the tasks Ms Silverman is reminding physicians to do are federally or otherwise mandated, that doesn’t negate the fact that’s it’s deeply frustrating to have them force themselves into the practice of medicine, nor is it surprising that it breeds frustration directed from clinicians towards the enforcers of these rules, even if the administrator in question did not create them. To put it somewhat bluntly, when an administrator chases after a physician to get them to complete “even the simplest administrative tasks mandated by OSHA”, even with the best of intentions, the administrator risks being seen as a collaborator of an occupying force rather than a “team member”.
"The providers who make my job harder and make me feel useless insinuate that we administrators follow rules blindly, as if someone like me were part of a herd of sheep and not an adult with a master’s degree."
While I appreciate this perspective might I add my physician perspective. Before the take over of health care by corporate, mostly nonprofit, medical behemoths, we had hospital administrator that worked with physicians not CEO's. I'm not real sure why being called a hospital administrator was so degrading that we had to get rid of this term but we did.
Now instead of working with we are being told. The whole focus as I see it is on control. Control is even more important than the second most important goal which is profit. And I'm not talking legitimate profit I am talking lewd levels of profit.
If this change came with better access to care, efficiency, and most importantly improved health/life expectancy I would be more accepting.
But instead of the old way, in which we focused on patient care, and rules/regs from govt were not our primary focus now they are our only focus. Yes we followed rules in the past but we did not have rules be more important than patient care, taking all of our resources before the patient was even looked at. We tried not to read into every regulation and make up new ones we thought were in the regs just not clear and we create incredible rule bloat. We also take many incredible direct patient care nurses, allied health providers and doctors and have them doing jobs such as "safety officer". This used to be a position you were assigned if one didn't show up for a meeting as an add on responsibility. But now we take from direct patient care highly educated personnel, put them in this job and they have us doing fire drills. I actually think some of these people feel guilty they don't have more to do so they make up stuff to do that takes us away from patient care.
CEO's should be tackling the hard problems, like making EPIC work better. But no this is hard and we don't like hard.
So what do, we make up problems that don't exist and we fix them and claim success.
I do not feel, as the article stated, that administration follows rules blindly. No they follow the rules as this is easy and familiar. Fixing/improving EPIC is unfamiliar and hard.
My final comment on this is motivation. I know very few Doctors that went into medicine to make money. Yes we want to be comfortable but if we wanted to make money we would have gone into business and become an MBA. Hmmmmmm...... UH oh...... We are F'ed.