No one should be rude to anyone. We should certainly treat administrators with respect and courtesy. At that same time, it is not wise to assume that the work administrators do is valuable and necessary. It may be that we create more problems than we solve with some (not necessarily all) of the bureaucratic and administrative infrastructure of medicine.
Your post could not have come at a more timely moment. Thank you for your honesty and openness. I like many other physicians and practitioners commenting on this post also have had my fair share of frustration with hospital and medical admin. Unfortunately this is leading to a higher rate of burnout. I am only 4 years Post fellowship and I am already burning out. Mainly the problem seems to come from administrators and even physician department heads who are acting primarily in the interest of revenue or their own specialty perspective.
I am a relatively recently trained epileptologist (neurologist specializing in seizures). To the surprise and dismay of myself and other "fresh out of fellowship" new providers, we are finding challenges being told how to take care of patients 1) by people not trained in our field (our department head is a neurosurgeon who has told me when a continuous EEG should be indicated....), 2) having expectations to administer expensive treatments to boost revenue against our preferred practices and judgement (I e. Aducanumab) 3) base expectations on patient care from retiring or retired "senior" providers whose standard of care and practices never left the 1970s. (Ok that last one was a bit harsh but I get tired explaining why I get so many EEGs for my patients who carry a diagnosis of "petite mal" epilepsy at age 20, now 20 years later are still on phenytoin...).
So rant aside, thank you for your honesty. I wish more admin were like you. Thank you for helping remind us to respect, be grateful and appreciate your work! I hope that we physicians can also have some respect that our clinical knowledge may be helpful too. (Oh and by the way, always call me by my first name. To paraphrase Crush the Turtle from Finding Nemo: "Dr Valenti is my father."
As a physician leader responsible for employee health in our system I feel your pain, Rebecca. I get to experience both sides of the coin, and I am regularly embarrassed when my peers behave badly. We should all be able to work together and do what is needed to make the system work. I enjoy all of the administrators I work with and appreciate the work you do - and I also truly appreciate all that my executive assistant does to make my life easier.
As a retired hospice nurse, I can agree with everything you said. I worked in the worst and the best places - homes of people who could barely pay their rent and those of the affluent and powerful. Everyone Poops - not only a great children's book, but very true as well. We clean them up, put fresh clothes on them and make sure they are comfortable, then head over to the next assisted living or home. Time spent training is worthwhile. Time spent in useless and pointless meetings is not, and takes away from what is important - patient care. Bureaucracy exists everywhere and each bureaucrat has to justify their existence somehow - but don't mess with the jobs we do without good cause, because we do the good work, the hard work of helping people to feel the best they can, or, in the case of hospice, to have the best death they can have.
I might be tempted, but (of course!) I wouldn't suggest that Ms. Silverman wrote the perfect response to he essay: "There are parts of all our jobs that are annoying or 'below us.'"
Thank you for this post, Rebecca. While I appreciate the content of many of Vinay's posts, I often find the polarizing language off-putting. Yes, there is plenty of crap to be angry about, but I don't think insulting whole categories of people, whether hospital adminstrators or publich health physicians, moves us in the direction we need to go.
Ms. Silverman: Step 1, don't call doctors "providers." You may think the fact they bristle at that is silly, or inappropriate. But it is a fact of life that most of them hate it. Heck, many NPs and PAs don't much care for it, either.
I do think, though, this misstep is indicative of a general theme: The administrators who sail the ship of our health care system are out of touch with general sentiment. I mean, they know what people think. But they don't really believe it.
So in that sense, I do think there is a respect gap. But not in the way you've described.
That said, you're right that we should all be kind to one another. Lord knows there are too many people that don't do this.
Please suggest an acceptable term that encompasses MDs, DOs, PAs and NPs, and sometimes nurses (not that we are a set of vowels!). I firmly believe in distinguishing these roles clinically in loud and certain terms. But for the sake of rules that apply to us as a group—such as annual federally mandated training—we do need an umbrella term. If you do not agree with umbrella terms, then “administrators” would also be inappropriate.
The term I use for that is "clinicians." Which, itself, has been met with the occasional frosty glare from a subset of physicians. But it isn't "providers," and LORD do they hate "providers"!
Ultimately, what the last few years have taught me, is that bureaucracy and "admin" has given themselves massive bloat and are ultimately ANTI health and ANTI democratic.
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”.
To a degree. Charting isn’t directly part of the “human journey” of medicine, but at least aspirationally it is more directly related than many administrative tasks. Good charting actually helps communicate the patient’s history and their diagnostic journey to date so that others taking care of them can do a good job. But frankly, this is far and away the smaller part of charting that needs to be done these days. Most of it is bloated, and actually actively impedes looking after the patient.
I completely agree—but the administrators cannot fix this problem—yet they are responsible for enforcing compliance so that the facility is able to bill for provided services. Hoping for new solutions!
Yes. Like I mentioned originally a lot of the frustration directed towards administration comes from the sense that, even if they are not responsible for making the rules, the enforcement of them feels like collaboration with an occupying force.
My hospital in upstate New York, where I have worked for 40 years and established a reputation as an outstanding surgeon, was recently taken over by the local university. They used the electronic medical records to eliminate my competition from their employed surgeons. When the referring physicians, now almost exclusively owned by the university, make a referral for a surgical specialist, my name doesn’t appear on their referral list. It can be found, but it takes a few more clicks on the computer that no one’s willing to do. At 70, they could’ve waited another year or two and I would’ve retired. But this is what my administrators did to me.
Thanks for this balancing perspective. I was one who responded to the first piece by pointing out that many administers don't understand the 'rough' experiences of bedside practice. And this lack of understanding is a problem. But of course, there are two sides to every coin, and I am glad this other perspective is shared here (with great rhetorical skill I would say), and I entirely endorse this perspective.
BTW - During my career I worked on both sides of this 'divide', and I wish that I had brought up something like what has been shared in today's essay, and I certainly hope the division can be minimized. The discussion here can assist with that...
Thank you for a valuable reminder to all of us with a bit of blood on our lab coats. Great perspective! Very well written look into an office which seems like a mystery to many of us.
No one should be rude to anyone. We should certainly treat administrators with respect and courtesy. At that same time, it is not wise to assume that the work administrators do is valuable and necessary. It may be that we create more problems than we solve with some (not necessarily all) of the bureaucratic and administrative infrastructure of medicine.
Your post could not have come at a more timely moment. Thank you for your honesty and openness. I like many other physicians and practitioners commenting on this post also have had my fair share of frustration with hospital and medical admin. Unfortunately this is leading to a higher rate of burnout. I am only 4 years Post fellowship and I am already burning out. Mainly the problem seems to come from administrators and even physician department heads who are acting primarily in the interest of revenue or their own specialty perspective.
I am a relatively recently trained epileptologist (neurologist specializing in seizures). To the surprise and dismay of myself and other "fresh out of fellowship" new providers, we are finding challenges being told how to take care of patients 1) by people not trained in our field (our department head is a neurosurgeon who has told me when a continuous EEG should be indicated....), 2) having expectations to administer expensive treatments to boost revenue against our preferred practices and judgement (I e. Aducanumab) 3) base expectations on patient care from retiring or retired "senior" providers whose standard of care and practices never left the 1970s. (Ok that last one was a bit harsh but I get tired explaining why I get so many EEGs for my patients who carry a diagnosis of "petite mal" epilepsy at age 20, now 20 years later are still on phenytoin...).
So rant aside, thank you for your honesty. I wish more admin were like you. Thank you for helping remind us to respect, be grateful and appreciate your work! I hope that we physicians can also have some respect that our clinical knowledge may be helpful too. (Oh and by the way, always call me by my first name. To paraphrase Crush the Turtle from Finding Nemo: "Dr Valenti is my father."
Find me an administrator that only triples my non-clinical responsibilities, and I’ll kiss his/her feet.
I’m a doctor and I love your post.
As a physician leader responsible for employee health in our system I feel your pain, Rebecca. I get to experience both sides of the coin, and I am regularly embarrassed when my peers behave badly. We should all be able to work together and do what is needed to make the system work. I enjoy all of the administrators I work with and appreciate the work you do - and I also truly appreciate all that my executive assistant does to make my life easier.
As a retired hospice nurse, I can agree with everything you said. I worked in the worst and the best places - homes of people who could barely pay their rent and those of the affluent and powerful. Everyone Poops - not only a great children's book, but very true as well. We clean them up, put fresh clothes on them and make sure they are comfortable, then head over to the next assisted living or home. Time spent training is worthwhile. Time spent in useless and pointless meetings is not, and takes away from what is important - patient care. Bureaucracy exists everywhere and each bureaucrat has to justify their existence somehow - but don't mess with the jobs we do without good cause, because we do the good work, the hard work of helping people to feel the best they can, or, in the case of hospice, to have the best death they can have.
I might be tempted, but (of course!) I wouldn't suggest that Ms. Silverman wrote the perfect response to he essay: "There are parts of all our jobs that are annoying or 'below us.'"
Thank you for this post, Rebecca. While I appreciate the content of many of Vinay's posts, I often find the polarizing language off-putting. Yes, there is plenty of crap to be angry about, but I don't think insulting whole categories of people, whether hospital adminstrators or publich health physicians, moves us in the direction we need to go.
Ms. Silverman: Step 1, don't call doctors "providers." You may think the fact they bristle at that is silly, or inappropriate. But it is a fact of life that most of them hate it. Heck, many NPs and PAs don't much care for it, either.
I do think, though, this misstep is indicative of a general theme: The administrators who sail the ship of our health care system are out of touch with general sentiment. I mean, they know what people think. But they don't really believe it.
So in that sense, I do think there is a respect gap. But not in the way you've described.
That said, you're right that we should all be kind to one another. Lord knows there are too many people that don't do this.
Please suggest an acceptable term that encompasses MDs, DOs, PAs and NPs, and sometimes nurses (not that we are a set of vowels!). I firmly believe in distinguishing these roles clinically in loud and certain terms. But for the sake of rules that apply to us as a group—such as annual federally mandated training—we do need an umbrella term. If you do not agree with umbrella terms, then “administrators” would also be inappropriate.
Thanks for the kindness.
The term I use for that is "clinicians." Which, itself, has been met with the occasional frosty glare from a subset of physicians. But it isn't "providers," and LORD do they hate "providers"!
Love that this was published. Yes to free speech.
Ultimately, what the last few years have taught me, is that bureaucracy and "admin" has given themselves massive bloat and are ultimately ANTI health and ANTI democratic.
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”.
Same applies to chart completion?
To a degree. Charting isn’t directly part of the “human journey” of medicine, but at least aspirationally it is more directly related than many administrative tasks. Good charting actually helps communicate the patient’s history and their diagnostic journey to date so that others taking care of them can do a good job. But frankly, this is far and away the smaller part of charting that needs to be done these days. Most of it is bloated, and actually actively impedes looking after the patient.
I completely agree—but the administrators cannot fix this problem—yet they are responsible for enforcing compliance so that the facility is able to bill for provided services. Hoping for new solutions!
Yes. Like I mentioned originally a lot of the frustration directed towards administration comes from the sense that, even if they are not responsible for making the rules, the enforcement of them feels like collaboration with an occupying force.
My hospital in upstate New York, where I have worked for 40 years and established a reputation as an outstanding surgeon, was recently taken over by the local university. They used the electronic medical records to eliminate my competition from their employed surgeons. When the referring physicians, now almost exclusively owned by the university, make a referral for a surgical specialist, my name doesn’t appear on their referral list. It can be found, but it takes a few more clicks on the computer that no one’s willing to do. At 70, they could’ve waited another year or two and I would’ve retired. But this is what my administrators did to me.
AMEN. Sing it, sister!!!
Thanks for this balancing perspective. I was one who responded to the first piece by pointing out that many administers don't understand the 'rough' experiences of bedside practice. And this lack of understanding is a problem. But of course, there are two sides to every coin, and I am glad this other perspective is shared here (with great rhetorical skill I would say), and I entirely endorse this perspective.
BTW - During my career I worked on both sides of this 'divide', and I wish that I had brought up something like what has been shared in today's essay, and I certainly hope the division can be minimized. The discussion here can assist with that...
Thank you for a valuable reminder to all of us with a bit of blood on our lab coats. Great perspective! Very well written look into an office which seems like a mystery to many of us.