The Cost of Waging War

 white and yellow flowers on green background 

“I need to hire another person to help with referrals. We just cannot keep up.”

It was true. 

To get a patient an appointment with a specialist requires multiple phone calls and faxes and flat out being pushy. It would be nice to be able to fax over a referral request and information and trust that the specialist offices would contact the patient, making the appropriate arrangements but that is not how it usually works. Not even hardly. More often than not it is more like waging war on that patient’s behalf. 

War requires soldiers.

“Ok. You should know that will put you above the recommended full time employee per physician recommendation. Here is how that will affect your salary.” He laid a single sheet of white paper down on the desk and turned it towards me. 

There was a jumble of numbers. 

Yeah, yeah, yeah….

I scanned down to the important part. There it was in black and white. My income would decrease by almost $40,000 by the time I was through paying for this employee’s salary and benefits. 

Still. It was the right thing to do.

Meanwhile, this man sitting before me was paid a salary by corporate (via the money that myself and all of the other practicing physicians and surgeons paid into the system) that approached $120,000. He was 27. He was fresh out of MBA school. The many people above him were making much, much more. This decision would not affect his bottom line.

I felt the anger well up. Jealousy. Frustration. Embarrassment. The realization that they were making money off of me… us. And yet, I do need them. I need legal and malpractice coverage. I need finance and accounting help. I need compliance. I need tech support. 

Mind you, this was a few years ago… I am long over the shock.

We talk about how cash strapped physician practices are, how there is so much pressure to see more patients. Rush, rush, rush. Fine. Why? When our healthcare system in the US is so expensive, when vast sums of money are exchanging hands….

Where is it all going?

Why can’t my patient in the hospital have adequate staffing to ensure that he can get the required assistance to get to the bathroom before soiling himself? Take just a few million from the hospital system CEOs $21 million compensation package and hire a few extra staff. Right? 

More staff may not be cost effective, though, when you can have a “concierge” come through later after the poop is cleaned up and hand the patient a $25 gift card for the hospital cafeteria as a way of saying “so sorry”. $25 vs a whole emoloyee or two for good patient satisfaction surveys? It is a no brainer.

Whispered behind closed doors: She just has no clue about the economics at play here. We are essential to the practice of medicine. She would have no insurance contracts if it weren’t for us. We do what physicians cannot to make medical practices successful.

Maybe I am ignorant?


If you want to read more about it, check out this recent NY Times article, Medicine’s Top Earners are not the M.D.’s.

Meanwhile, I think I will go get an MBA…


103 thoughts on “The Cost of Waging War

  1. OK. So it’s a stressful day here at work. Deadlines. I have 15 minutes to spend. So here I come to my buddy VD. And she raises my blood pressure. That was not nice!

    I have been arguing this fact for a long time — doctors are usually (not often) worth their weight in gold. But the MBAs produce nothing. They fix nothing. They just collect the debris like vultures. And as the number graduates of business programs increase, there will only be more of this.

    Liked by 3 people

  2. Same in long term health care. Corporate dictates how many employees we get based on resident’s ADL scores. Here have a $25 gas card for working extra because your burnt out coworker called in. And don’t forget you have to be off the clock before 7 after or you’ll get a write up. I hate corporate. Get out of you cushy offices and come WORK.
    And my kids’ doc us allotted 7 minutes per patient. SEVEN! I wonder when he gets to see his wife and daughters?…

    Liked by 2 people

  3. I am sure you have ruffled many feathers with this one. We all know it is true of course, but is there really anything that can be done beside black market medical? Too many lawsuits against the medical field now days. They think you are all miracle workers, and at times you are, but it has turned out to be a way to make a quick buck. I know this sounds appalling, unfortunately it is true.
    Hang in there Doc us old timers do not run to a lawyer every chance we get. We are also grateful when we are blessed with a doctor who takes the time to explain thing to us, and answers any questions we have. If you lived close to me I could volunteer my time to help you out. Maybe you could place an add and get an old timer to help you. :o)


  4. Our last surgery wanted to put all our medical data on one database so that everyone could access it. Our concern was ‘everyone’ not being medical people, but hackers and our details being sold abroad. We signed a document to say we were not prepared for this move and they were not to add our details to the database. Turns out the letters were sent to patients after the event. Livid doesn’t begin to cover it.

    Liked by 1 person

  5. Our society is rife with parasites who are willing to get between those who pay and those who earn. It’s the Yosemite Sam approach, “We’re partners. You dig the gold, and I’ll share it with you, 50/50.” I see it in all walks of life now. Prevalent in law, real estate, insurance, and more.

    Liked by 1 person

  6. You are right Victo, there are a lot of inequities in the system. If there wasn’t so much greed at the top there would be a little more to go around and everyone would benefit. (except the CEO’s) They are making choices as what kind of society that we are going to live in, and it isn’t pretty.

    Liked by 2 people

  7. Sheesh – I am feeling worthless. That there is some serious MBA bashing. There are MBA’s who work fpr NGO’s and Not For Profits who make a pittance. There are many MBA’s who do pro-bono work for charities.

    They are often the tool by which Shareholders and Executive increase profits – it is rarely the MBA;s who dictate policy, they are just tasked to find ways to make it work.

    Part of the issue is the capitalist system. Don’t get me wrong, it is one of the best economic systems that humans have come up with but it needs improvement. It has produced an almost endless list of products and services that make our lives better. It also transfers more and more wealth to a smaller and smaller percentage of the population., That has to be addressed or this will cause all sorts of problems,as you are seeing – it maximizes remuneration to those who handle the money, not the ones who produce the service or add the value.

    There was talk a few years ago of some Scandinavian countries mandating a system that put a ceiling on executive paychecks that was to be no more than 10 times the wage of the lowest paid full time employees. So, if the exec wanted an increase, they had to raise the bottom earners too. There was also talk of gov’t mandated profit sharing plans whereby a fixed percentage of profit would be required by law to be returned to the employees who actually made it for the companies.

    Adjustments like these have to be made in the capitalist system or it will eventually fail; the problem being, of course , that the wealthy have to buy on and they won’t.

    There are docs here Victo who organize into clinics that are owned by the docs themselves. Strength in numbers. Then they don’t have to put up with corporate and yet can still get the benefits of numbers,.Kind of like a Credit Union for docs – member owned. That still leaves the issue with hospitals and that is more complicated.

    I wish you the best of luck. Let us know if you find any answers. πŸ˜€

    Liked by 2 people

  8. They are trying to put a cap on salaries here within banking and health for this very reason.
    I remember when I was a student nurse I was going out with my now husband who was a trainee accountant. One day after work, as I was leaving I discovered a patient collapsed. He’d had a cardiac arrest. I began resuscitation and the team were called. I eventually got to meet my waiting boyfriend one hour and twenty minutes later. I calculated I would have received about €2 for my time if in fact I’d not been off duty. Not a lot for saving a life. My trainee accountant would have received five to six times that. Nothing has changed in the twenty years since. BTW the gentle man recovered fully.

    Liked by 2 people

  9. Grrrr. This issue drives me insane. The decision makers are always prepared to impact everyone else and never themselves. Cut, cut, cut, but meanwhile executive bonuses increase.
    I’m so sorry whenever I hear about anyone caught in that hamster wheel 😦

    Liked by 1 person

  10. Had a wonderful eye doctor years and years and years ago who fought insurance companies. They won. He had a coronary. The whole story is maybe something I’ll post someday. I guess one has to choose ones battles, but this one is a very icky one.

    Liked by 1 person

  11. It has to be so frustrating, Doc. Forget the MBA..go get yourself a techie job, maybe develop a new video game, or new music-streaming software, or strip like a Kardashian and post a sex tape.

    Please don’t do any of those. Stay with medicine, and work toward the changes you seek. Respect.❀️

    Liked by 1 person

  12. Doc, I have no idea how your income can go down because you hired someone to make your business better and more efficient. Seems like a lot of…. well talk about soiling yourself.
    There is no science, or balance , or humanity in health care any more.


    • Interns and med students take time instead of helping. They have to be taught. Most retired physicians are retired for a reason (we are suckers for punishment until we are broken!). A volunteer might be feasible but I have never had anyone offer to do that before. I feel like the issue is more a misappropriation of funds. There should he plenty of funds for staff for this type of thing. Instead, it is padding someone else’s pockets.


  13. It is fascinating to me that you have to jump through so many hoops, that your good intentions are being hindered by greed. I know this to be true in other areas, and, generally, about medicine, but to hear a personal account is eye opening to say the least. I know this won’t make you feel any better because you went through significantly more school than me or my husband, but the same stuff goes on in elsewhere. I can’t elaborate because it’s not my job I am referring to, but his, and I wouldn’t want to jeopardize it.


    Liked by 1 person

  14. type type type
    delete delete delete
    type type type
    delete delete delete
    So many issues, so many emotions.
    Instead… :::hands you a nice, cool, refreshing, but high octane, favorite adult beverage::: and turns on Netflix for something fun and mindless to watch.

    Liked by 1 person

  15. I’ve realized the same thing after leaving the medical field for the corporate world. I think all docs should do a short stint in a corporation to just see how easy other people earn a living. Doctors in India haven’t been tamed to the extent they have been in the US, but with the increase in the number of boutique hospitals and medical corporations (I don’t have a better term for them), it’s only a matter of time before they are.

    Liked by 2 people

  16. I get annoyed every year when a local hospital runs its fundraiser. I used to work for that hospital, and I know that the money from those fundraisers does not go into patient care, but rather into executive salaries and beautifying the administrative offices. People who donate have no idea where their money really goes.

    Liked by 2 people

  17. Welcome to Finland. We may have our problems, but at least we’re not capitalist scum. An aged alcoholic living in a shelter will get the same top of the world treatment for AMI as would our prime minister. And we don’t have to fight insurance and greedy corporations. Usually :).

    Liked by 1 person

  18. Help! Doctor! My neck is hurting from nodding in agreement.
    In fewer words- where there is money, there is corruption.
    As soon as I saw the increased commercials for advanced degrees in Health Care Administration about a decade ago- I became worried. The hospital I’ve worked at for the last 15 years has gone through a transition that represents everything you said above. They bring up the recession from 2008 at every forum we’re forced to attend but brighter minds know that is only part of the problem.
    We went from a CEO who’d been with our hospital since the 1960’s (he started out in the office after getting his bachelor’s) to a CEO who came from finance and later was busted in a prostitution ring- twice, to now one of our long standing MD’s who everyone appears to reserve their opinions of until he’s implemented things of his own (or not).
    The latest swing of these corporate-minded administrators (even though we’re non-profit) tend to be VP’s on up and are usually the last to take a pay cut as they cycle throughout the different hospitals in our metropolitan area. They follow the money trail while everyone else gets laid off or takes pay cuts.

    Liked by 1 person

  19. I’m sorry, did you say fax? Who uses a fax anymore? Half of your audience doesn’t even know what you’re talking about.

    I hate finance people. They’re vampires. The living dead without beating hearts. If my daughter becomes involved with asset management I’ll consider myself a failure as a parent.

    Liked by 1 person

  20. I had to go read the article you referenced. It was very enlightening. Of course, the accumulation of money at the top of the corporate structure is not unique to health care, shameful, to be sure, but not unique. It is part of the current trend towards pure (i.e. unregulated) capitalism. Pure capitalism does not lead to a stable equilibrium in the marketplace accompanied by fairness to all participants. It leads to oligarchy because the marketplace is an inherently unstable system. (Oops. Sorry. Wrong soapbox.)

    Anyway. Yesterday’s Times had another interesting article relevant to this subject ( Apparently, nobody really knows what many of the health care procedures actually costs. Figuring that out would be a valuable function for those otherwise useless, but expensive, MBAs.

    Liked by 1 person

      • I wish you would. Lots of interesting questions to be answered, especially in the corporate environment. I can see how, following the conventional wisdom, inside the doctor’s office, testing and data gathering get pushed to the least expensive staff member able to to the task. But, that probably leads to more staff, so is it really less expensive in the overall picture.

        In the hospital, a lot of testing is done using expensive equipment and facilities. That would lead to corporate pressure to do those tests more often to recover the infrastructure investment costs; so there would also be cost-based pressures that affect the way you practice medicine. Are there associated incentives?

        Liked by 1 person

      • There are incentives to do more procedures and lots of physicians I hear feel pressure to admit more patients, do more tests, do more procedures in order to invoice bottom line. However, in a system where you get a set amount of money for an admission for say pneumonia, no matter what is done, then more tests costs the facility more and the pressure becomes to do everything less. There is insane waste at the hospital level and identifying that is a good thing. We should be able to say what the cost is for everything that occurs in the hospital (or office for that matter). Once you have savings, though, who gets the money? Not the patients…


      • Well, of course, the savings don’t go to the patients. But, if you don’t know the actual costs of a procedure, then the charges are set to ensure that the organization doesn’t lose money. “Let’s see. I think that procedure probably costs about $50. Is 10 times that enough, or should we charge more?” And, they never go down after that.

        Liked by 1 person

  21. If you ever have to confront a suit-wearing idiot pretending to know better while you have the actual advantage: give the the long distance cold stare and if they ask for it go Dirty Harry on this person.

    A solid tone of voice and correct lines are enough. The gun is overrated. That cold Clint Eastwood stare and Spaghetti Western silence will break their resolve and you went Nancy Sinatra on their gluteus maximus.

    Liked by 1 person

      • I feel all right as long as I can get the app with no problem. I know that there are the docs who do it for their patients all the time. Good for them. I like my GP, wouldn’t change him only because of that. I am certain that if I really got something life-threatening, he would make a call for me.

        Liked by 1 person

      • If I were a busy mother I would appreciate someone making a call for me. My GP makes arrangements with a surgeon when I need my little operations once a year. When I need a rheumatologist appointment, I make it myself. I don’t see it as a big deal. My expectations are rather related to the quality of medical assistance, not the office procedure.

        Liked by 1 person

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