Hi everyone, it’s Dr. Incorporated bringing you the Truth About Employed Physicians. I want to thank you today for that PA that you worked on in your office or your clinical setting. I don’t know about you, but PA’s are such a pain in the rear. And I know that you’re probably getting ready to wind up your day, and before you know it, you got a fax on your desk or perhaps a note came across your desk or some message that was communicated to you that you had to complete some documentation that would allow a patient to get their medicine or to get their procedure done in the proper way for the insurance to cover it. And quite honestly, you may have been tempted to just say “I don’t have the time, or I’m tired of dealing with this.” But you didn’t. You realized that there was a patient behind that PA, and you remembered that patient, and what was going on with them. You reminded yourself, “if I was that patient I would appreciate the person working behind the scenes on my behalf to make the extra effort to get done whatever is needed to help them receive better health care”. And today you made that choice. You finished that PA before you went home, and even though it took you a few extra minutes. I want to thank you for that work–thank you for the way that you are taking care of patients, and thank you for the dedication, you have to a system that doesn’t always value you as a physician (or at least value your time or your medical decision-making). But I value you and I know what it’s like to keep battling on those front lines and keep remembering those patients are the reason that we do what we do.

10 Administrators

That brings us to today’s truth. “There are 10 health care administrators for every one doctor.” See the graph above, with 10 year old data and it pretty much says it all! This is probably not a surprise to most of you, but the question some of you are wondering is why does that matter? That’s what I’m going to unpack for you. Those administrators have a big influence over your life, your quality of life, and your sense of well being. One of the realities that this 10 to 1 ratio introduces is that you’re going to be micromanaged as an employee. There are going to be 10 people looking over your shoulder watching what you do, and not necessarily offering to help make your life better or more efficient or even more productive. Physicians are pressed for time, especially with the growing documentation demands that come between you and your patients.

Frankly, administrators have more time than you. They have sharp pencils, and they’re very interested in the productivity of one of their primary engines for profit-making, which is you, the employed physician. They can’t do what they do unless you are being efficient and productive. And yet, for that very reason, they find it beneficial to micromanage your work and what you do.

It Takes a Village of Administrative Helpers

Don’t you wish that some of those administrators could actually put on the white coat and wore a stethoscope around their neck in order to help your medical assistant, your RN, or your LPN in the trenches with patient care? That would certainly be more helpful than sitting at their desk and micromanaging what’s going on with you? It’s really a crazy time that we’re in right now. I saw a statistic recently that said it takes 16 healthcare employees to support what one doctor is doing with his average patient population. That’s up from about 14 healthcare employees two decades ago and this is even fewer than that 30 to 40 years ago when it was less than 10 support staff. For those 16 people in our medical office, six of them were involved with touching a patient, managing patients, and taking care of patients with a physician. The other 10 have to do with health care management and healthcare administration. That’s just an absurd statistic to me and it points to why health care is so goofed up today. But so be it. It is what it is, and as employed doctors, we’re very aware of all these elements that go on around us. 

Revolving Doors

Another element of having 10 administrators for one doctor is your direct report administrator will change frequently. I am certain that many of you have experienced this already, whether it be your office manager to change positions, or perhaps your area coordinator, the Vice President of Clinical Services, or even the hospital CEO. There are so many people involved in that chain of administrators that surround you and your fellow physicians that those people are changing all the time. They’re on a corporate ladder and they’re moving up or they’re moving out. It’s frustrating to finally develop a relationship with an administrator that understands you and the nuances of your medical practice, only to have that person move on with little warning. It’s just part of the normal process when it comes to corporate life. The movement of healthcare administrators is very different from most physicians who tend to stay in 1 location for an extended period of time. Much like a new head football coach who has to align with the starting quarterback he inherited, administrators and doctors have to go through the same dance. This can be exhausting and exasperating for many employed physicians.

Are You Known?

Being an employed physician you’re now involved in corporate life. It’s really an unnerving thing, yet it’s a normal part of the process that we’ve all had to learn to adapt to. The truth is that many administrators may not even know your name. I find it very fascinating that a lot of administrators really don’t know who you are and don’t know anything about you. Being known by your employer is akin to being valued. And when you are unknown, it makes a physician feel undervalued.

You Are A Line Item On A Spreadsheet

But here is what they do know, your name is associated with a line item on their corporate financial spreadsheet. They know how much money you’re either making the company or how much money you’re costing the company. Quite honestly, you are viewed through the corporate lens of P/L. You’re not viewed through the same lens that your peers or even patients see you through, but you’re viewed through the lens of an administrator. This keyhole always asks the question of “have you done for me lately?” and “what are you doing for me in the future?” It’s a harsh reality, but as employed physicians, we lose our personal identity in the process of signing up for employment contracts. We really become a line item in somebody’s spreadsheet.

Rising Costs Are Not Due To Doctors

The cost of health care is increasing due to the burgeoning cost of 3rd parties and administrators, not due to the doctor’s pay. Doctors don’t make millions in salaries and stock options like hospital and insurance CEO’s do. Many of you are paid well, just like I am paid well. But relatively speaking, my pay is not going up at nearly the same rate that healthcare administrator’s pay is. It’s unbelievable how much money the CEOs of these healthcare organizations make. If you are unaware, see the image below. There are all sorts of levels of administrators that are making oodles of money, it makes me as a physician ask why am I working so hard when these people seem to be making all this money off of my work? The funny thing is I think the general population, including the patients themselves, think because health care costs are going up the doctors are making more money. But you and I both know, as physicians, it’s not us that’s making more money, it’s our organizations, administrators, and those corporate shareholders that are actually making more money, not us. 

Majority Rules

We also know that when there are 10 administrators for every physician that you’re outnumbered in the organization. We are the minority in the healthcare organization. Those health care administrators bind together, they unify together, they follow the corporate line together, and being in the minority as you are, your voices are diminished. You lose your autonomy, you lose your control. You become subjugated to those 10 administrators that surround you in their corporate lingo, policies, and plans that drive them, which is a much different architecture than we’re used to operating under. We are used to taking care of patients and finding our satisfaction in helping patients every day and making an honest fair living out of that patient care process. It takes an emotional toll on physicians when are constrained to fuse corporate citizenship with clinical care, especially when tension exists between the two. When you’ve got 10 administrators sucking the life out of you by undermining the autonomy and control you have in our professional life, while cloaking it in corporate alignment, it can be quite frustrating and unnerving, if you’ve not figured that out yet. 

Loyalty To The Company, Not You

An administrator’s loyalty is to the corporate ladder, not to you. You may think that your administrator, who is your direct report, or the person who is a few levels above you, have a certain amount of allegiance to you. As much as you believe they are committed to resourcing your needs as a physician, they are not. While they should seek to place you in the best environment to succeed, their interest lies in placing you in the company’s best position for the company to succeed. You become a cog in a wheel that is about clinical service line inititatives and capturing market share. You will be placed as an engine to accomplish those goals, or risk being eliminated. It’s just how the corporate jungle rolls. Some of you know the pain of being eliminated from your employment simply becuase plans changed for your employer. And trust me, thjey are always changing.

You Are A Sherpa

Here’s the reality; administrators are aligned with the loyalty of the corporate ladder because they know their livelihood and their sense of job security comes from that alignment. Their desire is to move up that ladder because each rung they move up that ladder, they make a whole lot more money, gain more power, and gain more respect. (remember they have more opportunity to make a whole lot more money than you do as a physician). I can’t blame them for reaching for the corporate pot of gold, but physicians have to understand that this drive up the corporate ladder is on your back. You become their sherpa, so to speak. In that context, you are needed, but perhaps you are less personally valuable than you perceive, because, in reality, you are a replacable part of their movement.

Income Ladder

The reality is that your pay as a physician is relatively capped when it comes to patient volume (wRVU’s) or what the fair market value payment is for your clinical and non-clinical workload. But administrators don’t operate under that same corporate cap. As they move up the chain, they make more money. Thus for most, their goal is to typically move up. This process separates their alignment with you, as they become focused on other corporate assets that need to be managed. They get further from the front lines of healthcare and thus further from you. And when push comes to shove, they’re going to fall in line with their corporate superior and not you if there is a concern with your line item on their corporate ledger. Some of you have been burned by these experiences, some of you have learned the hard way that administrators can’t be fully trusted due to this natural process for them. And this doesn’t even take into account the fact their movement often occurs from outside of your employer’s corporate circle. Thus when they come on board, they know nothing about you and your value to your medical neighborhood. The process of being known by them, earning trust, and developing mutual respect gets re-hashed again until they move on in search of better income, and the same process repeats itself.

I hope your experience with administrators has been good and mostly positive, as mine has been. But don’t forget where their loyalty lies.  It’s not with you.

A Growing Pattern

There are a number of downstream consequences to 10 healthcare administrators for every one doctor. That’s not going to change any time soon. In fact, it’s probably only going to get worse as the number of administrators in American medicine grows. Employed doctors need to be aware of this landscape.

And even though we as employed physicians are in the majority among physicians in the workforce, we are among the significant minority within the health care playground. Understanding this minority position, as well as the growing awareness of its consequences should help us cope better with some of the challenges of our roles with our employers. Being employed has its benefits, but there is a trade-off.

What has your experience been in regards to this? I’m very interested in knowing some of your thoughts as well!

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