Are hospitals evil? As an attorney who negotiates physician employment agreements with hospitals on a daily basis, I have developed a healthy skepticism about mindset of hospital executives. It is painfully obvious that most executives in our hospital systems have a business school mindset, that views physicians as necessary (albeit expendable) cogs in the magnificent machine that is the hospital.
Executives can hardly be blamed for this attitude. Physicians will always take care of their patients first, with little or no regard to the impact on their health or personal lives. In short, physicians do not require the upkeep or care required of expensive machinery. Although that expensive MRI machine will simply stop working if due consideration is not given to proper maintenance, a physician can be counted upon to work endless hours seeing patients, and then working late into the night keeping electronic health records pristine. As a businessperson running the business of the hospital, you need to carefully monitor the condition of the MRI. The physician – not so much.
From a pure business perspective it makes sense to continually push the physicians. The physicians will not stop working (billing) until they drop. When you lose a physician, you can easily push that physician’s workload onto the other physicians until such time as a replacement is found.
The business perspective, however, seems to universally miss one important point. Physicians are humans. Although physician burnout does not seem to be much of a concern to the hospital community, it is very real. One of my major focuses when negotiating a physician employment agreement is always quality of life for the physician: patient contact hours, vacation, sick leave and other terms and conditions of the employment agreement that can grind down a physician if not properly addressed.
Unfortunately, when negotiating with hospitals I am frequently forced to deal with individuals who need to “explain” the importance of maintaining flexibility in their workforce (a wonderful business school phrase which appropriately dehumanizes the people who are accomplishing the purported mission of the hospital to treat the sick and injured). The hospital personnel frequently tell me that limiting patient contact hours to “only” 32 or 36 hours per week is considered part-time. Many contend that keeping the electronic health record boxes all appropriately checked should be done on the physician’s own time. I assume the hospital administrators would be pleased if a physician avoided any personal contact with the patient during whatever brief moments are allocated for a visit, so that the electronic health record can be put into a condition that allows billing for the visit.
Physicians, of course, spend their visits treating the patient as a human being rather than a unit on the assembly line that is their schedule. Doing so requires significant outside time polishing the record so that the hospital may bill. Hospital executives apparently view this as an inefficient use of resources, and therefore frequently insist upon 40 patient contact hours per week.
All of the above has given me a somewhat jaded view of the motivations of hospital executives. Still, the question remains, are hospitals evil? Over the years my attitude towards these individuals has gradually shifted. After about 10 years or so negotiating with them, I viewed them as universally evil, soulless, and defective. As I age, I am mellowing somewhat in my attitude. I still believe that they are wrong, but many of the hospital executives I have dealt with are genuinely concerned about quality of care rendered in their institutions. Their treatment of physicians (excuse me, the workforce) just makes good business sense. Physicians have not given the hospitals reason to be concerned about their well-being. That must change, or the increasing burnout and early retirement of physicians will accelerate, and the quality of healthcare for us all will deteriorate.
Physicians in the coming months may be required to make difficult choices – they must begin to take care of themselves with at least as much concern as they have for their patients. Otherwise, we can expect hospitals to continue to ignore physician well-being to improve their bottom lines.