If you have read the page on this website titled “Who I am,” you will know that I changed what I was going to pursue in life after the death of my first wife. I had grown up pretty much expecting to follow my father’s footsteps. Suddenly, I didn’t have a family I needed to support. I had been increasingly unhappy with what I was learning in my business administration classes. You might wonder what that has to do with this blog or as we used to say, “what does that have to do with the cost of tea in China?”
It’s my observations about what is happening to the medical community in this country. Everyone is aware of the high cost of medical care. How did it become so expensive? Someplace in the 1960s, there was a movement to bring business practices into medical care. It started with hospitals. Most hospitals were nonprofit, but that does not mean they can operate at a loss year after year. There is a need for every medical concern to make a profit, or they won’t survive. At first, this movement toward “proper management” seemed to succeed. Hospitals were put on a much more stable footing. What does that mean?
It simply means an administrator must earn a profit simply to avoid losses. Many terms in business administration classes are very general because they do not know where the students will be working after graduating; i.e., will they be working for a company making doors, or will they be working for a company that makes tables? You could use the assumption if you’re working for door company, that the doors are your source of revenue, income. However, you are taught that the workers who make the doors are your real revenue source. If you can get your workers to produce more doors in the same amount of time, the company’s income will increase. That is a dangerous proposition.
If you view your workers as simply sources of revenue, you tend to lose sight of the fact that they are human beings. Who are the people who have this view of their workers? It’s upper management. They tend to isolate themselves from the workers by working to produce more revenue. Middle managers who have day-to-day contact with workers can see how company policies are hurting the workers. In some companies, they have the ability to point out policies that are harmful. That is not true of all companies. The middle managers know if they raise too many questions, they will be out in the street looking for a job. Pretty soon, you have a medical concern where everyone from the lowest custodial job through middle management is unhappy with their work.
I know this blog is getting long. I’ll bring it to close quickly. So, what’s happening in the medical industry? Business practices have brought consolidation to the medical industry. In English, that means the little ones are being gobbled up by the bigger ones. How far have business practices gone? I’ll only give one example, but there are many. There are very few doctors with independent practices anymore. They are employees just like the rest of us. Doctors now have “production goals.” They must see a certain number of people every hour. If they do not meet those goals, they are encouraged to do so by the withholding of a portion of their basic pay. If they meet those goals, the goals will only be raised the next year to increase revenue. It’s a vicious circle that only leaves the very top management of any hospital, profit or nonprofit, happy.
