Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Avoiding medicine’s Boeing 737 Max

Marc Braunstein, MD, PhD
Physician
May 20, 2019
150 Shares
Share
Tweet
Share

I’m sitting on a cross-country flight to California with utmost respect for the professionalism of the crew, especially considering my life will be in their hands for the next 6 hours. Despite understanding the physics, I am still amazed by flight, and even more so by the coordination required to manage the logistics of shuttling so many people and their luggage around the world.

As health care leaders apply a business mentality to medical care, these administrators are apt to make comparisons to complex fields like commercial airline travel. While we physicians may resent the idea that any field is comparable to the challenges of medical care, to be fair, in some ways drawing on these analogies can improve health care systems. For example, at my institution we have a new division devoted to the patient experience, with the intention to increase patient satisfaction and decrease lapses in communication. These initiatives require investments of limited resources, and ideally, health care administrators should welcome input from physicians before applying outside business models to hospital operations to prevent unforeseen negative consequences, such as burnout among staff, which can potentially comprise patient care.

On October 29, 2018, Lion Air Flight 610 plunged into the Java Sea 13 minutes after takeoff, killing all 189 souls aboard. An investigation highlighting the faulty software ensued, but no changes were immediately made. Five months later, another Boeing 737 Max 8 jet, Ethiopian Airlines Flight 302, similarly crashed 6 minutes after takeoff, killing all 157 passengers and crew. We are still learning the details of both flights, however, initial reports point to a flawed system on the 737 Max 8 that was created to adapt to changes in this new aircraft designed for cost savings, which would allow for more sales in a competitive market. As we learn more, a narrative is taking shape that the roll-out of the Max 8 was done hastily, with lapses in supervision of the industry leading to a focus on profit over safety. While we await more details to corroborate this, one thing is clear: Safety becomes compromised when volume and revenue are the top priorities in any field, especially in an industry intended to keep the public safe. While advocates of Boeing have lauded the company’s track record of safety, critics have lambasted Boeing’s competitive drive for profits as superseding safety measures. As I write this at 35,000 feet, I believe I share the sentiment of most of the public: Could these tragedies have been prevented in the first place and how can we prevent them from happening in the future?

The analogy here to medicine is obvious. What physicians are experiencing as more of us become employed by large health care systems is a tug-of-war between administrators who are well-intentioned to keep the hospital system profitable to achieve growth, our duty to patient well-being, and a health care system that places limitations on reimbursement due to insurers’ myriad cost-containment measures. The concern here is also whether financial drivers are superseding the limits of being able to provide safe, high-quality patient care.

For example, many physicians’ contracts are based on volume, such as the RVU model, intended to motivate physicians to see more patients and increase their compensation. The question is, at what point does the motivation to increase volume become unsafe due to a shift in priorities from public safety to profit, as appears to have been the case with the Boeing Max 8? Should we continue to be double-booking appointments? Is it safe to supervise anesthesia nurses in multiple operating suites? Should we allow for more time to follow up results and other time-consuming clinical issues by carving out more administrative time? And the list of potential questions like these goes on.

Residency programs often limit the amount of time trainees can moonlight, since they understand that the economics of earning additional income may drive residents to take even less time to rest, which can endanger patient safety. Why does the current system which focuses on volume then become the motivating factor for physicians when they transition to attendings? I’m not sure what the solution will be in the long run, but one thing is clear to me in the short run as I continue on my current flight: I really hope the crew are content, confident that their leadership welcomes their feedback, and certain that passenger safety is not at risk of being compromised for the sake of profits. Now there’s an analogy I would love to make to medicine.

Marc Braunstein is a hematology-oncology physician and can be reached on Twitter @docbraunstein.

Image credit: Shutterstock.com

Prev

Should adults receive another dose of MMR?

May 20, 2019 Kevin 1
…
Next

Sex in the elderly is not a need. It's a privilege.

May 20, 2019 Kevin 5
…

Tagged as: Hospital-Based Medicine, Malpractice

Post navigation

< Previous Post
Should adults receive another dose of MMR?
Next Post >
Sex in the elderly is not a need. It's a privilege.

More by Marc Braunstein, MD, PhD

  • How electronic health records preserve patients’ legacies in the words of oncologists

    Marc Braunstein, MD, PhD
  • 10 ways medicine is like the airline industry

    Marc Braunstein, MD, PhD
  • Keeping a cancer diagnosis silent

    Marc Braunstein, MD, PhD

Related Posts

  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • Why academic medicine needs to value physician contributions to online platforms

    Ariela L. Marshall, MD
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • KevinMD at the Richmond Academy of Medicine

    Kevin Pho, MD
  • Medicine rewards self-sacrifice often at the cost of physician happiness

    Daniella Klebaner
  • Medicine won’t keep you warm at night

    Anonymous

More in Physician

  • The alarming epidemic of physician burnout and how we can combat it

    Tomi Mitchell, MD
  • A retired physician’s battle with moral injury

    Hayward Zwerling, MD
  • Unveiling the secrets to effective resuscitation and overcoming obstacles

    Deepak Gupta, MD
  • A tense family drama unfolds as a young daughter pursues unconventional career path

    Osmund Agbo, MD
  • Decoding the brain’s decision-making: insights for medical professions and strategies for success

    Harvey Castro, MD, MBA
  • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

    Jay K. Joshi, MD
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Empathy and awareness: Unveiling the hidden dangers of food allergies [PODCAST]

      The Podcast by KevinMD | Podcast
    • The alarming epidemic of physician burnout and how we can combat it

      Tomi Mitchell, MD | Physician
    • A retired physician’s battle with moral injury

      Hayward Zwerling, MD | Physician
    • Unveiling the secrets to effective resuscitation and overcoming obstacles

      Deepak Gupta, MD | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • FDA Panel Endorses mAb to Prevent RSV in Infants
  • Novel LAA Closure Device 'Promising'
  • Acute GvHD Risk After Allo-HCT Higher With Some Antibiotics vs Others
  • TTFields Therapy Yields OS Improvement in Second-Line NSCLC
  • Mental Health Provider Disclosed Personal Patient Info in Google Reviews

Meeting Coverage

  • Novel LAA Closure Device 'Promising'
  • TTFields Therapy Yields OS Improvement in Second-Line NSCLC
  • Upper Airway Stimulation Device for OSA Holds Up in Real-World Analysis
  • Morning Naps in Elderly People May Reflect Dementia Risk
  • Extra Follow-Up Confirms Benefit of Nivolumab in Muscle-Invasive Bladder Cancer
  • Most Popular

  • Past Week

    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • Empathy and awareness: Unveiling the hidden dangers of food allergies [PODCAST]

      The Podcast by KevinMD | Podcast
    • The alarming epidemic of physician burnout and how we can combat it

      Tomi Mitchell, MD | Physician
    • A retired physician’s battle with moral injury

      Hayward Zwerling, MD | Physician
    • Unveiling the secrets to effective resuscitation and overcoming obstacles

      Deepak Gupta, MD | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...