Health care is big business, with medical practices vying for contracts, hospitals undergoing facelifts in order to cater to patient experiences, and insurance companies making deals with pharmacies. Some of these arrangements are negotiated in the name of reducing health care spending, but there has to be some skepticism when for-profit entities are implicated. Physician salaries aren’t exactly growing with inflation—some fields have had massive cuts in spending over the years too.
The problem with these stagnant and reductions in physician salaries are that they are targeted in the name of curbing health care costs since there are no more dollars to be distributed in the system. All the while, the number of administrators and middlemen/women in the system consume more health care dollars. Yes, this may be an oversimplification of the problem, but I’ve seen hospitals hire minders to explicitly observe whether a health care worker uses hand sanitizer in front of a patient! Talk about waste in health care dollars! When you slash the compensation of the people on the ground while making them do more work, there will undoubtedly be unrest.
From fast food to health care
Just as how a successful fast-food business such as McDonald’s relies on its workers to function, health care relies on doctors, nurses, and allied health workers to run. However, this is just about where the similarities end. In the fast-food industry, these workers are entry-level employees that keep the ship running. One could argue that this industry takes advantage of the labor to pad its shareholder profits and administrators’ pockets. This industry also provides a means for someone to earn income. If the employee does not like the management, she could simply leave and find another occupation. If this person wanted to open her own franchise or establishment, she could do so (yes it wouldn’t be easy but possible). There is no particular skillset that ties down the fast-food worker to the business.
Unfortunately, physicians aren’t all able to do the same for a number of obvious reasons. Many medical specialties are bound to hospital care, simply due to the subspecialization of their trade. Intensivists, for instance, have specialized training for care that can only be delivered in an intensive care unit. Other specialists who have traditionally been able to practice medicine on their own are more restricted today by insurance contract limitations and high costs of startup. The amount of student debt that many younger doctors have makes it challenging to take out loans to start their own medical practice. Hence, many physicians are stuck laboring away to supply jobs for many other health care workers.
I’m not sure what to think about how my labor supports the jobs of dozens of health care workers. Are these workers all needed for you to do your job? How much of that other person’s salary could be going into your pocket? How much of health care dollars could be saved if you weren’t required to have a certain number of staff under your name? Let’s look at a real example:
Take, for instance, the number of supporting staff for a moderate volume ophthalmologist. Her clinic has three technicians dedicated to her, along with shared front desk and ancillary staff. The local ambulatory surgical center has an equivalent of 1.0 FTE scrub tech and circulator essentially dedicated to this surgeon. There is also a CRNA who generates a third of her weekly salary from that surgeon. This amounts to essentially 4.3 FTE plus front desk that is feeding from a single doctor!
This amounts to $210,000 of additional health care dollars used, feeding over four full-time workers! The bigger question is whether these workers are needed in order to deliver care in the system. How much would one fewer office technician impact productivity? Would a decrease in a $55,000 salary reduce overall revenue by $70,000 but improve the sanity of the doctor by a tenfold? Is the doctor mandated to have this set number of support staff by the medical practice?
The predicament that many doctors face is that they are not able to exit the system. Their skills are tied to an inefficient system. If they were to leave, most other options are likely similar to the system that they sought to escape.
“Smart Money, MD” is an ophthalmologist who blogs at the self-titled site, Smart Money MD.
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