When physician leaders get acquired and squeezed

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As a child, when I first read The Little Prince and saw the picture of the boa constrictor swallowing an elephant, I would often ponder what it felt like to be the elephant. Later in seventh-grade science class, when I learned of amoebae and how they surround and digest neighboring life forms for their sustenance, the same wonder followed. Enlightenment to what it feels like to be subsumed came to me as a mid-career physician leader in a medium-sized health system through an acquisition.

When it began, it was referred to in light terms as a merger. Regularly reassured by all—our board, our own executive team, and that of the predator—this Goliath of a system sought to “learn” from our highly functional, recognized, and rewarded health system. This was easy to believe: Our leaders were regularly asked to lecture and consult nationally, sharing the early innovative work we had undertaken with great success. Eventually, through due diligence, it became clear even to the naive that this was no merger though it was not until after the completed purchase that we fully grasped the mistruths.  Murmurings of “partnership” were simple sedatives to subdue the prey so they would not resist sub-summation. Like a spider anesthetizing its catch before binding it in the web, we patiently waited, ambivalent, submissive. While the boa constrictor unhinged its jaw, we lay at his salivating mouth, oblivious.

Enlightenment came as the digestive juices began breaking down our outer layers, and the discomfort intensified. Colleagues, long collaborative, became sparring foes as survival drove dominance. Pivoting to save team members from extinction, all while whispered reassurances of rich severance packages allayed executive fears were they not to fit into the new structure; it became a solitary race. The catch-phrase “integration” actually beckoned disintegration, a living division, the dismantling of a whole into its individual parts. Righteous indignation replaced the benefit of the doubt, once a guiding principle, and we stewed in our juices, no longer virile, no longer whole. Yet while we fell apart in the belly of the beast, the beast, oblivious, slumbered.

Like Kubler Ross’ Five Stages of Grief, there was denial, then anger, bargaining, depression, and ultimately, acceptance, which came in one of three ways. Some chose an early exit, damn the retention bonus and promise of well-deserved severances. They fought the boa constrictors squeeze and emerged from the jaws, if not damaged, then intact, and scurried from the threat, their departure leaving a ghost of memories and whispered resentments. Others, either optimistic to a fault or desperate due to circumstance, rode the waves of digestion, floundering to grasp any security, until they were cast into the depths or meekly accepted a lifeline: their soul for their master. The third cohort of once-executive-leaders, dismissed repeatedly through neglect, eventually understood there would be no severance but instead a series of incremental diminutions. Reduction from decision-maker, uninvited to the meetings they once led, stripped of authority, demoted in title and deed, eventually with a salute they abandoned hope and accepted defeat at the hands of their captor, skulking from the melee into oblivion.

The slow-motion destruction of an executive team came in waves: erosion of faith, amnesia of pride. We watched years of countless 80-hour workweeks dismantled in a handful of months.

Who is the victor? Did our destruction create a positive for the universe? Did the balance of evil and good yield ultimately for good? Was our sacrifice, in fact, for the best? Certainly, not the individual leaders or their teams, disrupted without care, the lofty promise of lifeline severances going to the lowest-paid workers for the shortest duration of time. Certainly not the community, who had been promised an abundance of care for the most vulnerable, a mockery of fact, political fiction. Certainly not for the state, who welcomed a new predator into its kingdom, where the march would continue, without a mighty foe, unstoppable. When all is said and done, the stockholders will count their shares, calculate their gains, and thump their chests … and our system of health care will continue to transform until a select few control the many and the profits of illness and crisis fall to the victor.

The author is an anonymous physician.

Image credit: Shutterstock.com

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