As a foreign medical graduate and a multiple-time career changer — from being a doctor to a hospital process improvement and leadership coach to a business professor to a transformational career coach for female physicians — I have closely examined the U.S. health care industry from various lenses.
The one thing that stands out for me is the us vs. them attitude. Us being physicians and them being administrators.
I have seen both sides. In my previous as a process improvement analyst, I have been in the trenches with overburdened physicians following them and studying the utterly complex processes of health care delivery. For instance, I have seen how they have to click on so many items and go in and out of so many systems that do not talk to each other. And how they are expected to be fast and perfect in how they code and document their visits and procedures.
I have also been in innumerable meetings and locations, observing equally complex business processes, witnessing the muck administrators are dealing with to collect payments, ensure timely paychecks to employees, and keeping the hospital up and running. For instance, I have followed the extremely complex and frequently frustrating Medicaid reimbursement process and how a patient accounts director spent days and even weeks tracking down a patient’s whereabouts and eventually writing off the amount.
On a daily basis, physicians are going above and beyond to help patients in spite of the broken processes. They call insurance companies for prior authorizations and home health and other entities to discharge their patients. The time they are spending seeing patients is drastically shrinking, yet they give their best to their patients. New regulations and policies are increasing the documentation load, and they are completing paperwork on their own time at home, sacrificing their time with their loved ones. They are on committees, attending meetings to help improve patient safety, quality, and throughput. They are teaching residents, doing research. Seeing patients not getting better and even dying and they are dealing with this on their own. They are working hard to meet the productivity metrics that do not really encompass everything they do. Nobody is seeing them. They aren’t feeling appreciated. They are feeling undervalued. They are feeling left out from decision making. They feel as if they have no say. They feel administrators are all about money. Physician satisfaction is the last on their agenda.
The administrators feel they have no choice but to mold according to insurance companies to prevent impingement on the cashflow. They are feeling the pressure to constantly meet the insurance requirements. There are paychecks to be paid. Vendors to be paid. Outreach to be done to maintain and even expand the market share. Keep the electricity and equipment running. Keep the patients safe and satisfied. Retain and engage employees. They are investing in software to keep things in one place and btw, also speaks with systems nationwide for continuity of care. They are looking at other industries to learn how to improve processes and safety. Nobody is seeing them either. They are feeling they are doing a thankless job. Nobody seems to be happy with what they do. They feel everybody only wants to complain, and no one really wants to come to the table and collaborate. They are not feeling valued. They are not feeling appreciated.
Are insurance companies to blame then? That’s quite tempting. Isn’t it? We absolutely want to improve access to health care and reduce health care costs. You should know though, even with the best health care system, we will still need to figure out a lot of challenges. The midlevel providers will still be needed because there is a shortage of providers. We will still need to correctly document the codes to differentiate the level of care and complexity. We will still need to manage our schedule to maximize the number of patients to be seen because people are waiting way too long to be seen by a doctor. We will still need to improve processes and eliminate wasteful complexities and keep our patients and employees safe.
The health care business is ripe for a change. It needs a complete overhaul. Until that happens, there is something that would make a huge difference.
This isn’t taught in any medical or business school.
Health care has started to become the most ruthless profession. It has lost the human touch, which was the very foundation of providing care. The idea was to eliminate the pain and illness and provide comfort to patients.
Yes, we are providing care, but the metrics that most seem to matter are the ones that connect to the bottom line. The providers and administrators are feeling the brunt of it. They all are feeling stretched.
Health care is a unique kind of business. It involves life and death. It also involves feelings of everyone serving and those being served in this industry. The best approach is to use the words care and profit in the same sentence and mean it.
It is time to shed the animosity and come together to address the problems. It is important to internalize that nobody wakes up in the morning and come to work with the intention to insult and make each other’s life miserable.
Physicians might be tempted to say they don’t have the time for this, but they can’t afford to not make time for this. Administrators might think all they need is to simply push data in physicians’ inboxes and pit them against each other to improve the metrics. It is not going to work anymore.
Physicians will need to stop blaming and dumping their anger on administrators for laws and policies created by policy and lawmakers. Administrators will need to put aside their unwarranted fears of approaching doctors and start involving them in decision-making.
Physicians and administrators will also need to realize that times are changing. Times are such that they will need to leave their degrees and titles at the door (even if it feels scary and giving up control) and put their heads together if they truly wish to transform health care.
Everyone wants to be treated with kindness and respect. With rigid organizational structures and hierarchies, it is easier to forget these basic human values. It is about time everyone learns to elevate each other and achieve the common vision, valuing and celebrating what each brings to the table.
It is time to have candid conversations and talk about how to help each other.
When we approach a problem with empathy, we shed our defensiveness and start seeing more similarities and reasons to connect.
It is time to see each other. It is time to realize everyone is in this together. It is time to end the us vs. them bickering and start building bridges.
Mrinalini Garv is a physician and career coach.
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