I recently took a new position in the healthcare system where I work–a big change that would place me right at the heart of a nationwide initiative toward patient-centered care. My first day at the new, larger, sparklier hospital, all the new hires were taken down the long hallway of the administrative building and encouraged to gaze upon the Wall of CEOs, pictures stretching back, down the hall, to the beginning of the hospital’s history. All men. All middle-aged. All white. I made the decision a few years ago to switch medical tracks and head toward a degree in hospital administration, hopefully getting a master’s in public health and, eventually, a PhD. When I first started working in healthcare in ernest, I realized right away that the medical professionals themselves had a frustratingly small effect on change when it came to hospital system politics. Each year it seemed they spent more times with their hands tied than on patients they were treating. I want, perhaps naively, to be an agent of change, a force in healthcare reform, and I realized that I couldn’t do that and practice as a physician – if I really wanted to devote myself to reform, I had to be an administrator. The trouble is up at the top and trickling down, negatively affecting the way physicians and nurses practice, the health of patients and the economic health of hospitals and clinics. I read an article this week in the New York Times that states that it’s administrators, not physicians, who are the top earners in the healthcare industry. Was anyone actually surprised by this? Maybe people who don’t work in healthcare, but I reacted to the headline with more of a “Yeah, and?” — for nurses, doctors and hospital staff, there’s no surprise in the simple fact that the CEO is easily making six or seven figures despite not being the most highly-trained staff and never laying a hand on a patient. Some, I’m sure, find this immediately disconcerting, but at least here in the United States, medicine is first and foremost a business. The general public may forget this because popular culture shows gleaming, exciting portrayals of doctors in movies and television, and often shows the pitfalls, but it’s rare that we see a glimpse of the true hierarchy. The distilled version between residents and interns is played out again and again, but the larger picture, wherein the pariahs of the hospital are not the senior physicians but, in fact, the administration, is far less ingrained in the public consciousness. Television shows like House and Nurse Jackie give us a glimpse at administrators- both, interestingly enough, female administrators. Lisa Cuddy, having given up her medical practice to become the youngest director in the history of Princeton Plainsboro, is constantly exasperated and yet somehow still devestatingly sexy (because this is television). It paints a portrait of female executives that says they must first and foremost be a bitch who is constantly humored by her male colleagues and that secondly, she must also be beautiful because without sexual tension to wield, how could she ever hold court over male physicians? In the case of Nurse Jackie, on the other hand (which is really a female-centric cast of nurses, doctors and administrators) Gloria Akalitus is the no-nonsense nursing supervisor/administrator who, while not running around in fitted pencil skirts (that being the job of Dr. O’Hara, apparently) relies on a more comical take on toughness to keep her likeable. Real-world administrators, even with these charms, do not have it easy. Still, they are often in a position of power financially that physicians are not – nor would they even have time to pursue. What we never see on TV is the administrator vesting several million in stocks which boom their salary at the end of the near far beyond seven figures, while the hospital they run perpetually smells like urine, the doctors only have ten minutes per patient and nurses are butt-busting so hard they couldn’t sit down even if they had time. According to the New York Times article, America’s healthcare administrators are paid more than administrators in any other country. Yet we still have one of the most fiscally malnourished healthcare systems in the world. So why is this even happening? Well, when healthcare systems are in dire need of rehabilitation, as is such with many healthcare systems in the US, you have to offer some pretty major incentives to top executives to get them to even glance your way. With so many opportunities, if you want to hire and keep a CEO long enough to save your ailing hospital, money talks. And we’re not just talking base salary: there are also benefits, bonuses and as previously mentioned, stock. Where does that money come from? Up to 20% came from US healthcare spending last year- that’s just on administrative costs. Not medicine. Not physician salaries. And this is a bone of contention between doctors and administrators. It’s no wonder that there’s real-world drama, probably running deeper than any televised story-arc could capture. Healthcare employment as a whole has incredibly high salary disparity: while it has some of the highest paid professionals in any industry, it also has some of the lowest: technicians who work in ambulances, who are directly responsible for patient care, often make just at or above minimum wage. They work long hours, and often, because they make so little in their primary profession, must take on other part-time work to make ends meet. All of this being said, why would I still want to go “over to the dark side” of administration? If I really care about healthcare, about patients, about community, wouldn’t I rather be in the trenches as an MD? Well, yes and no. Ideally, I’d like to do what’s best for patients as often as I can. But I have also learned that seeing “the big picture” in healthcare is essential. As much as I see the value of concentrating on the “big picture” in a patient’s diagnosis and treatment, patient care is a microcosm of our healthcare system. I think before we can help patients, we have to help doctors. So, instead of helping patients by helping patients, I want to help patients by helping doctors. I had made this decision long before this article outlining the “perks” of a healthcare administration career showed up. I’ve been told by colleagues and superiors for a few years now that I seemed to be on the track to administration, whether I wanted it or not. Does knowing that there is potentially a lot of money in my future change my decision at all? Not really. At 23 I already make more than most of my peers, have benefits that include a steadily growing retirement fund and someone to manage my stocks. When I started working in healthcare, as a patient, I had none of this. I began poor, uninsured and sick. I worked very hard to get to a place where I would be “just okay” — and I was rewarded by having a little more than that. I don’t take it lightly, and I recognize that it came purely from hard work. I’ll get as much out of a career as I put into it. I want to work in hospital administration because the way the healthcare system is right now, I wouldn’t want to be a practicing physician! I want to help make medicine into a field that I’d actually want to work in. It won’t be an easy journey, certainly not for a young woman, but I truly believe it will be worthwhile. If someone wants to hire me years down the road as a CEO at their hospital, they won’t have to entice me with stocks and bonds, a corner office or a big payout: all I want from them is the willingness to change. And money can’t buy that. Source
