Commodity Practice Employment Philosophy

Entrepreneurial Practice vs. Bureaucratic Existence


You couldn’t ask for a better analogy to illustrate the difference between entrepreneurial practice and the bureaucratic world of one size fits all medicine envisioned by many pundits as the preferable world of the future.

Dinner at the family-type chain restaurant, Rock Fish. Pleasant but not fancy, yet clean and decorated nicely. We were greeted warmly and served promptly. Every five minutes or so the waiter came by to see if anything else was needed. He brought the check at an appropriate time. He was chatty and polite, not cloying.

Standing in line at the Post Office. Dreary but not quite prison-like, trash on the floor, priority mail envelopes not in stock. A line of 15 or so customers. Two clerks behind the counter, but one is simply moving pieces of paper from one pile to another and refusing to make eye contact with anyone. The clock ticking toward five o’clock, bordered by two large signs warning that mail accepted after five will not be processed until the next day. The one remaining clerk walking away from the counter into the back room between “helping” each customer, and, when she deigned to “help” someone, made it abundantly clear that she was bothered by their presence.

Rock Fish wants to succeed and there’s tough competition in the moderately priced family restaurant market. No, their food isn’t fancy, but it’s good and the service is wonderful.

The Post Office, which is a monopoly, can’t even compete against services outside of its protected bounds — consider FedEx which charges at least a 3,700% premium. Their only solution: raise prices more and float the idea of rationing delivery from six days a week to five. Their employees don’t care to elevate the level of service or satisfaction because they almost have to shoot one another, and sometimes do, to be fired.

Of course, this blog post isn’t about restaurants or the Post Office, it’s about bureaucratically controlled and delivered healthcare. And, not just as it impacts you, the reader, as a healthcare provider, but you as a patient as well.

Do you want to take a number and hope it’s called by five?

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